,

P
\uz

{,i INltr.ttt)u(t-rt()N
Y

Deliuering witb Botb Feet on the Ground

IN SEVERAL ARE.ts oF HoLLAND, mid- bowel movement, and if someonc sug- Midwives arc Ending thar en i.scrcas-
wives urd the women under *reir carc be- gesred thar wc should do so, we wouldnt , ing number of womcn prcfer ro rcmain
gan co erperimcnt with a numbcr of trkc them seriously. Ifit weren't for culy' positioned venically during dclivcry. \r:ar-
spontaneous delircry positiors used pri- tural condirioning, dre idea of dclivering ting, siEting, knecling, and send.ng facfi-
or to drc cightccnrh cennrry dut had been supine-and therc\ hampering a physi- ace rhe binh proccs for both mothcr and
almosr forgotten by Vcstern mcdicine. ological process by going ageinst tbc lerr of child Awarcncs ofthe adranages ofvcr-
During the past rwo deedcs, $cse mid- gravity-rvould saikc us al cqudly absulcl cical birdr is growing arnong doctori. In
wives have gined in'ralu:blc expericnce Pressurc placed on main blood ves- some hospirals, verrcical dclivcry is already
with verriol birth, the most mnrral and sels widrin rbc pclvic caviry is rnothcr me- cusromary
,rncienr method of delivery. flhird Vodd jor disadvrntage of supinc dclivery. Thc It gocs widrout srying thar a birdring
o"nons have contirured m use vertical po- ,babv's weiehc as well as that of the amni- position can bc eEective onlv ifit is sirn-
C, u for childbearing.) Exploretion for otic fluid and glacente f.e.<cr onto the ple ro assume, eesily meiatained, and very
\--prnativcs ro the current conventional vesscls that provide thc blood flow jnto seble. Durilg dcliverier etrcnded by mid-
oiirhing position did nor cooe out ofthe *re phce!.ta. blood f,olv which is vitai fol wivcs, nuny wonen innritircly wcar inro
bluc; tbe disadweaagc ofdelivering while thc childt oxveenerion. the supporrcd squat. The rupponed sguat-
lying on onc's back, in dre supine pori- ln drc scventies, many midwives rc- ring positio+ bccausc of is simplicity and
tion, heve loog bccn known. jccted the supinc posirion.and switchcdfabiliry, is an obvious position to choosc-
, F:sc e loc oftime and coergy is wasr- to thc semisining posirion ic which rhe A partrcr sis on a sof+ chzir, or bed bc-
/ cd on an unnecesary batdc agairut gravi- wom:n half sits and brlf lics, supported hind rbe womeq who squaa bctrcen her
ry. Lying on her back-legs in thc air, by pillows, with her lcgs slighdy bcnt and parmcr! legs. She rcss bcr errns oo tf,eir
knccs pulled up toward the chcst and hcr feer fat on the matqes. A new prob- . thigtu. If drc prshing is prolonged br any
spread aparr, chin on chesc-is cxccmely lem erosc; in this position, the woman! rcason, as it oftcn is with a fist child, the
riring for a woman in labor, In esscnce, weight tcn& co estrict thc birdr opening, woman is supponed by r small birthchair
this is a horizonrel squaning position, lcaving too litde room for drc baby! heed or by e bucket with a widc edgc on
which does opcn up thc pclvi: rnd rele-r and shouldcrs. If a womm wcte co rcmain which shc can rit couforably. Thfu cr-
the rnusclcs ofrhc pelvic floor, though io this posirion, she would expcrience an . ne support is usudly rcmoved thc mo-
nor u much as squ:tdng when onc ! ver- uncomforable countcrplcsur 6om che mcnt thc head pre:cnrs itsclf, becausc
ncal (sec Increased Mobiliry ofdrc Pelvis, rrrttrcss 15 the hcad dcscended end the during vcrrical dclivcries from thet point
gage 5). But 'tquattinC' whilc on one! anrs begur ro bulgc. This position is prr- on, many worncn no longer need ro
back rrn5 cravity inro e hindrance rather ticulady unsuitablc for a finc-timc moch- push.
than using it ro assisc delivcrv. The infcr- e( who musr exert more strcngrh to push Soine womcn shy awav from the
ibiliry of giving birrh in rhe 5upmc po- her baby rhrough rhe unpreplrcd birlh squatring posirioo bccause rhey've heard
f
tsition is rnadc very clerr when onc canal. If she is halfinrry berween sining rnd rhe misconceprion that Westcrn no^rV/
consrders the posicion assunred for defe- lying down, she cannor brrce henclfsuf- have become totally unaccustomed to
qi,r'-o, anorher expulsive funccion of chc ficienrly. Ic is not wichouc rcrson, lfter :quatting rnd chat the,v shor.rld mke spe-
|] We sit upright on rhc toilct, lnd pushing in this ptrsirion for l while with- cial courscs ro le.rrn to squac lintn rhe chinl
no faciliries:rre rvail:rble-on r out succLss. shc is .rdviscd ro lic down frr- monch oI pregn,rncy ou. lvtost wotncn
)in
camprng crip, tbr exlnrplc^_rve
sqult. [t ther ro pruvidc rnore roonl tbr rhc held who have rlelivcred in l squirttirrg posi-
ncvcr occllrs ro us ro lie dorvn to hrrve. :r
<r prsr thnrtrgh. rion hive, irt tlcc, pmcticcd vew lirrlc. E.r-

crcis!. durirg prcgr:tncy is helptirl but
shJlelns 6.r.Fio rest bctwcen contr:rc-
rions. Tirgether they watch chc child being
oorn.
More and morc ofren a woman will
invire r girlfriend or someonc with
whom rhe couple is very close to attend
rhe delivery. Their prcsence adds an extra
dimension to the birth. Childbirth bc-
comes morc ofa communal evenr. Flaving
a girlGiend prescnt givcs the woman who
is delivering e fceling of securiry which
hclps rclax her body, and thc woman at-
cending has a wondcrful oppomrniry to
expericnce a binh 6rst-hand, gainilg di-
rccr c'ensfercnce ofknowledgc ra*rer dran
having to e-xeact all her informarion 6om
books.
A Thc current devclopmcns in vertical
\' ;rh have taken place primarily ia
pmen's hornes. This is undersrandablc;
t{r at homq in her own csdrcnmccg sur-
rounded by people of her choicc,
,/woman fcels free to take on her own po-
sition ald to follori thc. signals ofhcr
body. Not only is thc position altercd but
the whole amr.osphere around chc binh
ch.angcs. Corsequendy, drc idea to which
wc balc bcen conditioned for two ccn-
mries, that a bcd is neccssary for binhing,
is no longer acceptcd as truc. Horpial de-
Iiwry rooms in which vcrticd deliverics
are standard praccicc coocain no bcds.
Bedrooms, oftcn small and the cbillicsr
rooms of the house, ztt usurJly less than
ideal locations for homc dclivcries. A
lwoman should choosc the spor in hcr
J home rhat is most comfortable and warm.
The di-fercnccs in emorioru between
u tr wotnln in r horizonca.l posicion and l
l.
F woman in a vcnicd porition arc ptobund.
In rhe vcrricrl positioo, shc h:'< "bgth fe"t
t1
F.t
\'
I
is on rhe gn>uml": slre krrows clcrcdv what is ofbirth is ful-
cnsu.r. lhirt dre cxpcrience
tilling ro yoLr rnd rhc orhers involvcci.
Abovc rll, keep in nrind rhrt this is your
dclivcry, your chiltl.
THE Fot.LowtNc Att,E somc of the issues
1ou will want to rrise:
This is not thc crse whcn a women is in WHo wlr oe at the dclivcry?
che supine posi<ion. Shc lies in a bed as if Do you want only your partncr to be
ill. rnd people rower lbovc hcr. making prEscnt, or do you want o invisc e friend,
her feel smdl aiid dcpendcoc. Whcn thc sistir, rhother, or other rclativc.
delivcry doci ndt go smoochly, she tends If you hrvc orhcr children, do you
to surrcnder to dre specialist and gives up feel they should bc there, or wou.ld their
resporsibfiry. prcscnce discact or inhibir you?
Quitc aa unexpected dcvelopment in
rerms of thc mothcr's 6rst conract wirh WHERE AAr You gging to dcliver?
thc aewborn cbild was mede possiblc by At home or in a hospital? Ifin a hos-
thc rrcrtiel delivery: she can see her chilSl pial, visil scleral in advance and ask about
immediarely and is the fi$t pcrson to hola their rcgulerions. Choose che. onc wirh
her baby. Whcn a woman- deliven in dre which you feel most con,fortable.
sup+e position, thc midwife must lctive- If you decidc to deliver ar home' in
V asstst thc hby! btd. Ithasbeenotlr-. what room will you give birth: thc iiving
expcrience fiat such inrc.rcntsal!-lrs4ry. room, thc bedroor+ chc bathrioom? Re-
unnecess:lfv rrrlrn \rerucar ocuvcrtes. The membqr to take iq(o consideradon the
cHfd ts born bv tsrtf. duc rc:se c""E "- size of the roorrq thc noisc lcvel, and the
tions and grrvity, and $e midwifc {nctelv hcacing' You will also want to decide if
-circhcs
it. The baby slidcs onto en ob- akiug a bach or sbower during labor or
sreEic pld on thc floor in &ont of thc dclivcry sounds appeding lo you.
a morher. Thcre ale !o dmc prcssures; a
waman cau, adhcc to her own rhythm, WHrcH PosITloNs aPpcal to you?
rec6wring her brceth and bccoming at- srrl you squat, sen4 or krrecl? Ouc
tuncd to hct child at her own pace. of the misconccpcions abou( sqqatting is
that one must plectice flom thc third
mon& ofpregn:nry. Aldrough uscfirl, ex-
MAKING ARRANGEMENTS ercise is not necessary. Most womcn in-
FOR T!{E DELIVERY tervicwcd in this book who delivered
Early ic your prcgnanry, it is wire to vcnicrlly did not do squ:aiag c:<crcises.
discoss rhc type ofdclivcry envision
wirh pur "ou and to
midwife or obstericien Wr.rAT Do You VANT to happen during
comc to firll agrcemcnt with bcr or him. your 6rst conact with your child?
To 6nd out during dre dclivery thet your Do you want anybody clsc to coqch
opinions abour giving birth don't corrc- &c baby besides you and your parmer?
spond with rheir mucine wou.ld be an un- Do you urant to bathe che babY Your-
plcasanr surprise. If you feel the midwif;7 sclf or would you like your partne! !o do
or doctor should stay in rhe backgtound this? Would you like to grr into che rub
and lervc you ro iniiiaEe cvcnrs, yqu with rhe baby?
should talk rbout this. Both pardes must
be rbsolucely clerr rnd srr.righrforwrrd to
t I W',""- (:;.i-" n;ai
 Wrtical Deliuery

