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Tuesday
Sep222009

"Best of" Week: Woman to Woman Childbirth Education

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Ergonomics in Birth

Some years ago, “ergonomics” was all the rage — ergonomic chairs, ergonomic keyboards, even ergonomic juice bottles became permanent additions to our lives. (I still have and love my ergonomic keyboard!) The term comes from two Greek words meaning “work” and “natural laws.” The idea is to minimize what the joints and muscles have to do in order for you to perform a particular action, and thereby to reduce the strain on the body. Of course, I had to relate this to birth — after all, here, as nowhere else, are “natural laws” relating to “work” or “labor.”

This is an interesting article on ergonomics. It mentions how that deer instinctively move in “the most efficient way possible,” but that humans are not that way, because we don’t operate on instincts. We observe others, we develop habits, and we learn how to move — in ways that may not be “natural,” “instinctive,” or “the most efficient way possible.” The author says, “We mistake ‘habitual’ for ‘natural.’”

I thought these two paragraphs were especially good as relates to birth (although that is not the intent of the author):

To truly improve the way we move, it is necessary to step back and question our assumptions about what is “natural”. Sometimes learning about the mechanics of body movement (“Here is where your leg bends, here is where your lungs are,”) can make a big difference. Sometimes watching a movement in the mirror can provide surprising new information. (“I had no idea I was doing that!”) And sometimes a quiet hand on the shoulder can help us become aware of excess tension.

When we learn to recognize our habits and to stop doing them, we can recover a more natural, easy, and pleasant way of moving. We become better able to notice when a work situation is set up poorly, and we are more likely to benefit from ergonomic aids. Moving in a more efficient manner, learning new skills becomes easier, and old skills can become more refined.

Starting with the first sentence, let’s question the assumptions about what is “natural” in birth. What do movies and television shows portray? Women lying in beds, typically on their backs, with monitors strapped to their bellies, one arm in a blood-pressure cuff, the other arm (or hand) with an IV in it. That’s what the typical “woman in labor” looks like. Fast-forward to birth and what do you see? Women still in bed, although the bed may be in different positions; their feet may be in stirrups; they may be flat on their backs, although it is more typical in modern U.S. hospitals to have the upper body raised. Many times women are in a “C” position — sitting on their tailbones, hunched over — and frequently someone is holding their legs up, with their knees pushed up towards their ears. It always gets me when they tell the woman to “hold your legs like you’re squatting” while she’s on her back. I wonder, “if squatting is so good, then why not just let her get up and squat?!”

But this is not natural. It’s not instinctive. And it’s certainly not the most efficient way! It’s habitual, and the woman-in-bed position started to give doctors a good view of her genitals, and for their ease of access, and so they wouldn’t have to squat down and demean themselves by being lower or beneath a woman. You can go to YouTube and look at just about any home birth video and contrast it to any hospital birth video, and you’ll see what I mean. Most midwives who attend home births consider it as part and parcel of attending births to adapt to what the woman needs — for the midwife to change positions so that the mother doesn’t have to; to get on the floor so the mother can remain comfortable; to squat or kneel and work by touch, so that the mother doesn’t have to get into the “stranded beetle” position just so the birth attendant can get a good look. Home birth is set up to accommodate the laboring and birthing woman; hospital birth is set up to accommodate the labor and delivery nurses and doctors.

Midwives encourage women to follow their instincts and assume natural laboring and birthing positions. Here is what is important — what works for one woman may not work for another; what works at one point in labor may not be beneficial at another time. Women are different; babies are different. Also, the position the baby is in (facing the mother’s belly, side or back), the stage of labor, and the woman’s preferences greatly affect what is comfortable for her, and what is conducive to labor.

Now, on to the second point of the above-quoted paragraphs: the mechanics of body movement. Squatting is a wonderful position for birthing a baby. Not only does it allow gravity to help, but it allows the tailbone to naturally flex outward while the baby’s head moves past it, and it opens up the pelvis allowing the baby to more easily move down. Lying on your back actually requires you to work against gravity, because you have to push your baby up and over the coccyx. (Here are a couple of videos that show this.) While being in the “C” position (basically sitting on your tailbone, instead of lying on your back) helps a bit because you are able to muster more of your muscles for pushing (imagine having a bowel movement on your back, versus on a toilet), you are actually preventing the tailbone from moving, which narrows the outlet through which the baby must pass. A friend of mine broke her tailbone this way. Her epidural had so numbed her that she couldn’t feel what was a good position to be in; and she didn’t feel it when it happened, but she was miserable for months afterwards if she tried to sit for any length of time.

