Childbirth can be one of the most empowering and transformative experience of your life. However, the process has become so medicalised and standardised that it often overlooks what our bodies are capable of doing, and the intuitive power that lies within us. One of the most common practices that undermines this great natural process is giving birth on our backs - a position that's been widely adopted in modern midwifery and obstetric practices, but doesn't always make sense when it comes to supporting the physiology of birth. So let's talk about why birthing on our backs shouldn't be the default, and explore the benefits of active labour, where movement and different positions can make all the difference.
The Historical Context of Supine Births
The practice of birthing on the back, also known as the supine position, became popular in Western medicine largely due to convenience for medical practitioners. This position provides easy access for interventions and monitoring. However, historical and cross-cultural perspectives reveal that an active and upright birth better supports the physiological birthing process. This understanding which is also backed by some of the best experts in midwifery and obstetrics, is now part of many progressive antenatal classes and hypnobirthing courses that look at promoting a more holistic and women-centred approach to birth.
The Downsides of Supine Birthing
Gravity Works Against You: Lying flat on the back during labour means that gravity is not aiding in the descent of the baby. This can make the pushing stage more difficult and prolonged.
Reduced Pelvic Opening: The supine position can decrease the size of the pelvic outlet, potentially making it harder for baby to navigate through the birth canal.
Increased Pressure and Pain: This position often increases pressure on the mother’s back and tailbone, leading to more intense discomfort during surges (contractions).
Poorer Oxygen Flow: Lying on the back can compress major blood vessels, which can reduce blood flow and oxygen to both the mother and baby, potentially leading to foetal distress.
Suboptimal Foetal Positioning: Lying on your back can impact the baby’s rotation into a more optimal position for birth. Upright and active positions encourage baby to move into the best alignment for passing through the birth canal, reducing the chances of malposition and complicated births.
Higher Rates of Interventions: The supine position is associated with higher rates of interventions, such as episiotomies, forceps, and vacuum deliveries, which can lead to more complications and longer recovery times.
The Benefits of an Active Birth
Active labour allows you to move freely, changing positions as needed. This approach is aligned with the natural birthing process and has several known benefits:
Greater Sense of Control: Being able to move intuitively and choose positions that feel most comfortable can significantly increase your sense of control during labour and can truly feel empowering.
Gravity-Assisted Birth: Upright positions like standing, squatting, or kneeling make use of gravity to help baby descend more easily, potentially shortening labour and reducing the need for interventions and the risk of tearing.
Optimal Pelvic Alignment: Different positions can help align the pelvis in ways that facilitate the baby’s passage through the birth canal, reducing complications and the need for assisted delivery.
Improved Oxygenation: Positions that are upright or side-lying can improve blood flow and oxygenation to both mother and baby, reducing the likelihood of foetal distress.
Natural Pain Relief: Movement and position changes can help alleviate pressure on various parts of the body, providing natural pain relief and reducing the need for opioid-based medication or epidural analgesia.
Embracing a More Natural Approach
Promoting active labour involves more than just encouraging different positions; it requires a supportive environment that respects the birthing person’s needs and choices. This includes:
Education and Advocacy: Educating expectant parents about the benefits of active labour and their options during childbirth is crucial. Advocacy for birthing plans that prioritise mobility and comfort can empower women to make informed decisions that are right for them and their babies.
Supportive Healthcare Providers: Midwives, doulas, and progressive obstetricians who support and facilitate active labour can make a significant difference in the birthing experience.
Creating the Right Environment: Whether you choose to birth at home, in a midwife-led-unit or in an obstetric unit, get or ask for the props that will support a more dynamic labour such as a birth ball, birth sling or rebozo, mats, pool, birth stool, etc...
Conclusion
While the supine position for childbirth has been the standard in many modern healthcare settings, it is not necessarily the most beneficial for the birthing person or the baby. Active labour, with its emphasis on movement and position changes, aligns more closely with the natural physiology of childbirth and offers many advantages, from reduced pain and shorter labour to fewer interventions and better outcomes. Embracing active labour, along with techniques like hypnobirthing, can lead to a more positive and empowering birthing experience, one that respects and utilises the incredible capabilities of the human body.
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