History supported from behind by anorher

HRoucHolrt rHE 'r'orld unril
the eighteenth cenrury, the
vertical dclivery was thc mosc
prevalent way to givc birth.
Thc illustrations thar follow arc rcprcscn-
tations of womcn fiom differcnt culturcs
rnd periods ofhisrory during dclivery. [n-
variably, dre women in lebor is dcpicrcd
in a vcrtical posirion, cidrer squatting, sir-
dng, or standing.
Ancient Egypt provides numerous
t--rpresentatioos ofbirth. The wom.an qsu-
-
lly sat on a primitive birthchair, made
bricls, or kneclcd A drewing after a bas-
relief on thc templc of Esneh (Figuc 1)
shows Cleopatra giving birth on her
knccs.
We come upon similar knceling po-
sitions in Grcco-Roman mydtology- Fig-
urc 2 porcap Leto's childbidl. In order o
woman, while rhe midwife, :s was cus-
omery in thosc days, sis in 6ont of her
rnd with hands under ttre woman's skirts
"blindly" performs the dclivery, (Roslin,
Eucharius. Det swatgcrn Fruuwcn und
Hebammcn Rotega cn [The Prclnenr
Womcn's end Midwife's Roscgardcn].
1513.) Somedrner the birthchair was rc-
pleced by dre "living birthchair," and the
leboriag wornm would sit on the mid-
wifet lap for r "lap delivery."
Figu!. 2
of hbor with "one knee rcsting on thc
of soft gres," shc gave birdr to cwiru, Arcmit-
and Apollo.
Represenarions of venicd delivcricl
&om the Middlc Ages show rhar r low

FiguF I
birthchair was uscd, Thc mid,wifc set in
front of the womrn on a small stool.
Helpcrs, on cithcr sidc or bchind, sup-
portcd the woman giving birrh. Birth-
Figure 1 Figiu$ 4
chairs ranged from hendsomely dcconted
dcliver, Lero had to flee ro rhe island of pieces such as Figure 3 (Moincr, Paul. Figurc 5 shows a Sious delivery, The
Delos bccau:c shc was chased by chejeal- "L'6nigme
de la Papesse Jeanne l' .Emiape woman, supponed by hcr parmer, scandt
ous Hcra. (Lero was expecting ,r baby by
fJanuary 19291: 320.) to simple woodin ro deliwr, and drc midwiG sis bchind her
Zeus, Hera! ,pous. ,rnd rh-c sl'lp..rrre chairs rhat wcte owncd by the commuoi- co carch thc child. (Witkowski, G. Hisain
dciry) Leco could bc dclivercd only ty end lent out for dclivcrics. Figure 4 dq Amrchements dc Tirrt lrr ftrrphs fWodd
,Greek
che hclp ofthe birth goddess Eilci-
n shows:t Rcnaissance delivcry on such r History of Giving Birthl. P.rris, lfitlT.)
is oftcn depictel giving birth irr An lbundance ofbirrh sccncr show-
\ ". *- poririon. birthchuir.
,rKnccling After nine long days The wornun in lrbor sis bolt upright, irtg deliverics in ..r virriery oi vcrticrl po-

