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. 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 probably that’s one of the reasons that in India they do not allow the husband/ partner to be in the labour room.
I also had an interesting conversation with my maid who is 50 and has had 4 kids. She delivered in her village and she distinctly remembers squatting (like sitting on the Indian toilet) and the baby coming out. She also prides over the fact that she had no tears or stitches for any of her births. I was intrigued. So, like any inquisitive mind would do, I delved into the history of it.
It’s story time!
Before males were allowed in the field of gynecology, midwives were assisting childbirths everywhere. They followed a more instinctual birthing technique. They let the mother choose how she wanted to give birth while they just assisted the process. Slowly, as males started entering the field, these things changed.
Up until the 16th century, births were only done by midwives. The only males in the birth process were the surgeons (who were called butchers at that time) who were called in for complicated births (Image 1). Slowly the males started infiltrating the whole birth scenario.
Francois Mauriceau of France was the first one to introduce reclining position for births without any evidence backing it (Image 2). The aristocrats of that time, preferred for the lying down position as well because the 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 medicalization of a beautiful natural process.
Thus started the medicalization of birthing practices and the birthing instincts were broken down bit-by-bit
Five top reasons why Lithotomy position is very damaging1
- 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 backward. When we lie down, we restrict this movement causing less space in the pelvis and these cases are falsely diagnosed as CPD (cepahalo-pelvis disproportion) and taken into c-section.
- Labouring on back is against gravity. The baby is coming up instead of going down along with gravity. Hence, the mother has to put more effort in this process.
- Putting your legs up restricts the blood flow to them. This increases the chances of cramps and fatigue. So when the mother is considered unable to labour because of these reasons, they are taken for a c-section.
- Damage to Ulnar nerve in the hand. When the woman holds both her legs so tightly, there are chances of damaging the nerve in the hand. This can cause wrist pain, swelling and restriction of movement.
- Higher risk of perineal tears and anal sphincter injury (which can cause fecal incontinence, pain, discomfort and sexual discomfort)
Yes, in some cases lithotomy is indicated (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 UK, Ireland, USA, and Australia are claiming back their midwifery birth practices slowly. 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 common place etc.
As a doctor who has seen how childbirth has changed in many countries, I say it’s time we in India change it too. And this will not happen unless we women educate ourselves more on what we are getting into.