I love the dashboard on my blog that allows me to see who is linking to me. I have found a lot of great blogs, including Stand and Deliver. I guess, considering her blog title, it is appropriate that the first time I link to her, it is for a blog in which she discusses Ecuador instituting vertical delivery in a maternity ward. She links to a wonderful article, in which Dr. Luna (love the name!), the chief ob/gyn of the ward, describes vertical birthing as a Kitchwa tradition. He also claims “Vertical deliveries…have also helped reduce Caesarean sections from 18 to 8 percent at the hospital.”
This is not just the affectionate musings of a local practitioner. Vertical second stage delivery is supported by evidence based medicine. It is sadly not very surprising that a technique that is associated with “with a 4-minute shorter interval to delivery, less pain, lower incidences of NRFHR monitoring and of operative vaginal delivery, as well as higher rates blood loss of > 500 mL compared with other positions in 20 trials, including 6135 women” is rarely seen in US hospitals. This is one of the few interventions or techniques given a rating of A, which is defined as “The [US Preventive Services Task Force] USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.” Doula services also receive an A rating. Several common interventions, such as estimation of fetal weight, prophylactic tocolysis were given the rating of D, the lowest rating, which is defined as “The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.”
It is sad that an uncommon technique, upright birthing, is given the highest rating on a US government task force evidence based scale, but is still treated as a indigenous traditional novelty by journalists. A quick literature review would have validated this as a researched and well supported recommendation. The article is very supportive of the technique and mentions lower maternal mortality rates, don’t get me wrong. But, a mention of the evidence behind it that already exists would have been very welcome.