lL
 Lrbour in Centrrl Africt!' Edi uryh Mad.
icrrl../orrar,rl [April t884].)
FRoM VERTTcAL To
HoRTzoNTAL
[n the scvcntecnth rnd eightccnth
centurics, opinions rbout how to deliver
began to divergs from the spontaneous
verricrl positiooi that hrd rlways been
used- Europe flourished economically. and
the incrcascd weahh qlvc e boost to eL
lication of ?rcia dcsMaladies dcs Femmts
Grcssu et tk ccllzs qui sotrt trouwlle ent e'
Figur 5 6c change 6om lhc verticd to
sitions comcs &om Robcrc Fclkin's late
nineteenth ccntury rqPort' "Notcs on
Labour in Centnl A.&ica." ln Figurc 6, a
woman in hbor sis on 1 trec trunl by the
A' .idc. Bysqnders maks music to evcn
( \ ,:iris. Figurc 7 strows a deli'rcry in a
t"-'fng posirioq a helpcr a'certs consider-
-r1"'p.""t,ro. on dre woman's body 6om
behind. Figucs 8 and 9 prove tha.t stand-
ing duling dcli'/cry wus pncticed in A6ica
as well. (Felkia, Robert Wi."Notes on
Figurc 8
ouclrccs f!rcatise on thc Disc2ses Affcst-
ing Women During and Post Femrm] in
1668 by drc French obcrctrician Fnngois
Meuriceau in which thc anatoury arrd
physiology of Fmdc Epoductivs organs
were dccribcd in detr,il. Solutionr wtrc
sought ro hclp women drrough diEcult
labors rnd to rcducc rraternal end infent
deeth ratcs. At thc cnd ofdre ssvcntcndt
ob-
dirionel birdrctrair. Evidcndy, ince,ncntiors
lu.h - it cxternd rotstion of
to"al
"nd
the baby, rtmovrl ofa dcad fctus, an4 lat-
cr, thc appliction of forccps could bc
donc most e6ectiwly whcn a wornan was
lying on her bock. Naturrlly, lhcsc mcr-
surts wcte applicd only in pn:blerruric de-
Figu.! 6 & 7 liverics.
Over cinre, howcwr, evcn uncompli-
carcd detiveries torrk phce in a supine po-
rition. The fccrl srechoscope, used to listgn
to fetal heart toncs, was invcntcd rround
ttls0. Wirh this instrument, che baby\
hearr roncs can be heard best when che -
mother is lying on hcr back becruse lhere
is less movemenr.-tvlo$..nd.rnoq oftenr/
e"cn durinr normal dcliveries. che ert-
born in ordcr to intervene if 4cccssaqr
Fctal heart toncs were checkcd Ecqucndy
during d:c dclivcry mehing ic esscnrid fot
rhc woman to bc supine. In this way' with
en advance in tcchnology; albeit en in-
vcntion ofincalculable ralue, cven women
whosc h$ors progrcssed wi&out problems
werc delivcrcd ia a horizonal positioa-
Thc inveqtion ofdtc 6tal stcthoscoPe
expleias
-the
supinc+osirion6r dcliverics widrout
coriplications much mgrc pleusib.lv thalr
blhcr theoriG conccrning thls obstetrlc
-delelopsrcnt. ofdrc icxu-
such as *!c cab
ally perversc Louis Xw or dre cxpbna-
don *nt womcn harrc bcen "put ou *rcir
-!iEii-!nisraA*"..."-.;;;;;;
rics mcrely to Eqilitete dr obstecician!
job. The srory about Louis XIV cbirtr
rhar hc derivqd scxurl gntiEcetion by
wat&ing 6om beldnd I curtain rs his mis-
tcsses gzlrc birdr. If drcc women hed dc-
livcred fully dresscd on a
birthchair, he would have
. seenvcry littlc. To
cnsure that drc king
would hryc rnorr
oPPortuniry ro
obscrve,
 thc eoutt phvsicilrrr supposerJlv convincctl nkc rirne firr socicty u rvcll lrs
rhcsc rvorlcrr thar childbirth woultl be tirr rlrr>sr,. who *J,,. i*
csicr iithcy hid on I mblc. -"' ,:"fr.,|
r-..,,. ,.",-_--,_ - - l
Atttr<:u grr we t ",
A trorr :rcccpt trrc,ror,"- ;':,1,:,illjit.H";:;:i;:*:rX
\:;.r rrici:ur'.,i desirc tirr convcnicnceor to dour- rnrl ,, fr.gi" ,i,,i,ikiug
o",l
inrrc tlte dclivcring womirn ils rlrc rqlsorr wo*ing diifercncly.
t ui.r,..,
dtc srvitch to the supilrc positirrn. dr.
fehirrr-|. p.r,-,1"*r,.1". ,rlol J,r,*
tfu9 ptElqio-qlt-qdg4llrrp:
pnr.spective pirrcnts with rhc full
a,;Ec-9tl-Dcncve
P_c_1tjg_qF_ s9lt!9_o_t-!!$!!og_!L_g$!osgju: supporr of thcir nriclwivcs
or
sistiilg,tttg.llp-tle!-iq-llbo&-in!rc&,r.!!ci!9_ obstcnicians have choscn ro de-
chl@ livcr vcrtically, r posirive indi_
Jgled lo suft clcm. wl cacion of our rcadings ro neurn
work, the womrn docs nor sive ro this trrdiciona.l, locical posr_
birqh-the dqctor dctven hcr of her child tion for giviig
birth. pelvic inle4 and thc baby drrivcs in this
rnq prercnrpty ot her pain rs well. The
supine posirion exaggeraccd che vulncra_
wofd through rhe pelvic outler
biliry ofdre woman giving birdr and pavcd
y' Due to hormond chrnges muo,rt the
thc wey for inrervcnrionary carc, In thc Adoantades of lind of Prtenlnqv. che con..ctivr ri..r,-
^f
United Sates, beginnin'g in rhc mid_ninc_ . Waicalfiaui'y lcndons.end liramcns in and a$und rhe
ccljLoxy, rhis aniru& csulted in dre Srncs of thc pelyi.s rclxes. and the oclvis.
n).ee''fit nornldry r.tigid cubc becomes a dvnr&_
{, po..i"" ofpurdng worncn whose condi_ PttYstotocrc,rL ADVANTAGEs
rc a9d' ncxrbte strucnrrc (Figurc 11).
cions indicated rhry would havc roudne
I
delivcries under generrl ancschesia. Duc Increased Mobility of thc pelvis ,/ During delivery r woman can influ_
4 r/)
' \ to improved hcalth condicioru of uomen cric@
The pclvis, che basc of thc uunk, by chengi;s hcr eosirion. Squ:iaing,-benal
ll\ end developmens ofmcdical scrcncg ma_ consists of four bones rhat arc linked bv ing at the knecs lrd sprcading thc legs out
rernd end in6nc morta.liry ntes dropped
\!\ -t--:,-n-- six ligamcns, or bands ofscong conncc- far enough from rhc hips-rbout
dnsaically. n- -- ,
Docton'succcscs at applpng tivc risuc. This bony circlc rcrts on thc
cighc
inchcs on each ridc, e disnncc rhar comes
.ew medicd techniqucs increascd fiirh in drigh bones.
-
j medicd inrervention and augrrrcntcd trhe lre obsterics, wc speek
nacunlly to I pregn:rn! woman in otder
. ofrhc pclvisto mainain her balencc-nuc Eacdon on
aurhority ofobsteaicirru and their mcdiol
st:6. Unforrunatcly, the edweamgr. drc othcrwisc rcb:red pubic
^F 1. joi!! b.!rt D dr.lowt! brct rad r.cnrm
symphys! end increases che
_Sahryrl delfucrv in r vcrcicd p".irbn fu . 2, r.crollircjoilc1Joinr b..rr.r rb. trclura.nd istn)
women who didn't Jr Jonrl !.4!r\!c! rh. tcrutn .!d coc-yx pubic arch, or space undcr
,3, bip joi.ut
*rc pubic boocs. Bccaurc of
5. pubic ttmprrFi. ooinG b.rwr.o 6. rt'o pubic boE.r)
thc end of*re 1960s, thc Dopplcr this flcxibiliry, rhc pelvic
appamnrs wru invenred. This insEurnenc brim adjusa to rhc baby,s
scnds out ulrrrsonic sigads (high_frc- bead, which briags ebout
qucncy w"vEs thar thc huqun ear caqnot an eerly nrming ofdre head
hezr) ofdre uaborn child's hean aad con_ and prornotcs rotarion in
verts them inro sound so che fcEl heart the birth cand.
rone3 ciur bc heed. With this tcchnolo_ !e eddition, dre racroil- ,/
gy, the feEl heart ones can bc monitored iec joint gives rhe s"c*rn"Y
during or benrrcen conrcrctions whilc the drc bonc forming thc back
women is in any position. Since FiguF l0r wall of rhe pelvis, ccrrein
rh6l fexibiliry. When dre trunk
t fopplcr rppanrus has replaccd thc fenl /
TJrerhoscopc, bend: fonrard, as it does in
no convincing argu*.n, .._ I as consisting of (&om top co bormm) the
'mairs for r normd binh ro rhc squacing position, rhe sacrum urns
o-kc placc in a j upper pelvis (pelvic brim), pelvic inlcq on is rxis anci opens up rhe pclvis from
horizontal posirion - -J and the pelvic ourlcc. The child! hdrd
Naturrlly, crnsirions in sandard ob- bchind, incnrsing thc width ofdrc pelvic
scctric prtcice cannot bc
tt's in rhc uppcr pelvis throughout gw- oudec
cxpecred to oc- trtion, A! rhc cnd ofpegnancy. his or her
overnigtrt. Medical information Figurc 12 illustrares rhrt rs rhc ueDcr
lG .n:,"St
and hcad works ics w:ry down through rhe prrt ofthe sacrum, which is sonnccrcj ro
alone do not descruy a rtecp_
L pncdcc of sevcrrl cennrris. [t will ' Tlt ligun rnd ttlxc ctrrr foltow rrc lirrrn drc ocr- thc lowcr blck. mover firrwlrrcl. the krwr:r
;oo(cd rpsltiw of['o|(t"H (k,wn dm,uxh rhc pdvir rA,,n
slcrurrr is strctchctl blck urrlcss:r pcnl<rrr

Wrticul Dcliwry / s
 pubic synrphysis. Thc result: the pubic dilrtating slightly more wirh citch con-
lrch is not srretched at l. tr.rction s irr Figure 15.

J Thc supin" position (Figurc '14) is I Ovcr rhc cormc ofcervicrl tlilatarion'
Scccr posirion for deliwry rhrn thc scmi- contnctions lengthen irrrd inctease in in-
sitring poiition bccruse the blck rathcr tensity lnd frequcncy. Thc womb be-
rhirn the coccyx is used rs the push-off corncs nrrrowcr during a contraction'
point. tVhcn I woman lies down rnd which rrises thc intrrurerine pressure. The
oulls her knees owrrd hcr chest' thc coc-
cyx is unobsructed and the uPPer Part
ofthe body is bent in a way that incrtas-
es the size of the pelvic opening' The
major dnwback oithe supine delivcry is
Figue 12 that gravity is not uscd ro the woman!
adwantage.

Vlorlbg with GrevttY

During a delivery, severat
forces bring ebout *rc birth of e

breeth in coniunctio
Figute 13

sirs on r hard surface, il which case it is

or,-'
Dtr_ -d
_Clfolw'.rrq rcward the ceatcr of rhe
forward
n ;anal. The coccyx' or tailbone' lo-
\-+d et drc lowpr end of the sacnrm' rc-
irJuds in tike by cither moving back
out of chc waY or Prcsiog furward'
./ tr, ,h. semisitting Posirion
shown in Figua 13' PtEssuF is x-
ertcd in w:Y thar Saaens thc Pelvi:"
a
ffo e:<err scrength in this position'
a
babv! heart rcacs ro tbis prcssurc change'
Fll;*u*
5ffi i"
the waTT
n"pp.oing within1i4111f_:
hcr bodY and Thcn rbc conuaction subsidc and is fol-
lowed bv I brcak. Tbc interrnJ becwcen
o nlly thesc sources of strength' In the
contnctiors is viul bccrusc drc pres-
surc on *rc babY arrd the gleccnte is
-
relicvcd tcmporarily. Of earticular'1
importancc is tbc recovcry of thc \
blood 0ow chrough thc Plrceota' f
which is et is lowest lcvel at dtc Peak)
of a contnction.

