Birth position

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The term birth positions , even Gebärpositionen (ger .: maternal birthing positions, childbirth positions ), refers to the variety of postures, the woman in labor during childbirth can sprozesses taking.

General

In addition to the recumbent position , which is still favored by many obstetricians, alternative birth positions, including squatting, standing, kneeling and quadruped, are often successfully used, especially for out-of-hospital births, but increasingly also in delivery rooms . These positions are known as the upright birthing positions .

The World Health Organization ( WHO ) recommends letting the woman choose the birth position herself and offering and enabling different positions.

Often, however, there are limitations to these options, due to the equipment of the delivery bed up to prescribed delivery instructions or routine measures such as infusion lines or cardiotocography ( CTG ) cables. Also, epidural anesthesia (PDA) can prevent the woman in labor from moving freely.

Benefits of upright birthing positions

Assuming upright positions during labor and delivery widens the birth canal more than the lying position, so that the baby has more room for necessary rotations and can more easily cover the path through the pelvis. In addition, the indication for abnormal heart rates in children is lowered. As a result, interventions (e.g. forceps , suction cup ) are less common.

Upright positions during the opening phase can reduce this phase by more than an hour. When used in the initial phase, they also statistically reduce the need for caesarean section and epidural anesthesia in the further course of labor.

Different birth positions can be associated with different degrees of birth injuries. Obstetricians should therefore know a wide range of birthing positions, weigh the benefits and risks in each individual case and be able to combine the positions skillfully. Decisions about birthing positions should always be made in consultation with the woman giving birth.

Individual birth positions

Supine position (medically lithotomy position )

Here the mother-to-be lies on her back with her legs up and her buttocks near the edge of the table. This position is most comfortable for obstetricians as it allows better access to the perineum . However, this position is unfavorable for most women because the head exerts uneven pressure on the vaginal wall and labor has to work against gravity.

“A number of studies have shown that in the opening phase, the supine position influences the blood flow to the uterus. The uterus , which lies heavily on the abdominal vessels, can lead to their compression, which in turn results in poorer blood circulation and thus in poorer supply to the fetus . It was also found that the intensity of labor is influenced by the supine position and thus hinders the progress of the birth. "

Squat

The crouching position uses gravity and thereby increases the pressure on the pelvic area with minimal muscular effort. In the crouching position, the birth canal opens up to 20% wider than in any other position. Another advantage of this position is the even pressure distribution through the baby's head onto the vagina. The child's heart rate is better, but the risk of perineal ruptures and blood loss above 500 ml is slightly increased for this position. If used carefully, this position is recommended especially for the expulsion phase. Birthing stool or the partner support those women who cannot get their heels on the floor while squatting.

Quadruped

Some women instinctively stand on four feet. Many women find the position comfortable. Because the position uses gravity, it reduces back pain. Less pressure on the perineum reduces the risk of perineum rupture. Compared to squatting, this position doesn't open quite as far and is therefore a good alternative in the expulsion phase.

Lateral position

This position can slow the child's progression in the birth canal, giving the perineum more time to naturally stretch. The mother lies on her side with her knees bent, with the upper leg held up or supported. This position does not make use of gravity, but has the advantage over the lying position that the vena cava (main vein) is not squeezed, which could lead to a reduced blood and therefore oxygen supply to the child.

Move

When cables of the cardiotocography machine are attached, women often feel restricted in their freedom of movement. However, women connected to this measuring device are also advised to follow their urge to move. Walking around during childbirth has no harmful effects. Women should therefore be encouraged to do so if they want to walk around.

The equipment in the birthing facility is the key to real freedom of movement. Different pieces of furniture and props should therefore be available in the room that encourage the woman to try out different positions. Electronic fetal monitoring, intravenous fluids, and various methods of pain relief can affect a woman's mobility and ability to change her birthing position. Women need to be aware of this so that they can make informed decisions about their use.

Historical-cultural development

Originally, in almost all cultures, births took place in upright birthing positions. Due to the mechanization of the birth process, the lying position has become widespread in Germany and other Western countries, mostly to the chagrin of the parturient. Since the late 20th century, however, upright birth positions - also in the course of efforts to achieve a gentle birth - have increasingly come back into the consciousness of those involved. Pregnant women and their partners get to know different positions in birth preparation courses and can try them out there. Due to the shortage of skilled workers , which the German Midwives Association and the Mother Hood initiative have been drawing attention to for years, many births continue to be performed horizontally and with a high intervention rate.

