Blog

World Respect­ing Child­birth Week (WRCW)
Posi­tions in child­birth : actors, direc­tors, free choice…
WRCW — 23–29 May, 2005

Objectives

• to pro­mote the aware­ness that the cul­ture of obstet­ri­cal risk and active man­age­ment of labour (exclu­sive­ly jus­ti­fied by the con­straints of staff man­age­ment) led to the loss of self-con­fi­dence of a whole gen­er­a­tion of women with respect to giv­ing birth. A grow­ing num­ber of pro­fes­sion­al birth atten­dants (doc­tors and mid­wives) are now try­ing to step out of this “pro­duc­tivist” mod­el. How­ev­er, only well-informed users have the poten­tial to fos­ter a rad­i­cal change of med­ical prac­tice with the sup­port of law-makers.
• to encour­age the free choice of labour posi­tions with the effect of: 
  • min­i­miz­ing pain, and fur­ther the use of (epidur­al) analgesia;
  • reduc­ing the aver­age length of labour with­out stim­u­lat­ing it with arti­fi­cial hormones;
  • (accord­ing to a few stud­ies) to reduce the risk of post-par­tum hemor­raghe, the main cause of mater­nal deaths;
  • bet­ter pro­tect­ing the per­ineum dur­ing the ejec­tion phase.
• to share sci­en­tif­ic evi­dence via the AFAR database…

How to proceed practically

• broad­cast infor­ma­tion on the media;
• give access to infor­ma­tion to preg­nant women (social wel­fare office, gath­er­ings of moth­ers…) and teenagers;
• sug­gest actions for indi­vid­ual, infor­mal groups, non-prof­it soci­eties, pro­fes­sion­al agen­cies and media in var­i­ous countries;
• arrange meet­ings, con­fer­ences, inter­views with the local press or radio;
• sup­ply more links and doc­u­ments on this top­ic for the web pages and database;
• com­ment on exist­ing resources;
• orga­nize all sorts of satel­lite events;
• trans­late the avail­able mate­r­i­al to more lan­guages, etc.

Resources

• NCT (Nation­al Child­birth Trust) posters. These posters are dis­played in hos­pi­tals in the UK. A French ver­sion is cur­rent­ly dis­trib­uted by AFAR. [cor­rec­tion liens/2012 => page posters du site AFAR]
  • Rec­to (low def­i­n­i­tion in Eng­lish) -> buy paper posters on line
  • Ver­so (low def­i­n­i­tion in Eng­lish) -> buy paper posters on line
  • Rec­to (low def­i­n­i­tion in French)
  • Ver­so (low def­i­n­i­tion in French)
  • Rec­to (high def­i­n­i­tion A4 in French)
  • Ver­so (high def­i­n­i­tion A4 in French)
  • Rec­to (high def­i­n­i­tion A3 in French)
  • Ver­so (high def­i­n­i­tion A3 in French)
• Informed Choice leaflets (MIDIRS http://www.midirs.org/)
• Upright posi­tions use­ful for labour and birth (Empow­ered Childbirth)
• Birthing posi­tions in Swe­den (Folkhäl­soin­sti­tutet)
• Push­ing Posi­tions (Con­nie Banack)
• Phys­i­o­log­i­cal Sec­ond-Stage Labor (Mid­wifery Today E‑News)
• Push­ing for First-Time Moms (Glo­ria Lemay) [also in Span­ish and French]
• Birth posi­tions (Ron­nie Falcao)

• Posi­tion and Move­ment dur­ing the First Stage of Labour (World Health Organization)
  Sev­er­al stud­ies show that, dur­ing the first stage of labour, the supine posi­tion affects the blood flow in the uterus. The heavy uterus can cause aor­to­cav­al com­pres­sion and the reduced blood flow can com­pro­mise the con­di­tion of the fetus. The supine posi­tion is also found to reduce the inten­si­ty of the con­trac­tions (Fly­nn et al 1978, McManus and Calder 1978, Williams et al 1980, Chen et al 1987), and thus inter­feres with the progress of labour. Stand­ing and lying on the side are asso­ci­at­ed with greater inten­si­ty and greater effi­cien­cy of the con­trac­tions (their abil­i­ty to accom­plish cer­vi­cal dilatation).
  Despite the con­tin­ued preva­lence of the supine posi­tion many options are open to women in labour. How­ev­er, var­i­ous con­straints fre­quent­ly lim­it those options, from the design of the deliv­ery-suite bed to deliv­ery pro­to­cols or the pres­ence of rou­tine intra­venous lines or mon­i­tor­ing equip­ment. Where such con­straints are kept to a min­i­mum women can stand, walk, sit upright or on hands and knees, take a show­er or a bath to relax or adopt each posi­tion alter­nate­ly as they choose. Tri­als that have com­pared these posi­tions to the supine have found that, on aver­age, labour was expe­ri­enced as less painful (there was less need for anal­ge­sia) and aug­men­ta­tion was used less fre­quent­ly in the non-supine posi­tions (Chan 1963, Fly­nn et al 1978, McManus and Calder 1978, Diaz et al 1980, Williams et al 1980, Hem­min­ki 1983, Melza­ck 1991). One tri­al (Fly­nn et al 1978) found a sig­nif­i­cant­ly low­er inci­dence of fetal heart rate abnor­mal­i­ties in the upright posi­tion, but oth­er tri­als detect­ed no sig­nif­i­cant dif­fer­ences in neona­tal outcomes.
  In con­clu­sion, there is no evi­dence to sup­port the encour­age­ment of the supine posi­tion dur­ing the first stage of labour. The only excep­tion is where the mem­branes have rup­tured in the pres­ence of a non-engaged fetal head. If and when the mem­branes are rup­tured and the birth atten­dant has estab­lished a suf­fi­cient engage­ment of the fetal head, women should be free and encour­aged to choose the posi­tion they pre­fer dur­ing labour. They will often change posi­tions, as no posi­tion is com­fort­able for a long peri­od of time.
  (Ref­er­ence: Care in nor­mal birth: A prac­ti­cal guide)
• Mater­nal Posi­tion dur­ing the Sec­ond Stage (World Health Organization)
  […] for both the first and the sec­ond stage, […] women can adopt any posi­tion they like, while prefer­ably avoid­ing long peri­ods lying supine. They should be encour­aged to exper­i­ment with what feels most com­fort­able and should be sup­port­ed in their choice. Birth atten­dants need train­ing in coach­ing and per­form­ing births in oth­er posi­tions than the supine in order to not be an inhibit­ing fac­tor in the choice of position.
  (Ref­er­ence: Care in nor­mal birth: A prac­ti­cal guide)
• Apren­da a nascer e a viv­er com os índios: Par­to de cóco­ras, desem­pen­ho sex­u­al e ginás­ti­ca indí­ge­na (a book by Moysés Paciornik, in Portuguese)
• Ideas alrede­dor de las posi­ciones para parir y la sex­u­al­i­dad (in Spanish)

A point on actions in various countries…

(We will report all actions after WCRW, in June 2005)

• Argen­tine
• France
• Latin Amer­i­ca
• Québec (Cana­da)
• Switzer­land
• The Nether­lands
• Unit­ed Kingdom
• USA