@@
lwoman uses rhc cocqrx as a Pusn- The shaPc end Posirion of the
y'off point; thus, the tailbonq is not
uterus during a contracdon-ex-
I able romove ouc of tbc wzy bccause tendcd, tiftcd, end forward-rans-
I of thc councerprersurc produced by forms thc vromb into e continuation
Ithe bcd. In rurn, thi: Pressurc is Figut! 15
of thc pelvic axis so ttrc i.PlO-*'
trurnised o both Pars of 6e Pubic tt" eftctitcty- wfttn
arch, pushiag rhe pubic boncs towzrrd each tlF',d grevity wod<s egirut
a"[*ty, p*ncs
a wom3n
"g"i-a
is in "crvix
thc vcrtical Posluon as
thc ocher forces, but in a vertical dclivery
ot}r"r. Fordrcrmot , whcn sitdng likc dris' graviry docs not
it worls in conjunction with dre rcsr of in
rhown Figure 16,
a woman's thighs usually are noc spread the forward movement ofche
apart far enough to puc tension on che thc birth proces and promoccs thc child! counteract
bir*t. uterus during a contraction'
ln thc semisicing or the suPine Po-
DuRINc CERVICAL DILATATIoN: A con- sition, the uterinc muscles must cxcrt
tracrion moves likc r wave chrough rhe
womb: it incrcascs in srrength' reacnes a
peak, rnd diminishes gndually' While the
ccrvix Lr closed. the force ofconrncdons
is distributcd equ:rlly over the enrire
wrnrb- Durirrg the tint sogc of hboc ccr-
vicll dil:rtetion, cottr.tctions qrusc thc cf-
fecrd ccrvix (Jll PxgEr)) to opelr slowly' Figurc l7
Figu.c 14

6 ti<lrr of clte birch clnul bcntls upwartl..rr
) hcld
Flgure 18
rhemselves lo drc urnost during each con-
araction ro lift the womb againsr th force woman who i: in a vertical positroo
,of gnviry (Figure l7). flrs-rakelgflq_ "ukc r dcep breath, close offrhrcrc, pur
/_"*"y tfu- ".-i""1 aiUillil
1@
mother and child needlesslv.
|(, FF;lttti.rrr6that
woman leans forward as she sits, rhc
womb is r.lready ti.ked slighdy so ao en-
crgy nccds to be diverted &om the con-
traction to move the ucerus to this
position. In this maruer, graviry ncreascs
rhe eFectiveness ofthe contracsioru and
acceleraccs cewicd dilatarion.
f.t R.rNG Tt{E PusHrNG STAGE; The sup-
\orred squattiag posirion i5 somcri.gres
.)nsidcrcd ro bc too &tiguing, if not im-
Figqr. 19
possible, for wesrcrn womcn during
the
pushing scagc. [n our culture, wE slc on
chairs rnd arc noc used ro prolonged
squardng. People in ocher culturcs squar
whcn at rcsr as wcll as when workins.
During pregnancy, ir is advisable to bJ-
comc comfortablc wich the posirion,
)quacing*fhr foorcd wirh back agarnst
'r (Figure l9), sc.rrring wich
,,.t-'-
\:.:- . .mulcs fi a lirnc :rnd building up to
)
rcn to iit'tccn rnirrutr:r-,iitch day is I usc_
rut q.\(.rcBe.
In the verricrl posicion, the tnnsrnorr
t'runt rlihnriort contracti<lus to thc lctull
pushing ruru l nrurc nlnrnl coutrc. Dur-
rurg rnaximurn dilatacion. the babylr
pushcs with gn:atcr lirrcc becauc ofgrlv_
iEy. so the wornurr really feels the urge to
y'ush.. Ttaching thc "pushing cechnique.'
usultlly bccontcs superlluous lince rvQmcn
in rhis position almosr rlwrys san to push
inruidvely during che perk ofa cootrac_
tioo, Thcrc is absolutely no necd to rcll r
co
when a u short a pcriod of timc er five mjnutes
Figue 20
chin on chest" prcGrably rhrce timc dur-
ing a conaection. Uoless coached o oush
difcreatly, the rendincy ofa women dc-
livering supinc is ro :ubsritute making
noiscs &om rhc throes for using thc eb-
dominal musdcs ro move drc baby. push-
7q from the abdomen in r vcrtical
posicioa is morc ef,cctive for rwo reasoru:
fusdy, thc abdomind muscles nced uot
work againsr graviry, and secondly, thc
raoman does nor need o lG up hcr head
This means intra-abdominal and in-
c'rthoracic prcssure' pressurc betrrecn thc
rnodrer's neck end rbdomen, will not risc
as much when she is rrertical so there is
less chance of hindcring hcr circuhtion
one to
Figure 2l
Wrticul Dcliucry / z
or rlr t of lrqr blby. (.5i,c Circulltrr>rr ot,
Morhcr arrrl Qhild, belows.)
Irr the supinc posiri()d, tltc lirrll oor_
shown in Figurc ?(). IJecausc the wonuil\
pr.rshes
rylinst gr.rviry when shs lis dorvn,{
the pelvic tloor antl perineurn. th.
bctween rnus rnd vaginl, becorne "...,r )
rI
"nrounrain" over which she nrusr pushJ
tlre babv
/ Figure 2l illustratcs rhar pushing wirh
grrvity is the line ofleasc resisurncc.
S'RcyrArroN_CF MorH
Nerrly-dl-expeCrancrvomcnGmJEiii-
six monds ofprcgnancy on have e.rpcri_
cnced fceting lighdrcaded, shon ofbrqaih,
and anxious rftcr lying on their backs for
to balf rn hour. !n the supine posirion,
dre hczvy wornb css on thc ioGrior vcna
cava, e large rcin dret rcqrms blood to qhc
hcarq causing a severe drop of venous
blood to thc hean rnd a dccria;e ofoxy-
genaced blood o the aoro- Ukimarely, ar-
tcrial blood prcssurc decreases and the
women feels feint, but dicse symp<oms
disappear whcn she turns onto her side.
Thc hlporcnsion also affecs rhe blood./
fow through rhe placena, which means
the child! orygen supply is insufi.cicnt
when thc mother is supine.
A: mcndoncd previoudy rhe increz:e
of intrauteriae pressulc tt thc pcak ofa
contncion reduces placenal blooci flow
ro its lowest lcvel. The blood f,ow im-
prcvcs betwcen concactions, rnd the childT
can "rccover iE breath" whcn a woman
is uprighr. Dcliveriug in a rrcrtical posi-
tion prwens circub,tion problernr 6r bodr
modcr and child. [n drc supine posicion,
howencr, thc relaxed uctu5 6llr onro the
infcrior vene cava during this recovery
suge. A finrs io prime condition can bcar
quirc a biq u4 in gcnenl. the supine de-
Iivcy docs nor lerd ro infaots born in no-
ticerbly poor condirion. Nevertheless, ic
is not inconccivrblc thlc rhe chilu nuy
sutfer unneccrsrrily during ln cxcended
supinc delivcry.
 helpers turn ittto spcctators around espected rrury ltappen during rhe clelivery
Il*vt:goLo<;lcnL thrt requircr:l wotllan to be tmnsprrrrecl
(1, /ANTA(iES 't v:tgirrlr' which is suddenly Pronounced
to a hospitrl. Lrbor i: interrupted by tlrc
\!-,ff.,. verrictl poririon is the optinul ro be public erritory' Arsisunts nray nor
trip, lnd the wouun rnry tLcl rirsd fronr
,rot only because i! co- sce the whole womln-l
physical rnd
",.,J.r"
*"i,i"lt the contoctiotu and dis.rppointed thlt the
;".;;: ;ld.' " woman'.s physiology and enrotioni bring-when the woman she is sr'rpine'
giv- delivery b-not going ru plarured. A womarr
;:;;;;:; -*;, p".."b".""'"-of th" hr I venicrl delivery
nee& to grthcr her sttngh rt such r 1no-
birth dirccs the process md i5 activc
i.rioJ.ltti,"".:. n hu on her emotiond ing ment. Thc end is in sight' and thre is
i.'.r.'ri r".rr_u"i"g. when i wonirn phvsicdly rnd mentally. "Bystanden" bc-
comforc in knowing that r portion of rhe
jiil ;; i.ri*''-1ii ot r"*r *i*' T"" P.rT* *-!o, asisr hcr in her eEors'
"t '*
J,il":gr"grl''6,1*.".:"":ff:[:ililffi delivery took phce in her own environ-

she is their socnl equal. )ne ren HffiTiltrTffi lln ment. Her contcntmcnt with fie deliv-
cry should not dcpend upon whethcr the
around much les dcpcndcnt on iruauctioru &om
concrcr wich what is happening birth followcd I narural counc, but rarhcr
con- ochcrs' This bqoss hcr sclf-confidencc and
her and crn indicarc her desires, can with hcr unon the knowlcdge that she did cvery-
ne:c enables her.to deliver her child
; ;;"' or can waic quiedy for thc ,hir,g -i hitt htt powcr co bring chc de-
Own Strengtll'
COnFaCllOn' livcry to r hrppy and safc end, whercver
Another prychologicd bencdt sfde- end however rook plecc ln addition'
it
livcring upright is that shc is fa{niliar wi*r thc eadition of homc dclivcry has had r

