Malposition part two: Some whys
In the previous post I explained some of the basics about baby positions and how they can affect labour.
One of the things I didn’t address is why malpositions are common and why they can be such a problem in labour.
Although I believe our bodies have evolved to give birth successfully the majority of the time, there will be some for whom labour is more difficult, especially with a baby which is not in the optimal position for their pelvis.
Remember, we are all on a continuum of 4 basic pelvic shapes and some of these are a shape that need a baby to be posterior or asynclitic to engage or fit through the pelvis, so there is no one optimum baby position. Problems occur when a baby cannot get into the position it needs to engage or fit through the pelvis.
Why might this occur?
Whilst our bodies have evolved to give birth, they have also evolved to work best when we follow a paleolithic type diet, and exercise (like a hunter gather society) with walking at least 5-10 miles a day and frequent squatting. Many of us do not eat this sort of diet or manage to exercise like this.
Even if we do some yoga and sit on a birth ball in an evening, this does not necessarily correct the issues caused by working in an office all day and lots of driving. For women that also do not stretch and exercise regularly or who are obese, it can be even harder for a baby to get into an optimum position (for lots more info see http://www.plus-size-pregnancy.org/malpositions.htm)
Labour is a complex process
Like the flight of a bumblebee the complex process that starts labour and how it progresses normally is still not completely understood, but it is a complex process that involves physical (including hormonal) processes and also emotional and spiritual.
If women are evolved to have straightforward births, they are also evolved to have undisturbed and unmedicated births, which begin without interference, where they can allow their neo-cortex to relax so the hormones of labour, oxytocin and endorphins can do their work.
Some anthropologists have argued that society evolved to have women companions during the birth to give comfort and physical support to women in labour. Many indigenous cultures have birth customs that involve women being upright and movement, and also water, whether immersion in or squatting over steam baths.
In our current medical model of birth which has a rhetoric of choice, but is bound by a risk and intervention based protocol, it can be very difficult for women to go into labour naturally and to make the kind of instinctive movements (nesting in a warm, dark, private space) which can help babies negotiate the passage from inside her to the outside world.
If women are induced, they will have drips and monitors which mean they may labour on their back. An epidural as pain relief means most women cannot mobilise and make a posterior position more likely.
Some women can easily birth babies in whatever position they are in, without needing to mobilise. Others may need to do lots of work, either in pregnancy or in labour (like this! http://www.youtube.com/watch?v=mXmwtpJ6Lb8) to help their babies to be born without intervention (and it is these women that are most affected by time limits, and limits to mobility in labour)
I believe that this complex birth process is effected by a huge range of possible scenario’s. It is wrong to imply to women that if they trust enough that their labour will progress easily. For some women this may be the case, but for those whose labour does not progress, it is not the ‘fault’ of their mind (not relaxing enough to let go), their spirit/emotions or body but a result of the circumstances we find ourselves in today. Diet and exercise can be dictated by society and circumstance and also the level of deprivation in the local environment.
Research needs to be carried out so that the best ways to prepare women for labour and support them in labour are at the heart of birth protocols in our hospitals to give women the best chance of going in to labour naturally and allow their babies to be born without unnecessary and harmful interventions. Women with babies in non typical positions may have a different labour pattern to that which is typically expected on a labour progress chart but that does not mean with time, freedom to move and good support in labour that their babies cannot be born without assistance.
In summary, a babies position during pregnancy is governed by a whole host of factors and whether this affects the progress of labour and the interventions a woman has during birth also depends on the circumstances she finds herself in, however there are ways to prepare for birth and gather a support around yourself for labourand this can make all the difference between being able to birth without interventions which can have long term implications to the health of mothers and babies.