Individual evidence

  1. ↑ QUALITY REPORT 2016 OUT-OF-CLINICAL OBSTETRICS IN GERMANY. (PDF) 2016, pp. 47–48 , accessed on October 18, 2018 .
  2. ↑ R. Keen, J. DiFranco, D. Amis, L. Albers: Non-Supine (eg Upright or Side-Lying) Positions for Birth . In: Lamaze International Education Council (Ed.): Journal of Perinatal Education . Spring, no. 13 , 2004, pp. 30-34 .
  3. ^ World Health Organization: Appropriate Technology for Birth . Ed .: WHO Regional Office for Europe. Copenhagen, April 1985: “During labor, pregnant women should not lie on their backs. They should be encouraged to walk around during labor and be free to choose which position to give birth in. "
  4. ↑ WHO recommendation on birth position for women without epidural analgesia. The WHO Reproductive Health Library, February 2018, accessed October 17, 2018 .
  5. ↑ Care in normal birth. A practical guide, report of a technical working group. (PDF) World Health Organization. WHO / FRH / MSM / 96.24, 1996, accessed September 8, 2016 .
  6. ↑ JK Gupta, A. Sood, GJ Hofmeyr, JP Vogel: birthing positions for women without epidural anesthesia. Cochrane Database of Systematic Reviews, 2017, accessed October 22, 2018 : " https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002006.pub4/epdf/full"
  7. ^ A. Lawrence, L. Lewis, GJ Hofmeyr, C. Styles: Maternal positions and mobility during first stage labor . Ed .: Cochrane Database Syst Rev. Volume 10 , 2013.
  8. ↑ A. Shorten, J. Donsante, B. Shorten: Birth position, accoucheur, and perineal outcomes: Informing women about choices for vaginal birth . In: Birth. Issues in perinatal care . tape 29 , no. 1 . Wiley, March 2002, p. 18-27 , doi : 10.1046 / j.1523-536x.2002.00151.x , PMID 11843786 .
  9. ↑ M. Hastings-Tolsma, D. Vincent, C. Emeis, T. Francisco: Getting through birth in one piece: protecting the perineum . In: MCN Am J Matern Child Nurs . tape 32 , no. 3 , 2007, p. 158-164 , doi : 10.1097 / 01.NMC.0000269565.20111.92 , PMID 17479052 .
  10. ↑ Care during a normal delivery. A practical guide . In: European Workgroup of Independent Midwives (Hrsg.): Midwife Birth Aid . tape 1 , 1996, p. 62 ( who.int [PDF]): “The positive effects of the upright positions depend primarily on the competence of the birth attendants and their experience in dealing with other birthing positions besides the supine position. A certain amount of knowledge about their advantages and the consideration of the woman's will to assume different positions can make an immense difference in childbirth care. "
  11. ↑ Care during a normal delivery. A practical guide . In: European Workgroup of Independent Midwives (Hrsg.): Midwife Birth Aid . tape 1 , 1996, p. 50 ( who.int [PDF]).
  12. ^ JG Russell: Molding of the pelvic outlet . In: J Obstet Gynaecol Br Commonw . tape 76 , 1969, p. 817-820 .
  13. ^ WHO Reproductive Health Library: WHO recommendation on birth position for women without epidural analgesia. The WHO Reproductive Health Library, February 2018, accessed October 23, 2018 .
  14. ↑ Monika Siller: Birthing stool - why better than lying on your back. In: schwangerschaft.at. Retrieved October 23, 2018 .
  15. ↑ MJ Guittier, V. Othenin-Girard, B. de Gasquet, O. Irion, M. Boulvain: Maternal positioning to correct occiput posterior fetal position during the first stage of labor: a randomized controlled trial . In: BJOG . tape 123 , no. December 13 , 2016, p. 2199-2207 , doi : 10.1111 / 1471-0528.13855 , PMID 26806596 .
  16. ↑ Care during a normal delivery. A practical guide . In: European Workgroup of Independent Midwives (Hrsg.): Midwife Birth Aid . tape 1 , 1996, p. 50 ( who.int [PDF]).
  17. ↑ SL Bloom, DD McIntire, MA Kelly et al .: Lack of effect of walking on labor and delivery . In: New England Journal of Medicine . No. 339 , 1998, pp. 76-79 .
  18. ^ L. Albers: The Evidence for Physiologic Management of the Active Phase of the First Stage of Labor . In: Journal of Midwifery & Women's Health . No. 52 , 2007, p. 207-215 .
  19. ↑ H. Spiby, P. Slade, D. Escott include: Selected coping strategies in laboratory: an investigation of women's experience . In: Birth . No. 30 , 2003, p. 189-194 .
  20. ↑ MIDIRS (Ed.): Informed choice for professionals; Positions in Labor and Delivery . No. 5 . Bristol 2005.
  21. ^ GJ Engelmann: Labor among primitive peoples . 1883.