ffi Vertical Delioery in Practice

DELIvERING Brtren:
oositivc influence on hospital obstetric
carc. In hospieJs in Holland, unlikc coun-
triss wherc toutinc deliverics takc placc
THE DUTCH SYSTEM in hospiub, a woman's individualiry is rc-
Historically, the Dutch havc prefcrrcd spccted-
6*ifi tft-"rt""g, feces gener:ll; leave
nrturrl birth, and midwivcs rnd obscetri-
the body, and, noc surprisrngty' most
ci:rs heve gone to the womaal homc 6r TO BE PREGNANT trS TO BE A
d ecn arc humiliacd m heve bystandcrs'
ttr-gFa' prescsn during this in- the delivcry. A priocipd componcut of Lrrrrs Btr HsetrHttF.
\".7"cirlty
' -L",. obrtcqic q:rc is the matcmiry nursc' who
She may experience feeling Thc saYing "PrcgnencY is a healthY
"ar. carcs for motbcr aad child in their home
diseasc" gives thc frlse impression rhar e
for tcn &ys after delivery. In most of dre
prcgnant wornrn is ill' whcn" ir facq shc i5
rcst of thc Wcrcrn worl4 woocn arc dis-
couraged from delivering et hornc' In slichdy morr healthy than a nouprcgnent
some satcs in thc United Stetcs' givhg
*iman. Dotittg Pregnancy' the body
birth at homc is cven illcgal. functions optimrlly, but being prcgnent
' takcs exrra cnerry, encrry the ctrild uses
The Dutch traditioo of bomc deliv-
cry is rnede posiblc by a uniSue md cyt to devcloP end grow. A woman! bodY
mekcs hcr awarc of rhis early in thc
preg-
tcasive grcntrl carc sysrm for rll womerl
This systcm proteca thc hcaldry women nency. Fetigue is one of sbc most com-
6om uruccasary rncdical intqrrrcntion' mon comphints mong exPsctant uiolrctr.
Ar tong shc listcns to thc signels
es
Midwivcs scrcc{r wontcn carefuily during
Dresnancy, and those women who risk 6om hcr body' woman can cononue lo
3

