Every woman is a world and every pregnancy too. Something similar happens when giving birth because each pregnant woman has different desires and physical conditions. Still, it doesn't hurt that you know the there are different ways of giving birth, its advantages and disadvantages, and discover which is the best for you.
First of all, I would like to clarify that the most appropriate way to give birth will ALWAYS be the one the woman chooses. This is something fundamental and that we must all be clear about, as patients and as professionals, because, in addition, it is protected by the patient autonomy law 41/2002 and is also included in the Ministry's clinical practice guide for normal delivery care of Health. Having said that, let's see what the scientific evidence tells us about the different possible positions for childbirth.
First of all we must differentiate between two types of postures, vertical and horizontal. Vertical we call standing, sitting, squatting, kneeling or hands-knees, that is, quadruped. Horizontal refers to the positions that are adopted in bed with the headboard elevated maximum 45º and are: supine, lateral decubitus and the gynecological position (called lithotomy).
If we dive into history, we observe that women always adopted postures that allowed movement, as is the case today in underdeveloped countries and in childbirth without intervention. Where does the fact of giving birth in bed come from, and especially in a gynecological position? From the comfort of the medical staff, if we go back to the seventeenth century, Mauriceau introduced such postures.
There is scientific evidence that supports the multiple benefits of vertical postures, among which we find, facilitating the descent of fetal presentation, improving contractions and maternal pushing, increasing the diameters of the pelvis, reducing the duration of the delivery and, even, reduce the need for instrumental deliveries. It should also be noted that women report a greater sense of control and their pain sensation decreases.
If we look for the best posture to avoid perineal damage, the evidence is still not very clear, but it has been seen that, although there are more tears in the vertical positions, more episiotomies are required in the horizontal positions.
To understand why freedom of movement is necessary, we must understand the physiology of childbirth. The pelvis is a 'bony labyrinth' through which the baby has to pass. It is not smooth, but has different curvatures and diameters in which the child has to fit. This is why, in each phase of labor, the body asks us for one position and another.
Observing a woman who gives birth without an epidural is the greatest learning that a midwife can do, after all, our bodies are perfect machines designed by nature and they tell us what to do. This, we can then extrapolate to situations in which mobility is limited by analgesia, and even with an epidural in place, we must advocate for postural changes and mobilizations.
At the beginning of labor, the ideal are vertical positions that allow a lot of mobility, as the baby goes down the pelvis, they tend to be more comfortable sitting positions, the use of the fitball and then women tend to lean forward and support or even get on your knees. When babies are not positioned in the easiest way to be born, it is advisable to adopt the quadruped position, that is, to get 'on all fours'.
Indicated for instrumental deliveries, lower risk of bleeding. It must be said that this posture does not promote descent, reduces the ability to move, greater pain and intensity of the contraction and a higher rate of episiotomies.
It allows you to rest and relax, reduces pressure on the perineum and reduces the risk of tears. Of course, there is a greater intensity and less frequency of contractions.
Among the good things: it increases mobility, favors fetal rotation in fetal malpositions and facilitates descent, there is less perineal trauma and lower back pain is reduced. Quadrupeds are sometimes poorly accepted for cultural reasons, experience is necessary in assisting this type of deliveries, sometimes with epidurals it is not possible.
Stand out, as an advantage, that it favors the maximum width of the pelvis and greater gravity, therefore, it facilitates the exit of the head. Reduces instrumental deliveries and improves rotation. It is a tired posture, in which it is necessary that there is no epidural analgesia or that it be of low doses (walking type). In contrast, it increases postpartum bleeding and the rate of second-degree tears.
Reduces low back pain, fewer instruments, comfortable posture, greater force in pushing. Greater vulvar edema increases the probability of perineal trauma, but decreases the number of episiotomies.
With all this information we can conclude that there is no ideal posture, which is something dynamic that changes throughout the delivery and according to the desire of each woman. The most important thing is that you listen to your body and remember: freedom of movement.
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