Here are some more links to posts about pushing that I really enjoyed: Bringing Baby Forth During Childbirth at Birthing Touch, and Upright Birth in Hospitals and Lie Down and PUSH at The True Face of Birth.

Perhaps they will help you (paraphrasing the above quote) to “recover a more natural, easy, and pleasant way of birthing. You can become better able to notice when a labor or birth situation is set up poorly, and you are more likely to benefit from ergonomic positions. Laboring in a more efficient manner, using new skills becomes easier, and old skills can become more refined.”

 

This post orginally appeared on Woman to Woman Childbirth Education on April 18, 2008 and was submitted by the author for “Best of” Week.

 

More of Kathy’s favorites:

Checking dilation without a vaginal exam

Bed Dystocia

Measure Twice, Cut Once

Why Nobody uses Mid-Husbands

What does natural birth sound like?

 

Kathy is a childbirth educator who blogs at Woman to Woman Childbirth Education. She enjoys blogging and everything about birth.

 

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Reader Comments (11)

I'm loving "best of" week. What a great post. I gave birth to all three of my kids in the "c" position. I really hope to experience an ergonomic delivery someday...

September 22, 2009 | Unregistered CommenterBuscando la Luz

Hi Buscando,

If it was comfortable for you, it might have actually been just the right position for you, no? I've heard from women who've surprised themselves by assuming that if free to move in labor, they would probably end up squatting or standing but instead migrated to the bed, laid down and gave birth.

September 22, 2009 | Registered CommenterJill

I loved my ergonomic birth, but I still broke my tailbone even though I was squatting. It flexed outward all right...ALL the way outward! ;) My family doctor said he hoped it healed that way so I wouldn't have to break it again next time. S'all good though. I'll take it over another C-section anyday!

September 22, 2009 | Unregistered CommenterJill

Jill, I was just thinking of you today and how your kid broke your butt. This has been a day full of weird coinkeedinks (equinox perhaps?).

September 22, 2009 | Unregistered CommenterJill--Unnecesarean

ok, I literally had my morning tea come out my nose when you said, "how your kid broke your butt". wow, lol. Jill, I'm sorry that happened to you! I can't imagine.

I have nothing of value to add other than I told my doula to smack me silly if I ended up on my back, lol ;-)

September 23, 2009 | Unregistered Commenterterra jones

I always thought I would give birth upright during my homebirth - but instead gave birth laying on the bed. I was EXHAUSTED.

September 23, 2009 | Unregistered Commentermichele

This is brilliant! And I have the same habit of finding the birth metaphor in just about anything I read or hear about!

September 23, 2009 | Unregistered CommenterAmy Romano

I am wondering if anyone can tell if the birth position has anything to do with vaginal soreness. I am 5 1/2 MONTHS post-partem with my second, a VBAC, and I am still feeling soreness. My tail bone also hurt for quite some time, but this is more like the kegel and groin muscles. It's definitely improved a lot but for the first 4 months I was REALLY achy--hurt to stand, hurt to sit. They had me on my back, knees up. I can't remember it being super uncomfortable but I did practically all of my laboring at home on my hands and knees (arrived at the hospital pushing) and coped with the contractions really well up unitl transition. Because everything was rushed and I was shocked at how fast my baby was making her way into this world, I couldn't think straight. They also seemed to believe there was some emergency (perhaps that I was a VBAC, which I heard them say several times, perhaps b/c there was no time to hook me up to monitors to see how the baby was doing...i don't know) and decided to give me an episiotomy without consulting with me. And my daughter shot right out after that. So I don't know if that had something to do with it. My OB hasn't been able to give me any good answers and I would like to avoid this kind of recovery, if possible, in the future.

September 24, 2009 | Unregistered CommenterKristy

I would venture a guess that your soreness has more to do with the episiotomy than it does with the position. Being on your back for what sounds like a precipitous 2nd stage could have put a lot more pressure on your perineum, true, but compared to intentionally cutting through the vaginal tissue, three layers of muscle, and skin?

I hope you get some relief soon! Oy!

September 24, 2009 | Unregistered CommenterDou-la-la

I think It’s not instinctive. And it’s certainly not the most efficient way! It’s habitual, and the woman-in-bed position started to give doctors a good view of her genitals, and for their ease of access.

September 25, 2009 | Unregistered Commenterjeux pour enfant
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