tuirrg co*plic"tions (epproximatcly 30 have an active life during prcgnancy' She

ofsheme and lonclines, and thc attcmpt
o suppress thcse cmotioru can disturb her
s.lf-confidence. By squatting and bend-
ing slightly forw'ard' she doca not fccl as
vulncrrble becausc she is less cxposcd'
./ Ciuing birth in the suPrne Posrson
makcs wonren fcel prsirrc :rnd help-
--oFen
F, r sornctitnes conrprrcd with
\-re
sen"sadon
hclplersne+r of I becdc otr its back' An
.lnh"r"u,,l"ng", otirhc supine positit>rr is
tlr:rt l wotll:rtt is rc'dtrccrl to thc "Qbjcct"
tiortt wltich,r chil.l is.lclivcrccl' Thc
oercent) arc rcfcrrcd ro en obscetrician should treat hersclf to cxcra rest end to
nutritious mcak' tfshe does noq rhe will
Ld m,rst dcli"er in a well-cquipped hos-
oical All odrcr utomen. the majoriry, havc not fccl wcll. In addition to having a
healthy lifestyle. being wetl informed
the choicc of delivering at homc or rn a
hospital. abouc what luppens during Pregnrdcy,
and especiirlly during labor rnci delivery
Sincc most disorden can bc dfugnoced
during prenrtal care' and hospial deliver- is importanr. IssP4sgPP:!ry.==
rqgluli.gslgc-llhisll4lsllsi
ies phnncd in rdvrncc for wotnen rvhose sion,
sinr:rtiors mlkc thenr trrorc likely to need @.se4*::i::!sr$-e$:-
boort thcir cttlltidetlce' wot.rlcn
intcrvetrtion, ihc sncccss of hortle deliv- 5i"th. To
crics on bc prt'dictcd rvith ,t hiuh tlegrrc fi
rcld books ort chi[lt'elrirrg ln'l lr-
prcgttlltcv courrcx rvlterc tlrcy will
of certlirrry. Noncthelcss. s.lrrlcthitrt: rrrt- rcud'
 co|lrc i|lto (otltxct wi!h othcr prL'{:Itnt
wo|llcrr. E.\(hiulqitr$ q)iPerisndqx ilnd iD- r,hr rxrr cirusc ccwicd dilxtilti(n but nrv hl
,.!' .Ilxd(nl glvlri.l wotllilll rcirjisurxrrcc. Shc che coune, of rinrq trsher in tlilurarion con-
fl -.-.n.,1,1 scrt.ch ti)r l cl:tss thrt hclps hcr tnctiur$. or nrxy subside, dislpperring en-
\:rcly hcrscl[ tirr the rype of tlclivery she circlv. ;ind rhe dclivery rnil rrot occur fbr
.rlsircs. ln thcse counls. shc rvill have the lnorhcr weck or so.
opporrunitv ro beconrc farniliirr wirlr
squrcriug, brmthing, rnd rchxation rcch-
niqurs: horvcvcr. l wouun shouid ncvcr
fccl thrc she crnnot dcliver without tint
"being trrincd."
PREcoNTRAcrloNs
Thc cervix is formcd of saong, rough
dsue, comparable to che tissue at the cip of
rhe nose. This tissuc keeps chc womb
closed righdy during psrrdon so is con-
tcnrs will not bc cxpelled prcmaturely.
Duc o hormonal changcs rnd ro prccon-
erctions, dre spout-shaped cervi.< softens
and becomes supplc, allowing ir to change
shage dowly. This proccss, called efface-
mcnt often begir:s during the find weeks
of prcgnancy and prcparcs the ccrvix for
/"'oaoo'
F{ Preconcractions arc minor, irrcgular
tqnc'actions of *re utcrus. Somcdmes p!E-
haactiors art crllcd "Else labor," 1 cerm
fiar can be discouraging 6r womenand ir
also raisleading sincc rhcy do have some
e6ecr on cfraccment. Otdinarily, precon-
tracsions can bc distinguished easily 6om
Eraxton-Hicks codtracrions, or thc so-
celled hard stomach, which arc painless
and sEcngthcn rhe utcrinc musclc for
dclivcry.
y' Worncri ptegn2rrt for ttre 6rst time of-
freo 6ad ir hard to disringuirh bcrwccn
ll prcconElcEions rnd contrectiors o[ cer-
fvical dilatation. A prccontracrion lasts
I lbour chirry scconds, and succcsive con-
I trJcrions do not incrcase in intcnsiry;
i \\'hereai canrrncdons of ccrvical dilararion
iincrcrse in length, unril at the end of di-
i
lrracion !hq/ lrsr e minute o a minuce irnd
;t half, ond as the dilaration progrcsses, the
\conEracEions becomc sfirnger rnd succced
t$ne
anothcr moru noidlv.-
7. '- is importan, lbr a *o,r,l.r.., o.
(j .rfrhc difrercnccs bcrween precon-
--$ons rnd concmcrions of ccrvicll di_
,fion. Precontnctions do noc llwrys
.trlrrtuncc the bcuirrrring of rlelivcW; tltc-v will hcr to scc ifdrc urtrbilicrl
'.xtnlirrc
corcl pnrhpscd rvherr rhc unuiocic tluid
leli tlrc vtgiur. A pnrlapscd conl ii I crrrr-
genlrs situ:rtiorr ud. fbrtunlrcly, docs nos
rxcsr olicrr. Anodtcr relson ftlr .r wonuu
to crll her uridrvit! irnrnc<liutely h if thc
rmniotic tluid is grcen or brown rarher
rhan clclr, This rrrerns rhe child har been
How DoEs LA Bo t\
or still is short ofo-xygen, cauring him or
ANN()uNcE [TsELF?
hcr to dcfccatc into the fluid. The mid-
Within the utcrus, rhe r:hild livcs in wife will come right away ro check tne
r kind of brlloon called che amnioric baby! heart tones.
mernbranss. Thgse rwo rransluccnc clas- Whcn a womani waters break and
tic mcmbranes hold abour a liter of rm- rhe rmniocic fluid is clear rnd rhc head
niocic fluid ar che end of prcgnancy. The has descended proped shc should glance
fluid and membrancs form a buffer for *re at chc clock and nore the time the mcm-
fetus. During pregnancy, rhc ccrvix is branes rupcurcd, then cry ro go back rc
closed ofby a ough plug ofmucous; chis slcep. She can wair unril morning ro tell
mucous plug and thc amniotic membnnes shc midwifc what happencd during rhe
prcrect fic fctus against in6ction 6om drc night.
ouside world The mucous plug bccomcs Once drc membranes have rupured.
liquidy at thc cnd of pregnancy. As ef- the utcrinc cnvironmenc is open to the
faccrrrcnt occurs, the plug leaves rhe body outsidc and infeccion is possiblc. Good
dong wi*r a snr.all amount of blood. This hygicnc is neccssery. Thc woman should
occurrence is called rhe "showi' Thc dis- rc6-r,in &om uking a badr unril ccrvicd
chergc, which in mosr womcn lcaves rhe dilaadon is in progcs1 altbough a show-
vegine r drcp rt r rimq emotmts to so lft- cr ar this poinr is 6ne, aad she should pirt
dc rhat it can somerirncs go unaoriced. nothing into her v'egina. Gencrally, chc
Although in most qscs hbor sarts with child will bc born wirhin rwcnry-four
dilaatiou conrections or with a show, ap- hours oF *re weten brcaking. If not, drc
proximetely 10 pcrcenr of thc time ir be- woman mry need to be admitted ro e
gins with the rupturc .of thc emniotic hospid bccausc thc chance ofinfcqoon
mcmbrrnes, or drc warcrs brealing, which incrcrscs. At rhe hospital. coarraction-
usudly happers at nighr. Occasiond\; the stimuleting hormones will bc adminis-
emniotic mcmbrancs do not ruptule on tcrcd to speed up drc delivcry.
their own and musc bc broken by tbc >, -:
-i.i*'i'. o, obfiiilI;iiffiii; :
:_ ^ -.. ^ DILATATIoN
@
during drc purhing.
zuERvtcAL
Wher giving birrh, a woman literally
Nerr thc ead of prcgnency, ir is im- and frguratively "operu up." During ccr-
portant for the midwiG to monitor the vical dihrrtioq rhe hormone oxyrocin is
position ofrhc child! head. Ifthc head is sccrcrc4 which causcs thc uccrlui ro con-
high in dre pelvis when labor begiru, thcrc rrac powcrfully. Changes ovcr which a
is a possibiliry ofurnbilical cord prolapse, woman hzs ao.control take placc wichin
or thc cord lying low in rhc pelvis. tn dris her body. !!-3g.39gp!g"d . nlilrgrng
poririon. the cord-thc child's source of mrny rspics ofour lives. so s,rrrenderinc
osygen-rnry be comprcssed or blocked rc rhe birth p.oc.rs A
completely lts the conrracdons force chc woman must rcrnembcr rhrr hcr body is
head downward. [f:rr rhc womlni prcvi- designcd for childbinh rd c:rn hrndlc rhc
ous checkup the heed hld not yet dc- pain thrt goes llong wirlr ir. When she.
sc'ended pn:perly into the prelvic brinr.she tighcs thegrirr. hcr rr.ljnrl blo!.!s rhe bocly'r
shor.rU cdl trer nridwifi inurrcttirrely th" nich*i*,111 Or,.-liJiiiffi
ruolrcrr! her w:rreni brclk. Thc ruidrvitl-.1opi,rg
rcsircing the physir.ll rcus.rriols, shr., crr-
Wrtic, f) iw,n I " I
 rcci slowly itlto x strlc of|rlind thlt lliows During dre conrncliotl\ urd rlre irc- gucsn lrrr.l shoul,l lrftrpt rhernsclvcr to hcr
t irstitrcts to takc ovcr' Thc key is to tull r,lclivery, choosing r position thlt is envinrrrrrcnt. Tlrc pn:scrrce ofl tiicrrd or
' lepc the p;rin lrs it cotrtcs lncl to lrust ronlly sildsryinq thc motnent-wficthct rslllivc clrr givc her a sense ofsccurity
r(ar it rvill dissiplte.@.S9tlglir: it be squ*dng, kneeling, strnding, walk- rnd help distrrct hcr t'ronr rhc pirin. Bgr
_tory ir nrav *ound. wclcorning dlscon{brt ing, or lying down-is of uutrost irnpor- if at ilry poinr during thc birth r womur
r,rther chln cursing ir gives r wonrn the tance. During cervical dilltrtion, wc prefen ro luw nrorc priuacy, she must tlel
qnd.strcngth to go on. ln encguBec.yomen to rr:.rrr"c positiogcd tice ro.uk_gucss co lcrve. lfthc possibili-
Iclt:coutidc.nce
iadiriorr, when shc is not tensc hcr body Jgrlgdly. [f r woman lies down during
acutBo|l, ry of rhis hrppening hls bcen discussed
p1gClcgt-mo -hgltrgq9lldlr4 cootrrctions, she will nor feel inclined to ahead of time, those rttending will un-
gndglphigl- This nan-rral painkiller alten a change her position because shc is stiff, derscrnd rnd will be happy to accommo-
woman's coq;-g-iqul4gqduring labor and and shc must bq persuaded ro get into l date her wishes.
delivery lecring !91 b. op"El9-lrhft-lerg vcnicd posicion at thc bcginning ofpush-
ing. Oncc ahc squ3ts, however, she will A woMAN's sexsu of bcing the dircctor,z
-- binh
In ordcr to rclax during the bc struck by the sirnple logic aad com- ofher own dclivery can bc disturbcd euY
process, which enablcs hcr body to pro- fort of this position- How omlormbh znd. ily. Onc of che midwife's tasks is !o pre-
ducc oxytocin and endorphiru, a wouun What a rclief s whzt we oftcs hcar. vcnr anyrhirig from interfering with a
needs warmth, rhc comfort of familiar A woman rrust keep in mind thet shc woman's emocional and physicd sates. A
fatcs surrounding hcr, and &ecdom to is giving birEh to hcr baby with her own dclivcry will go morq smoothly in pcace-
move. As soon as chc contrrccion5 have sccngth, and thc pcople arcund her ale ful surrounding- Anirnels search 6r a shcl-
begun, she shoold mate sure she ir rrrlrm- ttrcrc to assisq thc midwiG and odren tc tcrcd place in which to girc birdl; womcn
Therc is some truth in the Dutch srying, have r similar ncst-making urge. When
"A cold woman does not ddiver"' Turn- en anirnd is bcaring young, ihe concrac-
ing up rhc heat and Pucitg on a sweatcr tiors cersc ifshc hes to flce, Thc coneac-
Whetr to Call tbe MiduiJe
and rhick socks wi.ll help specd up hcr /\l -." tioru do not resurnc until peace has becn
light around
or wastetflcnn rcstocd and it is safc for her to have her
d 'gress. Doing chores tbe
$...r*. during early dilatation, whcn thc EVERY woMAN R.E icfs to tbe o ct liner. Thc human body rcacs much dre
' ;Conmction: rrc rcletivcly weak, distracs of diLaerion contractioru in hcr own surag way. Whcn e woman il ill ac easc ot
hcr so shc wotl't st4le lt the clock as she wry, Some womcn prcfer to hold oF ber concentration is disrupced. thc con-
weis for hcr ncxt cooe ctio!. She should nocifying dre midwifc or doctor and oastiom become less intcEc and rruy elen
allow henclftinre to get used to the con- Jo shaF cady coEEacdoss with only a stop. Bcing terse, eFeid, or cold stirau-
bcforc cdling the fricnds end parmcr. Others fecl more sccurc if lercs thc rclease ofadreqdinc, a hormonc
' tracrioru
.

