To be able to choose the position with which we feel most comfortable to give birth we must first know what are the different birth positions that we can adopt
The choice of the birth position is something very personal and depends on each woman. There is no ideal birth position, the best is that the woman feels more comfortable at all times. It can even be a combination of several postures throughout the entire birth process.
The most widespread delivery position in the hospital centers is that in which the woman is lying on her back on the delivery table with her feet subject to the stirrups of the table, also called gynecological position.
Despite being the most used, the horizontal or lithotomy position is not the only possible option, and perhaps not the most suitable for the good development of labor. There are other less known positions, most with the trunk upright, such as standing, sitting, squatting or kneeling. Also in quadripedia or on one of the sides.
We will talk about the different positions to know the advantages and disadvantages of each.
Lying Birth: the lying position (in lithotomy or supine position) also called gynecological position is what we have become accustomed to as it is the most widespread. But he has received many criticisms for the passivity to which the woman is subjected at the time of giving birth and because it does not favor the natural physiology of childbirth.
The new protocols on the Strategy for normal delivery dictate that each woman can choose the birth position she wants, there are even hospitals that have incorporated special delivery tables for the woman to adopt the position she prefers.
The disadvantages of horizontal posture are, for starters, that it goes against the law of gravity. Instead of the pressure of the baby's weight facilitating the expulsion, the mother does not have that natural help, pushing the baby through the birth canal in an ascending plane, increasing the chances of using forceps or caesarean section. An expert in chiropractic commented that the force that the woman makes to remove the baby while lying is 20 kilos, a force that can be significantly reduced by changing the posture to an upright position.
When lying down, the weight of the uterus compresses the large blood vessels interfering with the circulation and oxygenation of the baby. In addition, the pelvis flattens because the coccyx is crushed against the bed narrowing the pelvic outlet, which in addition to interfering in childbirth damages the mother's spine.
On the other hand, in favor of the supine position, there are investigations that ensure that there is a lower risk of blood loss during childbirth and bleeding after childbirth.
Some women who lie with their legs anesthetized and hung over the stirrups may even feel subdued, immobilized and helpless to participate in childbirth.
What other postures allow, which is not possible when lying with the legs raised, is the freedom of movement to adopt the position that is considered most comfortable. It is believed that the movement of the woman is convenient, especially in the early part of childbirth since it facilitates its progress and tolerance to the mother's pain.
When talking about the posture of childbirth, we focus on women, but the baby is also the protagonist at this time and the posture that is adopted will also have an impact on its benefit. Birth is the first physical stress of the human being and the way to come into the world must be as traumatic as possible.
Vertical delivery: The vertical delivery includes various postures in which the trunk is in an upright position such as standing, squatting, kneeling, sitting or semi-sitting.
In the vertical positions the law of gravity favors the descent of the baby through the birth canal. In turn, the pressure exerted by the baby's head softens the pelvic floor, facilitating dilation and reducing the chances of an episiotomy, that is, a cut to enlarge the vagina orifice.
Precisely because of the help that the baby himself provides when descending through the birth canal, some research shows that the dilation time is less and the delivery is shorter and less painful in a vertical position than in a horizontal position, although the threshold depends on that of pain of every woman.
Standing: when the woman is standing she has the support provided by her two legs. In this position, a support base that can be a wall, a bar, a rope or better, the couple is sought. This position favors the oxygenation of the baby.
Squatting: The pelvic outlet opens to its maximum capacity (between 1 and 2cm) facilitating the rotation of the baby and the descent into a difficult delivery. It may require less effort from the mother. It can be done on the couch or on the floor
Semi-sitting: It is a position that allows women to rest, allows fetal monitoring while being a good alternative for the midwife or the doctor. When incorporated, the mother can visualize the birth. There are hospitals with delivery chairs that allow this position.
Sitting: sitting on a stool or on the partner's knees allows you to lean forward to rest after each contraction. Massages can also be received to relieve lower back pain.
Those who defend the horizontal birth state that the help provided by the law of gravity is replaced by contractions that help the baby to descend through the birth canal and fit in.
Also, some doctors point out that in an upright position they have less control over the situation in case of any complications such as fetal distress. But if you allow me to comment, I think it is the mother who has to have total control of the situation at that time. In any case, if any difficulty arises, you can take another more convenient position.
Not everything is reduced to horizontal or vertical, the freedom of movement when giving birth allows women to also adopt other positions that, although they are of neutral gravity, have other advantages:
lying on one of the sides: allows the woman to rest and reduces the lacerations of the perineum
quadruped (on all fours): helps relieve back pain and allows greater elasticity in the perineum area.
Any of the mentioned postures can vary throughout the birth by choosing a position for the different phases of labor since none is comfortable for a long period of time.
Whatever your decision, it is recommended that you discuss it before delivery with your doctor, who will evaluate if your preferences are viable according to the characteristics of your pregnancy and if the center where you will give birth has the necessary means.
As I commented at the beginning and coinciding with the recommendations of WHO, the birth position It is a very personal choice. Maybe one is not so bad or the other so good, but the important thing is that it is a decision of each woman.
