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Unveiling the reasons behind the dominance of Supine Position in birthing

Despite being aware of the risks associated with the supine birthing position, it continues to be widely practiced in many settings.

Have you ever contemplated your preferred birthing position? Many women would naturally choose a more upright position, such as hands-and-knees, squatting, or kneeling, if given the option. However, the supine position remains the go-to position for giving birth.

Upon reviewing various materials on this subject, I arrived at a frustrating realization that the preference for the supine position primarily stems from the convenience of healthcare staff attending to the patient, rather than considering the comfort and preference of the patient herself.

It is disheartening to think that women enduring excruciating pain have limited or no control over their birthing position, which is truly absurd.

What is Supine Position?

The supine position in childbirth refers to a woman giving birth while lying on her back. It encompasses various subtypes that have been classified within this category. These subtypes include:

  1. Lithotomy position: In this variation, the woman’s legs are raised and supported in stirrups, providing easy access to the birth canal for healthcare providers.
  2. Semi-recumbent position: This position involves the woman being partially inclined upright, typically at a 30-45 degree angle. It allows for a more relaxed and supported posture while still maintaining some elements of the supine position.
  3. Dorsal position: In the dorsal position, the woman lies flat on her back with her legs extended. This is the most traditional and commonly seen form of the supine position during childbirth.

It is important to note that the supine position, including its subtypes, has been the prevailing choice in many healthcare settings for a long time. However, it is increasingly being questioned and challenged due to concerns about its impact on the birthing process, maternal comfort, and potential risks associated with prolonged pushing in this position.

Critics argue that the supine position may not be the most advantageous for women during childbirth. Research suggests that being upright or adopting more vertical positions, such as squatting or kneeling, may provide benefits such as increased pelvic space, better alignment of the baby’s head, and a more efficient progression of labor.

The discussion surrounding birthing positions is a topic of ongoing debate, with advocates for alternative positions emphasizing the importance of empowering women to choose the position that feels most comfortable and supportive for their individual needs. Collaborative decision-making between healthcare providers and birthing individuals is essential to ensure that the chosen position promotes a positive birth experience and optimal outcomes for both the mother and baby.

What are the risks of Supine position?

Despite growing evidence suggesting potential harms to both mother and child, the supine position remains the predominant birthing posture in contemporary medical settings. This position, where women give birth on their backs, has been associated with various risks and limitations.

One significant risk of the supine position is the potential for severe pelvic floor injuries. The strain exerted on the pelvic area during this position can lead to complications such as perineal tears and damage to the pelvic muscles. Additionally, research indicates that giving birth in a supine posture may result in longer labor duration and increased pain intensity for the mother.

Furthermore, the supine position can adversely affect the baby. Blood flow to the baby may be compromised as the position puts strain on vital blood arteries, particularly when carrying a full-term baby. This can have implications for the baby’s well-being, including irregular fetal heart rate patterns.

Despite the mounting evidence highlighting these risks, the supine position continues to be the favored choice for a majority of women in the United States. The lithotomy position, where legs are raised in stirrups, is frequently employed, and semi-reclining positions are often reported as the most common upright alternative. In contrast, only a small percentage of women opt for more upright positions such as crouching, standing, or lying on their side during delivery.

It is important to acknowledge the substantial body of research spanning over three decades that has consistently demonstrated the drawbacks of giving birth in the supine position.

The continued prevalence of this practice raises concerns regarding the well-being and autonomy of both mothers and infants. Encouraging a broader range of birthing positions and empowering women to make informed choices can contribute to improved birthing experiences and outcomes for all parties involved.

Why continue Supine birthing after knowing the risks?

Despite being aware of the risks associated with the supine birthing position, it continues to be widely practiced in many settings. One study conducted in Tanzania shed light on the reasons behind the persistence of this practice. The findings revealed that midwives, who are considered knowledgeable experts in the birthing process, often prefer the supine position due to its perceived advantages in monitoring labor progress and facilitating effective delivery assistance.

The study highlighted that the supine position provides midwives with a clear view of the perineal area, allowing them to closely monitor the progress of labor and intervene promptly if complications arise. This visibility is particularly valued in resource-limited settings where technological monitoring devices may not be readily available. Midwives’ familiarity with this position and their confidence in managing deliveries while the woman is in a supine posture further contribute to its continued use.

Moreover, the hierarchical dynamics between midwives and birthing mothers played a significant role in the prevalence of the supine position. In the study, women often viewed midwives as authoritative figures with extensive expertise, trusting their judgment and recommendations. As a result, mothers felt compelled to comply with the midwives’ preferred birthing position, even if they were aware of potential risks or had personal preferences for alternative positions.

Take away

The dominance of the supine position in many healthcare settings reflects the influence of traditional practices, ingrained beliefs, and the medical model of care. While evidence highlighting the disadvantages of supine birthing continues to accumulate, challenging the status quo and implementing change can be complex and require shifts in clinical protocols, professional training, and patient education.

Efforts to promote evidence-based birthing practices, empower women to actively participate in decision-making, and foster a collaborative relationship between healthcare providers and birthing individuals are crucial for addressing the persistence of supine birthing.

By recognizing the importance of informed choice, respecting women’s autonomy, and expanding the range of birthing positions available, healthcare systems can strive towards safer and more personalized birthing experiences that prioritize both maternal and fetal well-being.

References

https://evidencebasedbirth.com/evidence-birthing-positions/

https://www.cochrane.org/CD002006/PREG_womens-position-giving-birth-without-epidural-anaesthesia

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2726-4#:~:text=Nurse%2Dmidwives%20believe%20that%20the,and%20assist%20delivery%20most%20efficiently

https://www.whattoexpect.com/pregnancy/labor-and-delivery/delivery-options/labor-positions.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235063/

Unveiling the reasons behind the dominance of Supine Position in birthing
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