&.nily she has asked to atrcnd tbc delivery.
Some womcn may want to call ttrc mid-
wift or doctor imrncdiercly qPon dtc on-
ser of contncdons, while ochen choose
to wait awhile. Most likely, rhc midwife
' will gcrform a vaginal ocamination wbcn * her arnniotis fluid has a grccu or
she errives. Shc will fccl how soft thc
celvix h.s bccomc, to what cxteat
cewix hes opcned, and how far dre brby!
hcad has desccnded. Ttis procedurc can
be donc easily when the woman sirs on
a birthcheir, dnd in thi5 posirion, thc cx-
aminadon is less uncomforEblc becausc
rhe perineum is rchxed and che regina is
morc opcn. After scverrl hours of con-
tracrions, a womrn may be buming with
_.-c'riosicy to know how t'lrr dilatation has
(: rcsscd; the rnidwitt nr:ry be cqually
\urious bur rcluctant so chcck v-rsinallv
' u!dL{h<,&qJil{-ir-urEgs\{f _b9g*Es_glgh_
cs;rrnirurtion iocrclscs rhc chlncc ofirt-
rccll()ll.
thcy call for mcdical advice right
A woman should cdl for essis-
. taacc immediately in the following
ququttulatc6:
blown iilge;
the *hcr wrcss brcak ard dc baby's hcad
hed not dcsccnded propcdy at
her previous checkup;
a shc loses e corsider:ble rmount of
blood (saurarcs two saniury nap-
kins widrin rcn minutes): or
<shc fcels rnxious.
Ifnonc ofdre abovc applics, thc
crn wait to call hcr midwit'e or ob-
sretrician undl the contrecrions in-
rensif. llnd occur evcrv lhree to hve
.-minuces for h:rlf ln hotlr.
thar readys tbe body to defcnd itself.
Adrcneline countcrlcts oxycocin, andrz
rhercby rcduccs the effectivenqss of dre
contnclions. Conscquencly, dclivery is
prolonged needlessly, posing edditional
risk for morhcr and chnd. Di:ru1!arrc6,
which rt odre! aim6 would bc considctrd
inconscoucntid crrcng.-, wrooc word. a /
r:::::
lougn bucn. 1_!99!!egglggg!lP:9!_
@
woman drring contnctioru. An uncom-
forable position or a ringing phone can
cause irritation when shc is crying co givc
in what is happening in her body' Sim-
co
ple steps, such u closing the currains rnd
unptugging thc phone, cirn Prcvcnc Po-
tencial disruptions.
Most olicrt. r wottutn's hotrte is where
she'll Gel nro*t corrttirrcablc rvhcn givirrg
birch: howcvcr. sottre wortrcn tlcl slti'r
rrtd ntoni c(nntitfi:rlrlc clclivc'rirrg irt I lros-
pitll. lt:r worttirtr Prcfi'rs to lt:rvc hcr bxby
 bn,rthirg p:rttcrn to wlrich shc cao cling nraking it crsier for her to surrcnde.r t<l
' Vrtical Delioery
duriuq l contnrctiorr, Shc rhould brcrhc
l nunner dut corrcs nlnrmlly to her, as
itr
the linrl, nrost diflicult contractions of
ccrvicll dilirntion. [n r brrhtub. shc cln
at . " I
{ - '
tn a trlosDttal cxrtglrcnting hcr brc:rching by irrhaling or lie full-lcngh on her bitck or on hcr sidc,
,
'H()st'[f l,S H()US|: MANY
...
n:slucnt Uirc-
exhllhrg too rlccply might cluse hsr to letting her rrms lnd legs florr. lrr rhc
lrypervenrihre. shower, r womrn may wrnt to ii! on l
rri:r. llccrusc :r womln is in l frrreigr
srool lnd have her feet rcscing in a fooc-
cnvinrntttent. her body h:rs not hrrl I
Posm<>N.s;_ Ccrtrin posirions, which rrc barh.
chlncc to build up rcsisrance to thcsc
crlled lcrive positions, makc concrrctions
ofinllction. Thc dc-
pgicnd:rl sourccs
crsier :rnd morc effecdve. During ttre ini-
livery room noor E Probably not hy- PUSHTNG
tial contractions, urany women feel in-
gienic becruse so many pcople move
clined to w'rlk. As dilaocion procqeds, we The nexr phasc, thc pushing, begins
in and oltt of thc room during the
rccommend rhit womcn reduce mgvc- wirh chc pushing urge, which women de-
birth. Thercfore, thc hospital floor is
mcnr rnd assumc rn active posicion be- scribe a! en irresistible urge to bcrr down.
ursuitrble for vetical delivcries, and it
is neccsary to use r smdl pladorm to
causc mo much musclc activiry stirnuhtes lVomcn oftert say they 6il they can 6nal-
adrenaline, which can prolong delivry. ly coirtributc acdvely to the birth when
providc a sanitary foundation for dte
The posirions illustrrted herc usist thc pushing bcgins. After hours of dealing
birchchair. Only the woman end hcr
wqomb in ics movements end improvc with cervicd dihation, pwhing comcs as
partrlcr gP onto thc Platrorm, and thc
blood 6ow through rhc pleccnca as wcll a relicf. But pushing also means hard
midwifc or doccor sits in front of
as being soothing for *rc woman during work. A woman may ger discouraged if
chem.
labor. thcre is no visible progrcss aftcr half an

