Roots to life - Upright not uptight!

Nowadays it is automatically assumed that a bed is a useful, even perhaps an indispensable tool to have for delivering a baby. Many an engineer have developed several shapes and sizes of special beds performing various technological techniques offering so-called flexibility to make a modern birthing bed look more like a scientific gadget. It is assumed that this should work better for the mother. I have seen exotic shapes and sizes of highly expensive birthing chairs and beds, each competing for acceptance, and so good business, within a hospital system.

Having a baby in a bed is comparatively recent. Babies were, and still are in some countries, usually born while the mother squats on the floor. This is by far more physiological, as gravity and a wider opening of the pelvis help the mother give birth to her baby with less effort. It is interesting to know how the trend to having babies on a bed came about.

As history goes, in a society where birth was strictly a "female-only" event, Louis XIV, king of France, decided he wanted to be present at a birth by one of his concubines. He arranged accordingly with her attendants to hide himself behind a curtain, where he would be inconspicuous, but could be in a position to watch the procedure. The mother was placed on a table in front of the curtain, with her feet propped up, for him to get a better view. This position, was, to say the least, anything but comfortable for the poor mother. But the king had his wish granted, so who cared.

When doctors started to be included in the birth process, often to perform interventions such as using forceps or taking out the baby through the abdomen, today known as Cesarean section, they found the supine position, that is, the mother lying on her back, beneficial because it gave them a better view of the birthing area. But though this position is still used, as it is admittedly helpful for attending staff to control the birth, many a doctor nowadays acknowledge the fact that this position is anything but helpful for the mother giving birth.

Roberto Caldeyro-Barcia, past president of the International Federation of Obstetricians and Gynaecologists, states unequivocally: "Except for being hanged by the feet, the supine position is the worst conceivable position for labour and delivery." (ww.birthingnaturally.net)

How come that with all today's knowledge birthing on the back on a delivery table is still prevailing? With today's mentality of "a pill for every ill" and drugs that make a pain-free childbirth a possibility, the use of painkillers during childbirth has become widespread. These make the mother lose sensation and control over her body with the result that she is unable to stand and move. She becomes limp and practically has no choice but to take a lying position in a bed which supports her weight completely. In a hospital setting, psychologically, she becomes a "patient", a fragile, vulnerable person needing somebody else to take over her job, when in reality during birth she is a strong woman working her way towards becoming a mother. Indeed, this is nature's way whereby with proper psychological support by people who believe in her ability to birth her baby, she gains the strength, self-confidence and sense of fulfilment she needs to be able to perform well in her highly demanding role of mother. It is indeed a shame, that with today's idea of birth, and management thereof, many mothers lose this necessary emotional boost right at the onset of motherhood.

The use of a bed during childbirth is determined both by the ability of the mother to stay in control without drugs, and also by the management of the birth as required by the attending care-givers. We must keep in mind also that most mothers today are not used to being in a squatting position for long. Though this can be practised during pregnancy, the mother needs to be educated in such a way that she may take an active role during the birth of her baby. She may be encouraged to choose positions that help her both to decrease pain and shorten labour. Taking advantage of gravity and mastering the ability to relax are just two of many ways that help her do just that. Indeed, changing positions during transition may actually be a life-saver, both for the mother and for the baby. This is much easier in a home setting where different furniture offer different heights for the mother to lean on to, to take her weight.

A table, a kitchen sink, a chest of drawers, a chair and a staircase, to mention a few, offer various possibilities of standing, sitting and kneeling. All of these positions are ideal to lean forward, thus letting the hard-working uterus fall forward onto a soft belly. This alone drastically lessens the pain as compared to a mother who is lying on her back on a bed or delivery table. In the latter position, gravity makes the hard and heavy uterus fall on the spine, causing drastic unnecessary pain every mother can do without. As a result of a favourable position, the need for painkillers is diminished, to the advantage of both mother and baby.

Leaning forward onto a support or squatting during a contraction automatically opens up the mother's pelvis as the sacrum and coccyx, two flexible bones at the base of the spine, are encouraged to move outwards, making more space for the descent of the baby. This is specifically designed by nature for this purpose. The labour and birthing hours are automatically shortened. Another bonus is keeping the baby safe for longer, as with an upright, as opposed to a supine position, there is no restriction of the arteries near the spine which give the baby all the oxygen and supply needed during labour.

Unfortunately with today's management of birth, keeping the mother on the bed, giving her painkillers which inhibit her ability to move and keeping her attached to monitors for long hours of labour, affect her mobility and so her comfort. It does not help the baby much, either. In fact, continuous monitoring intended for the baby's safety, but requiring the mother to stay on her back for long hours, has been proved to cause distress in the baby more often, causing an increased need for births to be done by Cesarean section.

Today's latest trend to help the mother's mobility and comfort is a birthing ball. It is simply a large ball used in many gyms nowadays. It combines gravity with movement and flexibility while the mother does not need to keep all her weight on her legs for long. Many mothers who train accordingly, as taught during pregnancy classes, find it extremely helpful. Some hospitals provide a ball as part of their apparatus used during childbirth. Who said that buying highly expensive technological beds and chairs is what the mother needs? A rocking chair, a birth ball and perhaps bars attached to a wall at various heights to be chosen accordingly by the mother may prove to be more helpful for the mother who would rather be active and mobile for her birth. Not exactly state-of-the-art, one would say!

But who cares if such simple ideas have proved so helpful for many mothers in labour over the years. Having spent millions of pounds on high-tech equipment, mostly suggested by men who are fascinated by technology, buying ridiculously simple things for the mother's comfort as chosen by the mother herself, does not add much to the expense of equipping a hospital, really. It is not a question of budget, but more a question of mentality and perhaps control.

Enjoyment in giving birth may be a reality for the mother whether she chooses a pain-free birth with the use of drugs, or to be active and upright during labour.

The mother's choices need to be respected. Her caregivers may help her tremendously by accepting new ideas which are safe and by being more flexible to accommodate the mother's wishes.

It is her birth, an event in her life which she will carry with her throughout her lifetime. It is her attendants' responsibility to send her home from hospital not only with a healthy baby in her arms but also with a healthy mind and disposition to be able to feel confident in being a mother and thereafter perform her task well. This is what I mean when I say that mothers are society's best investment for the future! The birth of a baby is where it all starts.

• AMs Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.