is the all fours position. The presenting part rotates inside the pelvis more easily when a woman is on all fours. This position can be especially useful if the baby is lying posterior or the birth is very fast.
None of the women in all the recent studies were prenatally prepared to gain ease and comfort in the squatting, kneeling, crouching and all fours position. How much better would the upright groups of women have fared if they had the additional benefit of physical preparation. (A controlled study of this kind has not yet been done.)
Ideal Maternity in Pithiviers, France
Michel Odent and his staff have provided a setting for women to be active in labour at the maternity unit in the general hospital in Pithiviers in France. Here, for two decades, women in labour have had the freedom to follow their instincts in walking about and finding positions that are suitable and comfortable. He and his midwives, together with expectant mothers, have discovered many means of physical support during labour and delivery which have proved, over the years, to be a tremendous advantage in easing labour and especially delivery. They do not use continuous foetal monitoring, Pethidine, epidurals or forceps. Few episiotomies are given and induction is very rare. Their concept of obstetrics, to try not to disturb the normal physiology, is very different from conventional practice aimed at control. Also the physical and the human environment is very different – the birthing room has a home-like rather than a hospital atmosphere.
In this unit there are about 1,000 deliveries a year. Professional care is the responsibility of Dr Odent and six midwives. The midwives work in pairs for forty-eight hours at a time followed by four days off. Each woman is given her own room throughout her stay and there are few rules. As labour advances, she walks to the birth room which has a low-level platform with many cushions, and a wooden squatting stool. There she is encouraged to remain active and change her position as many times as she wishes.
Most women prefer to walk about, sit on the birthstool, kneel on all fours, squat and lean on their husband or the midwifes for physical support. Water is regarded as important and women, if they like, may take a warm bath or relax in a small pool which is available. No drugs are used, the membranes are not artificially ruptured. Most women adopt an upright position for delivery, usually a supported squat; others give birth on the birthstool or on the low double bed and some give birth in water. With the appropriate supported squat and the minimum disturbance of the expulsive reflex, there are no unnecessary perineal tears and episiotomies are rare.
After the birth, the baby’s bath and the delivery of the placenta, the mother walks with her husband and her newborn back to her own room. Of the 1,000 births that took place in Pithiviers in 1981, only eight babies needed intensive care.
Here is a maternity-care setting close to ideal. It has the safety of hospital delivery as well as the relaxed atmosphere of a comfortable and homely birth room. It is free of the frustrating regulations or limitations of routine hospital practices and is based on understanding of the instinctive behaviour of a woman in labour and her needs. They have a positive approach to an active, physiological birth with a natural outcome. The attendants are well-known to the mother and are constantly available during labour and delivery. Fathers participate and give their support. Women are given the freedom to move and adopt any position they find comfortable and the minimum use of drugs and interventions during labour are needed.
If the majority of women at Pithiviers can experience Active Birth safely and naturally in such a unit, why not elsewhere?
RESULTS OF 898 BIRTHS AT PITHIVIERS IN 1980
Since the time of writing, Michel Odent is no longer living in France and is based in London where his work continues with women giving birth at home. There are now many similar units and the results of their work reflect the same striking contrast to hospitals where obstetric management is still routine.
Your Responsibility
If the freedom to move and adopt upright positions makes sense to you and you want to give birth actively but do not have access to a maternity unit like Pithiviers, how can you go about it? You will have to make the possibility of an Active Birth your own responsibility; you will have to prepare your body to cultivate ease and comfort in upright positions as well as find a midwife, doctor or obstetrician (whether you wish to give birth at home or in hospital) who will support you in giving birth actively without the conventional intervention.
In parts of Britain, Europe, North and South America, Australia, New Zealand and elsewhere, increasing numbers of women, doctors, midwives and antenatal teachers are teaching and putting Active Birth into practice. Small groups are springing up everywhere spreading their message by word of mouth. (See here for The Active Birth Movement.) The women who form these groups have the proof of experiencing an active birth without drugs, without episiotomies and without tears. They prepare themselves to give birth actively by finding antenatal teachers who encourage them in this and they find doctors and midwives, maternity units and staff, who are prepared and willing to assist them to move about and use upright positions. If you want to give birth actively it will be helpful if you make contact with one of these consumer groups who help themselves to give birth actively and naturally. (See here for useful names and addresses.) If this is not possible, you will have to persuade your doctor or midwife or whoever to enable you to follow these suggestions. The support of your partner can be very helpful. If he is willing to join you in preparing for an Active Birth, his presence at the birth can contribute greatly to a successful outcome.
SUGGESTIONS FOR LABOUR
During the first stage of labour while the cervix is dilating it is usually best to be upright and walking about, or kneeling during the contractions and resting in between them.
During the second stage, standing or kneeling with the upper body leaning well forward during contractions helps to complete the rotation of the head. At the end of the second stage, supported squatting seems to be the most effective and comfortable position during contractions. Squatting, especially supported, gives the greatest increase of pressure in the pelvic cavity with minimal muscular effort and optimal relaxation.
Some women prefer to kneel on all fours for delivery, particularly if the second stage is very quick.
It is wise to make a point of meeting your midwife or doctor, or the midwife in charge of the labour ward, to discuss these ideas early in pregnancy if possible. As you read this book it will be helpful to list the issues that are important to you so that you can go through them together, and then attach a copy to your notes for easy reference by the midwife who attends you in labour. When labour starts it may help to request a midwife who is enthusiastic about natural, active birth and who has had previous experience in the use of upright postures.
The Pelvic Organs
Your uterus lies deep inside your abdominal cavity, between the bladder in front and the rectum behind. These are known as the pelvic organs. Your abdominal cavity extends from your diaphragm, beneath your lungs, to the muscles of the floor of your pelvis.
Before pregnancy your uterus is a small, hollow muscular organ, shaped like an inverted pear, measuring roughly 3ins. × 2ins. × 1in. Extending to each side from the top part, or fundus, are two narrow canals, the Fallopian tubes, and these end in finger-like projections called fimbria which surround your ovaries on either side and draw up the ripe ovum after you ovulate. The lower part or mouth of the uterus is called the cervix which projects into the vagina