in a hospital or has a medicd condirion

MASsAGE: Massaging the lower beck,
rhrc ,equir=s hcr o do so, shc should stuay
ffi aid" J"rJ p.i" arid, tcnsion. Wbat to Do If the aild
rhe hospital's rcgulatioru so she can fol- Sometimcs cxerting sccady prcssure in
her wishes widrin thosc liorications. drose arces abo briags rclief. Arriou Before tbe Midwit'e
n a\1 ..,.
( \ -nc horpite.ls allow a woman to 'anlk in or \)bsletnc@fl
*') corridon or ro nke shower du- Thc prcssurc 6orn
-a.hotmay wish !o ^+ol'yffR
.,tg Ehe conffaclions. She !o-q+
thc baby's hcad and shoulden in thc birth
SoMETIMES A cHILD's birth literelly
akes e modrcr by surprisc. Aldrough
bring e rable lamp 6om home in case thc canal ao.d the sacrching of ligaments of
births so suddcn occur quire inftc-
bright ovcrhcad lighting bothen her. thc uterus cause discomfort in chc lower quenrly, multipar6u! women run a
bacic and stomach. Plecing a hot-wercr
highir risk ofbeing utprcpard than
botdc on the sorc ererr can hclp tremen-
C o plNG wlTH do first-timc mothers. [n the rarc
doudY'
coNTRAcrroNa evenr a woman! ddivery progresses
chis quickly, there is linlc causc for
Thc inrcnsc physicd and emotional Warm wecer rchxes
'the womn alerm es such dcliveric usually pro-
erpericuce of working hard so dcliver e '$ggg4&g&E4q!1l
in hbor, incrcases che cffect cecd smootbly.
child ccmqns rhc de benvecn mothcr and of concactions, and rc[eves pain. Most 'Whea a womao fcels chat hcr
infant To eliminarc physical sensarion of- women enjoy having conrr3crions in
ren has an dienadng cfcct on the woman
baby is determincd to errive, she
wzrm weter buf prcfer to leave thc rub
rnd her baby. Necdless to say,. rhe usc of should push geady: Once drc infanr
or shower duriirg rhe pushing srage. A is born, hjs or her mourh and nose
.tncsrhcticr is indispensablc in some sirua-
w:rm bath can bc a very cffective w"v to shou.ld be cleand crrcfully, ifneces-
tiorrs, but rhe majoriry ofwomcn do not spccd ug ccrvical dilaterion.
In facr, di- sary, and then the baby should bc laid
require medical intervcntion. Givin! birth latation
advanccs so quickly chat uncx-
can bc morc fulfilling when naurral mech- pccted undcrwrter on is sidc so mucous can dnin &om
dcliverics havc his or her mouth. It is imporrrnc rhar
ods such er the following are used for cop- occurrcd (see tnfluence ofWrer, page 45). the newbom be kep( w!rm. ivelr rlr.
rng with lhe
Pa.in. When r woman's contr.rcrions arc in full Empa to clt tlg umbilicdl cord. This crn
wair uncil che doctor or midrvifc rr-
when r wqman hords her :ufft"l.':ll'"1TL:1.",'1,1,:i,t:
E$E4,r!Tgr rives. [fthc cord is cu( by somcon<
t, '. sne may experiencc temporxry womanls waters have brcken but dilata-
\-. wichouc experience, thc dlnger oiirr-
Brerching regrrhrly hctps
,.p,.tg ,n:,"-19
h.. i.ri-f,I *lIEi[ .l1 ."r, ,"k. " tlcrion is greirt.
senseuions of dilasr- showcr buc should nor sir in ":r barh-) Wr-
...,.1':,jn
u\,rr. Jnc wrtl tttaln hcr own p:rrricuhr tcr
rn:rkcs:t wonr:rn ticl ther lnd lightcr,
 ht>ur rrf pullritrg and nl:ry worry chllc her
, 'qinit is t(xt tlrrrow fbr che blby ro cvcr
( !flnce kr drc yrgin:t. Worncn find thc helt
,.,rrre out' At suclr r momcnt,
visudizing
\-l r)" b,rby'.s herd grinirrg way down the
binh cau:rl with erch contraction can bc
hclPtirt.
A wornan may Gel persistcnt pain duc
ro the pressure of the hcad on the Pclvic
floor rnd the wrll ofthc vagina' Tremen-
dous pressurc builds up in dre pelvic floor
thc v-.gina lnd 1nu5, to bc rehxed, rnd
squaaing pmduces such rclr)cadon. KecP
ing the pcrincum warm so the
bccomc plienr rebxcs il evcn mors- Be-
nveen diletadon conu:-rctionr or during
P.lvic doot .tru.dcr victld 6otn .bo!T
muscles bceusc thc beby's head slowly
strrtches thcln ald evcnlrally pushcs thcm
qas-
. zsidc. The less tensc musclcs alp, tbe
. i-r thry arc sEctchcd rud dre lcss pain is
A :. When squetting, the gluteus max-
t..nq r crusclc il dc buoocls, ir smrched
/e*ay &om the body. Squetting dlows
morc sPacc eround the levator eni, the
rnosr imporent muscle ofdre pclvic floor,
which stretches rcadily in this posirion.
Pdvic f,oot tn|t!.lc. vicwld &ortt bclc*
As disctrsed prcviously, the birsh cand is at
is widcst whcn a womrn is in a squaning
rt
posirion, rhd cvery millirneter couns
this point A woman may wanr to changg
her positic o during rhe pushing, r.ltcrnat-
ing berween
Besidcs offering somc
., iery switching positioor improves che
(: rd flow to her lowcr body. Anorhcr
\,6otion is thc birthch;rir.
During thc pushing, it is rlso inrpor-
rant for tltc gctittcttttt. thc:rrc:l bclwccn
thc ptrshing, ir wirrttt. wc! clotlr can bc
pnsscd rglirtst the pcrineun't ltnd thc ctr-
soothiug. TIrs tnidwifc can judge how firr
thc hcrd lus dcscended into the birth
crnal by how rnrrch thc perineurn bulS*;
r.! thc hrd conres down, it is nccessrrry
for hcr to hrve r good vicw of the per-
ineurrr. By placing :r minor under the per-
ineum, she can monitor thc vaginrl
enuincc r:i it is pushed open slowly. The
woman .rnd her parner can also follow
the developmenl! in chc rnirror'
When a woman is suPine, rhe babY's
wcight pushc on the brck ponion ofthe
pcrineum. Consequcndy, exccssivc prcs-
muscles sue builds up in drc and rcgion. In e ver-
rical position, the baby's wcight shifts
foru.erd in *rc ditction bfdrc pubic arch;
T'beBittbcbair
A woMAN wHo eusnrs much longcr than rcn minutcs uay find shc requircs
morc supporr dun tlnt which hcr parmcr can providc' Thc edditional.suppon
of
tbc birthihair is especially helpful foi 'romen dclivering tbeir 6rst child' during
which ttre pushing gencrzlly talscs longer rhan wirh sub'scquect dcliveries'
.ftttrougtr birGheirs in onc form or :nothcr have bcen uscd drroughout
history (se iistory pege 3), in the recent prg a undl buckct-w1 ycd
to suppon
birdrchrn is eraihble to
rh" ,",om"o ,r,hilc she squamd- Now e specidy dcsigncd
ftom material that cen be
faciliratc *re position. birthchairs are manufactured
c"sily cleancd, and a steinles ircel pan wirh a scalc reading to cerch and
measurc
blood and mniotic Suid slips into ttrc bottom of thc cbeir's base- In ordcr to
preveoc rcstriction ofpelvic dgr,unics, thc chair is loa' rnd sheped likc a horscshoc'
ih. ogp.t .htfu arrd ouccr pordon ofe woman! bottom resc on the lip ofthe
bi!&ci;. Exc-ellent suppon is grovided' which reduccs dre problcm of the lca
getting soc or felling aslecp, while et dte seme time drc trilbore rnd Pcrincun
rc-
i,.ir.irr.oo6o.d. ihc o,oman brs considerablc &eedom of movcmcnt' Thc
ctnir har no beck end no leg- or ermrtss' so no Paltiqqhr Position is imposcd on
hcr' sup-
dre vroman rs shc sis. The 'rdjrstrblc baclsJ' hct percncr who sis bchind
pors hcr ls she wishcs. The prrmct! head is close to thc woman's' rqaking it
casy for talking. This intimacy crc-
atcs e sease ofsccuriry. Beni'esn con'
oactioru, stre en lern back rnd rrst in
her percnerls ar[E o! can ge! uP to
itrqtch hcr legs or can lower herself
Eom the chair and kncel. During.che
final pushing conroctiors. as drc hsad
begiru to show the binhchair is usu-
a.llv tcmovcd: howevc( r wornan cln
continue to siton thc chair while the
child is born.
I
 rltcrctinr. tllc pcrirlcunl bccorncs lcs\ vul-
ncrrblc. Jltis xhlt! itl-wllght exphins thc:
,z'.rcsd-rrttr-t-jb:Lqt+Errtq -t!4s-nod-cpt
pruies (rr incision nr:rdc in the pcr-
ft\ 11,u,.,u.1
vagina) with vcrtical births;
h1;wcvcr, snltll labitl tears do occur more
frcoucntly rvhcrFthc wornen is uPright.
Such relrn lrc oftcn supcrdicial. heal prac-
cically rvithouc scarring, lnd d<> not cause
womcn discomtbrc during intercoune tbr
up ro six rnonths :rftcr the dclivery as is
often the casc with episiocomies. Whcn
oerincal rcrrs do occur in"a vertical dc-
*livcrv. -!h'erc can be considcrable blood
loss, most likcly due to snviry. nrisl.oL-
lcm is solved temporarilv bv having thc
/1
).;
@ AFTERB IRTT{
livery to stop th. hlecding-
On is way to the ousidc world, rhc
baby ha; to rum t corner underncath rhe
pubic arch. Duc to geviry this ekes place
more swiftly and smootbly in e vcrtical
dclircry. Whcn thc hcad has pasred thc
barricr of rhe pubic boncs, rhc prcssurc
on the ragina incrcascs and che head will
soon be in sight. Once thc head ir prc-
scnrcd in dic vcrticrl dclivery it docs nor
reEact, disappcari.qg bctrveen conertions
a numbcr of timcs, es is usually tbe case
in supinc delivcries- Ar dris sage, follow-
ing thc midwife's irssuctions is vital for
gtcvcnting tcars. Aftcr rhc head crowns,
pushing acrively is no longer oeccsary; in
facc, women are encouraged co pant,
which slows rhe passage of rhe hcaq, so
the vagina is strcrchcd gradually. tn gcn-
enl, r wom.an who listens ro hcr body can
tell rhat she must rlow rhe delivery tbr if -pl""cnto to
she doesn't, she will have a sringing,
ing scruadon in hcr ragina. All that s rc-
quircd for thc babyt hcad to be born is
for rhe wornan to sigh. Many times, with
onc more gendc pus[ thc resc ofrhe child
cmergcs inro chc hands of the midwifc,
who hy: the infant on *rc obsretric pad
so mother and child can enjoy chet first
contact in chcir own way. The woman
may sink ro hcr knees or sit down on thc
pad wirh hcr child. Immediarch she sees
*re child's gen&r and whcdrcr hc baby is
all right. Thcn she can adjusc to thc new
situation lt her own pace, picking up the
scwborn whcn she 6els rcady.
Thc uterus will coatrrct after the
child is born, causing rhe placcna and
membnles ro furdrct disengage ftom thc
uterinc wall end be born. This event is
cdlcd *re aftcrbirth. If a woman 6els anr-
ious rbout drc placcual rrrive!, her srcss
ruy disturb thc process. Scudies indicate
that 6e intque cmodons ofthe 6rst qon-
tlct bcclt ren nodrcr urd cbild induce sc-
crcticn of the horrnone oxytocin, which
incrgascs thc intcnriry ofuterinc concrac-
tiors. Oftcn whib she is cngaged wirh hcr
baby a woman will have concactions or e
slighc pu:hing urge, sigru *rat rhe placcn-
ta i5 on iE way.
Giving birth to rhc ptaccnra entrils
los ofblood, To prcvenr excessive blced-
ing, ir is cnrcial drrt thc userus continue to
I Tfu Wrtic Dclipcry / r.t
contracr stongly so the brokcn verisels irt
thc wrll arc tighcly constrictcd. The con.
tractious rhrt follow rhc child'.r birrh are
crlled rftcrpains.{he los of blood jgg3t'-
...-|--+
rer 1l9llt!4!9ry9ry !Q!y seem_iq_be
.----"i--'r;-----:-
rrtner he ry: duc to gnvity, arnnioEic tlu_
id and blood leave the bodv dmost rm-
mcdiatcly. This should nor alarn: the
woman as it is actuallv advanrageous.
Whcn bloo4 lcryrs drc urerus wi*rour dc_
try, connzguoru arc morc effectivc, which
dccrcrses fur(her bleeding and causcs che
bJ?iUG*IE*e, w. r.c_
burn- -ommcnd rhat rhc wornar, 5l! on a
birthchair so drc blood and placena can
bc collccted and mea:urcd in the pan ar
is base- In the supinc posirion, blood says
wirhin rhe urerus unsil thc pleccura is
born, which sometirncs skcr r few rnin-
utes longer to occur thzn wirh a yerticd
delivery.
In addition to helping dccreasc blood
loss, aftcrpai-rs rssist rhe womb in is rc-
tum to prprcgnancy size- Women oftcn
haw afterpains when they breesdecd be-
ceuse brcart stirnuletion rcleates oxytocin,
whid in Urrr4 causcs uterine conaactiors.
The womb ofa multiprrous wotrrn, a
woman who has dclirrcrcd morc rhan one
child, is less eladc than drat of a first-time
modrer. With cach delivery thc wcmb's
abiliry to rcturn to ic original size de-
crcascs. This los of elasticiry ecplains why
multiperous womcn ofrcn have morc in-
tcnsc afterpains and for a looger period of
tirne-up to duce to 6ur dap aftcr thc
birdr.
Following thc afterbir*r, rhc midvrife
chccks dre pcrineum and wagina for teas
thac may have occurrcd during thc deliv-
ery. A sevcrc tclr or ln episiocomy must
be rcpairtd. Thc rrea is scnsirive now, but
thc women is givcn r locrl ancsrhecic. A
minor tear will herl of is own eccond lnd
does not rcquirc sticchcs. Afer the raginal
argr is checkcd, morhcr and child can con-
!inue their finc corrcacr.