When you want to understand the logic behind something, delve into its history.
When I was in medical school, I never understood how women took such uncomfortable positions during labour pains — lying on their backs or reclined on the chair (at a high-end hospital) with their legs up in the sky or hung in stirrups. This is a disturbing image and that’s probably one of the reasons why the woman’s husbands/partners are not allowed in labour rooms in India.
I had an interesting conversation with my domestic help who is 50 and has had four kids. She delivered all her kids in her village and distinctly remembers squatting (like sitting on the Indian toilet) as the baby came out. She also prides on the fact that she had no tears or stitches during any of her births. I was intrigued and so, as any inquisitive mind would do, I delved into the history of labour.
It’s storytime!
Before males were allowed in the field of gynaecology, midwives assisted childbirths everywhere. They followed a more instinctual birthing technique. They let the mother choose how she wanted to give birth while they just assisted in the process. Slowly, as males started entering the field, things changed.
Up until the 16th century, births were only carried by midwives. The only males in the birth process were the surgeons (called butchers at that time) who were called in for complicated births. Slowly, males started infiltrating the birth scenario.
Francois Mauriceau of France was the first to introduce a reclining position for births without any evidence backing it. The aristocrats of that time preferred the lying down position as well because mothers could cover their faces or be sedated through the whole process. So the female was reclined on the chair with the curtain between the doctor and her. The doctor didn’t have to see her face and could perform the delivery without any interference.
In addition, this position made it easier for them to give episiotomy (the Cut), which was again administered because it was considered safe (without any solid evidence to back it up). Once this practice was common in Europe, it also became popular in America. And slowly, the instinctual birthing positions were replaced with the lying down position without any scientific backing.
And from there began the systematic medicalisation of a beautiful natural process, breaking down birthing instincts bit by bit.
Five Reasons Why The Lithotomy Position Is Damaging For The Mother
1. It restricts the movement of the coccyx and the sacrum. During labour, the pelvis moves to create more space for the baby to come out. This is achieved by the sacrum and the coccyx moving backwards. When we lie down, we restrict this movement, causing less space in the pelvis. These cases are falsely diagnosed as CPD (Cephalo-Pelvis Disproportion) and taken into C-section.
2. Labouring on the back is against gravity. The baby is coming up instead of going down with gravity. Hence, the mother has to put more effort into this process.
3. Putting your legs up restricts the blood flow to them. This increases the chances of cramps and fatigue. This disables the mother from going into labour, taking them for a C-section.
4. It damages the Ulnar nerve in the hand. When a woman holds both her legs tightly, there are chances of damaging the nerve in the hand. This can cause wrist pain, swelling and restriction of movement.
5. It increases the risk of perineal tears and anal sphincter injury (which can cause faecal incontinence, pain, discomfort and sexual discomfort).
Yes, in some cases lithotomy is suggested (depending on the position of the baby and requirement of episiotomy) but it is never universal. Now, it is high time that we adopt safer birth practices. A lot of countries, including the UK, Ireland, the USA and Australia, are slowly claiming their midwifery birth practices.
A lot of changes have been incorporated in their guidelines as well. For example, episiotomy is no longer routine and given only if it’s indicated. Hospitals are more open to giving different birthing positions, water-births are becoming commonplace etc.
As a doctor who has seen how childbirth has changed in many countries, I say it’s time we change it in India too. And this will not happen unless we women educate ourselves on what we are getting into.
References
1. https://www.ncbi.nlm.nih.gov/pubmed/23281859
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600206/