Standing up for birth

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.


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7 responses to “Standing up for birth

  1. THANK YOU for putting your finger on what it was that bugs me about this article and others like it. They smack of exoticism. I get excited to see anyone extolling the virtues of mobility in labor and vertical birth. If this had been an article about a hospital in the U.S. encouraging women to give birth vertically and use medicinal herbs, I think we’d find it posted on Stuff White People Like with a discussion of “why don’t those crazy middle class white laydees just get the epidural like everyone else?”

    All I know is that the best thing that my midwife could have done when I had pushed for twenty minutes (?) squatting was have me stand up with my right leg on the edge of the tub and I felt my baby spin right out. It was glorious, man. =)

  2. Do you have access to the full text? I usually do to most journals through my university library, but this journal is showing up as abstract-only access.

  3. MomTFH

    I do have full access. I will email you a copy.

  4. Question about your comment about prophylactic tocolysis–this doesn’t seem to be about fetal monitoring iin the text of the article, but rather administering a (uterine relaxing?) drug in the presence of non-reassuring FHTs. Or was I reading it wrong? I didn’t find anything about monitoring at all in the paper, which seemed quite odd since it’s such a huge part of labor management. Is it because the research is already so widely known that continuous EFM doesn’t improve outcomes but increases CS rates? (Although the practice in hospitals certainly doesn’t follow the evidence!)

  5. MomTFH

    Rixa, you are completely right. I am going to edit the post. Thanks for pointing that out.

  6. It is very very frustrating. Many folks just don’t listen. Many folks just don’t take the time to look at the evidence. We have know Doulas make a difference but do we invest in hireing doulas in the hospital? No.

    I will have to look this article up now in the med library. The good news is that some of the Docs I know do read the literature and change accordingly. It just takes more effort of their part.

    The logistics are tough with standing up for birth. Almost every woman who comes into the hospital I work for wants THEIR epidural right away. It is as if our society has programed women to think they cannot birth with out an epidural.

  7. For my VBAC labor the *only* position that I was comfortable laboring in was standing on the floor and leaning on a stack of pillows on my bed. Had I not transferred to the hospital I have no doubt that’s the way I probably would have given birth (even though I had planned a waterbirth).

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