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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Currently 3004 records
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https://afar.info/id=1317

Created on : 20 Oct 2005
Modified on : 25 Nov 2018

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Bibliographical entry (without author) :

Positions maternelles pour l’accouchement. Gynecol Obstet Fertil. 2005 Jul-Aug;33(7-8):533-8

Author(s) :

Racinet, Claude

Year of publication :

2005

URL(s) :

http://www.orthophonie.fr/enbref/position.doc

Résumé (français)  :

Positions maternelles pour l’accouchement
Par Claude Racinet (RHEOP Isère)

Introduction

Les positions adoptées par les femmes pendant le travail et lors de l’expulsion fœtale terminant l’accouchement ont été historiquement et universellement dominées par la mobilité et la verticalité, spontanément adoptées en association avec diverses aides matérielles et humaines Ces aides représentent une spécificité de la parturition humaine : elles sont rendues nécessaires par la difficulté de l’accouchement secondaire à l’acquisition de la bipédie et à l’augmentation progressive du volume cérébral de l’espèce.

En effet, depuis la plus lointaine antiquité et jusqu’à une période assez récente, la documentation dont on peut disposer (1) démontre que, outre la déambulation, les femmes utilisaient des positions verticales variées (debout, assise, accroupie, à genoux et sa variante à « quatre pattes »…) afin d’accoucher le moins douloureusement possible et avec le maximum d’efficacité pour éviter la dystocie, évolution redoutée car parfois mortelle pour le fœtus bien entendu mais également pour la mère. Différents accessoires permettant la suspension ou l’appui direct ou indirect ont été imaginés et tout particulièrement le Moyen-Age a vu fleurir un nombre incalculable de chaises obstétricales.

Depuis Mauriceau en 1668 (2), l’Obstétrique occidentale a amorcé un tournant remarquable en adoptant sa proposition de faire allonger les parturientes en position semi-assise sur un lit, au moment où se manifestaient les efforts expulsifs, sans réflexion sur la physiologie de l’accouchement, mais essentiellement pour faciliter la surveillance du travail et pour permettre l’exécution de manœuvres, devenues d’autant plus nécessaires que les conditions physiologiques n’étaient plus respectées.

Cette proposition s’est imposée lentement mais sûrement dans tout le monde occidental. Elle s’est généralisée avec la prise en charge quasi-exclusive des accouchements en milieu hospitalier et donc la quasi-disparition des accouchements à domicile, que l’on peut situer en France vers les années 1960.

La re-découverte des postures adoptées spontanément par les parturientes est récente, tout spécialement sous l’impulsion de Paciornik au Brésil (3), Odent (4), Gardosi en Grande Bretagne (5), Navé en France (6), suivi par De Gasquet (7) puis Lucas et Racinet (8). Bien que les fondements anatomo-physiologiques de ces postures apparaissent très convaincants, à l’ ère de la médecine basée sur les faits prouvés, il apparaît incontournable d’étayer ces pratiques par une recherche clinique la plus pertinente possible.

L’objectif de ce travail est d’analyser cette recherche clinique afin de pouvoir éventuellement proposer l’application des conclusions, étayées sur le niveau des preuves (NP1, NP2, …), à une population cible vivant en milieu européen occidental.

Abstract (English)  :

Maternal Positions for Childbirth
By Claude Racinet (RHEOP Isere)

Introduction

The Positions Adopted by Women During Labor and Fetal Expulsion Completing Delivery historically and universally dominated by mobility and verticality, spontaneously adopted in association with various material and human aids These aids are a specificity of the human parturition: they are made necessary by the difficulty of the childbirth secondary to the acquisition of the bipedalism and the gradual increase in the cerebral volume of the species.

Indeed, from the most distant antiquity and until quite recently, the documentation available (1) shows that, in addition to wandering, women used various vertical positions (standing, sitting, squatting, kneeling and its variant “four legs“…) to give birth as painlessly as possible and with the maximum efficiency to avoid dystocia, dreaded evolution because sometimes fatal for the fetus of course but also for the mother. Different accessories allowing the suspension or the direct or indirect support were imagined and especially the Middle Ages saw flowering an incalculable number of obstetric chairs.

Since Mauriceau in 1668 (2), Western Obstetrics has begun a remarkable turning point by adopting its proposal to extend the parturients in a semi-sitting position on a bed, at the moment when the expulsive efforts were manifested, without reflection on the physiology of childbirth, but essentially to facilitate the surveillance of labor and to allow the execution of maneuvers, which became all the more necessary as the physiological conditions were no longer respected.

This proposal has been slowly but surely imposed throughout the Western world. It has become widespread with the almost exclusive management of hospital deliveries and thus the near-disappearance of home births, which can be located in France around the 1960s.

Re-discovering the postures adopted spontaneously by the parturients is recent, especially under the impetus of Paciornik in Brazil (3), Odent (4), Gardosi in Great Britain (5), Naved in France (6), followed by De Gasquet (7) then Lucas and Racinet (8). Although the anatomo - physiological foundations of these postures appear very convincing, in the era of medicine based on proven facts, it seems essential to support these practices with the most relevant clinical research possible.

The aim of this work is to analyze this clinical research in order to possibly propose the application of the conclusions, supported by the level of evidence (NP1, NP2,…), to a target population living in France. Western European environment.

Sumário (português)  :

Posições maternas para o parto
por Claude Racinet (RHEOP Isere)

Introdução

As posições adotadas por mulheres durante o parto e expulsão fetal Completando o parto historicamente e universalmente dominado pela mobilidade e verticalidade, adotada espontaneamente em conjunto com vários materiais e assistência humana Essas doações representam uma especificidade de parto humana: eles são feitos necessário pela dificuldade da entrega secundária para a aquisição de bipedalismo e aumento gradual do volume cerebral da espécie.

De fato, desde a antiguidade mais distante e até bem recentemente, a documentação disponível (1) mostra que, além de vagar, as mulheres usavam várias posições verticais (em pé, sentadas). agachado, ajoelhado e sua variante “quatro patas“…), a fim de dar à luz sem dor quanto possível e com a máxima eficiência para evitar distocia, evolução temido porque às vezes fatal para o feto, mas, claro, também para a mãe. Diferentes acessórios permitindo a suspensão ou o apoio direto ou indireto foram imaginados e, especialmente, a Idade Média viu florescer um número incalculável de cadeiras obstétricas.

Desde Mauriceau em 1668 (2), Obstetrícia ocidentais começaram um ponto de viragem notável ao adoptar a sua proposta de alargar as parturientes ao meio-sentado em uma cama, quando se manifesta esforços de expulsão, sem reflexão sobre a fisiologia do parto, mas essencialmente para facilitar a vigilância do parto e permitir a execução de manobras, o que se tornou ainda mais necessário, uma vez que as condições fisiológicas deixaram de ser respeitadas.

Esta proposta foi lenta mas seguramente imposta em todo o mundo ocidental. Tornou-se difundida com a gestão quase exclusiva de entregas hospitalares e, portanto, o quase desaparecimento de partos domiciliares, que pode ser localizado na França por volta da década de 1960.

Posturas descoberta espontaneamente adotadas pelas mulheres em trabalho de parto é recente, especialmente sob a liderança de Paciornik Brasil (3), Odent (4) Gardosi na Grã-Bretanha (5), Nave na França (6), seguido pelo de Gasquet (7) então Lucas e Racinet (8). Embora os fundamentos anatomofisiológicos dessas posturas pareçam muito convincentes, na era da medicina baseada em fatos comprovados, parece essencial apoiar essas práticas com a pesquisa clínica mais relevante possível.

O objetivo deste trabalho é analisar essa pesquisa clínica, a fim de propor a aplicação das conclusões, apoiada pelo nível de evidência (NP1, NP2,…), para uma população-alvo que vive na França. Ambiente da Europa Ocidental.

Full text (public) :

Comments :

Présentation des fondements anatomo-physiologiques des positions d’accouchement, complétée par analyse de la recherche clinique.

Plan :
1/ Classement des positions (horizontales, verticales)
2/ Conséquences anatomo-physiologiques (effets sur la pesanteur, sur les contractions, sur l’efficacité des efforts expulsifs, sur l’hémodynamique maternelle et placentaire, sur la ventilation pulmonaire, sur les dimensions du bassi)
3/ Mise en pratique de la mobilisation et de la liberté posturale maternelle
4/ Résultats et discussion (revue de la littérature)

Argument (français) :

Présentation des fondements anatomo-physiologiques des positions d’accouchement complétée par une analyse de la recherche clinique.

Argument (English):

Presentation of the anatomo-physiological foundations of birthing positions completed by an analysis of clinical research.

Argumento (português):

Apresentação dos fundamentos anátomo-fisiológicos das posições de parto complementadas por uma análise de pesquisa clínica.

Keywords :

➡ position during labor ; perineal/vaginal tears ; postpartum hemorrhage ; dilation

Author of this record :

Bernard Bel — 20 Oct 2005
➡ latest update : Bernard Bel — 25 Nov 2018

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#2042   Vendittelli F. (1998). Position allongée ou verticale durant le 2e stade du travail : revue des méta-analyses. 28e Journées de la Société française de Médecine Périnatale, Arnette Ed., Paris, 1998, 167-176. ➡ https://afar.info/id=2042
#1209   Radkey AL, Liston RM, Scott KE, Young C. (1991). Squatting: Preventive medicine in childbirth ? Proceedings of the annual meeting of the Society of Obstetricians and Gynaecologists of Canada 1991;Toronto, Ontario, Canada:76. ➡ https://afar.info/id=1209
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#1176   Kafka M, Riss P, von Trotsenburg M, Maly Z. (1994). Gebärhocker - ein geburtshilfliches Risiko? [The birthing stool--an obstetrical risk?] [Article in German]. Geburtshilfe Frauenheilkd. 1994 Sep;54(9):529-31. ➡ https://afar.info/id=1176
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