Assume the Position

30 Weeks

I suck at meditating. It's the hardest thing in the world for me. I'd rather run a marathon in a shitstorm than sit for any length of time without moving. It's taken a lot of research, patience, and perseverance to cultivate a regular meditation practice over the years and I still suck at it. 

I always thought it was my mind that was the problem. My brain is like the fucking Swamp of Sadness. My thoughts wander into a bottomless sandpit of doom and literally suck me into oblivion. I’ve battled depression since the ripe old age of fifteen, at times seriously enough to be medicated. Physically moving around, running or practicing yoga asana for example, can help to calm me down. Sitting still with no distractions often makes things worse.  

My dear friend Craig, who I've written about before, was a practicing Buddhist and Zen meditation teacher. He gave me this book and clued me into the fact that it wasn't my brain that was the issue. We often think of meditation (and depression for that matter) as an activity involving our minds, but in truth meditation, and I believe depression to some extent, is initiated by assuming a specific gesture with our bodies. If any one element is out of whack, it's practically impossible for the mind to achieve stillness and clarity. 

What we need to do- first and foremost- is turn our bodies into a cathedral and create space for our minds to follow. Instead of carved stone, the building blocks of the human body are the feet, lower legs, upper legs, the pelvis, the abdomen and lower back, the chest and upper back, the shoulders and arms, and finally the head. If these segments can be stacked on top of one another, the body will be able to sit (or stand) in an elegant and balanced way.

Like so:

A balanced posture requires very little energy to sustain and also allows the body’s major muscles to relax. Subsequently it’s much easier for the mind to relax as well.

I remember the first time this 'clicked' for me. Craig sat me down on his meditation pillow and added additional support under my knees. He adjusted my chin (apparently I have writers neck from leering forward at a computer screen all day) and also tucked in my lower ribs. Once I relaxed into this gesture, I felt like I'd just popped an Ativan: a quiet, dull calm settled into my bones. My body sighed and my mind (finally!) let go. 

That feeling of mental and physical ease lasted all of thirty seconds, but since then it's been easier to 'click' into that space where my whole being can mindfully rest, if only for a short amount of time. 

So here's what I'm thinking… 

If posture can have such a significant affect on our body and mind's ability to relax, why not apply the same principles to childbirth? Surely squeezing something the size of a small watermelon out of my vagina could be made slightly more bearable by assuming the optimal position, no?

Unfortunately mainstream medicine doesn't feel the same way.

More than half of women who gave birth vaginally in hospital in Canada reported that they lay on their backs in labour. Slightly more than one-third indicated they gave birth in a propped up (semi-sitting) position. Is it any wonder that interventions such as episiotomies, forceps and suction births are so much more likely in hospitals?

There are a number of reasons why lying on your back with one's feet in stirrups is not even remotely helpful in opening the hips and pelvis. 

First of all, stirrups are for cowboys. 

Secondly, lying on your back actually decreases the size of the pelvic outlet; it forces the woman to put direct pressure on her sacrum (tailbone) which flexes it upward, forcing it into a curved position which can inhibit the baby's descent. The birth canal is effectively placed in an "uphill" orientation, forcing the mother to push upward against gravity to expel the baby. 

Thirdly, what about gravity? Sitting or standing upright makes sense because of the simple fact that the weight of the baby will naturally pull it down, in, and out of the pelvis.

Optimal birthing positions use a combination of gravity and physiology to relax the muscles, allow the mother's sacrum and coccyx the freedom to rotate backward and consequently create a perfectly stacked 'cathedral' for the baby to pass through.

*insert sounds of heralding angels here*

There are five main types of labor and birth positions that facilitate heavenly pelvic opening. While some are definitely not glamorous, they each offer unique benefits to mother and baby.

1.Quadruped childbirth positions (on hands and knees) are beneficial for back labor, turning a posterior baby, and are often the best birth positions for birthing a large baby.

2. Sitting positions combine the helpful force of gravity with relaxation. A birth ball, rocking, or toilet sitting can be utilized to rest while gravity helps labor progress. 

3.Squatting positions are helpful in opening the pelvis to allow a baby to find the optimal position for birth. Squatting can be performed through use of a birth companion or a tool such as a squatting bar.

 

 

4. Side-lying positions are beneficial for resting during a long labour, promoting body-wide relaxation, and minimizing extra muscular effort. They are best used in the latter stages of labor since gravity isn't able to speed the process.

5. Upright positions for childbirth use gravity to the mother's advantage. They help the baby drop into the pelvis and prevent pressure from being concentrated in a particular spot. They represent the most under-used birth positions. 

 

These positions have been documented historically in cultures around the world. So the lingering question for me is this: if studies confirm that a mother needs to explore her own optimal birthing positions based on her unique physiology and the position of the baby, why the hell are most of us still stuck on our backs with our feet in the air?

The story, true or not, is that Louis XVI wanted to see the birth of his son (something men were not permitted to do at the time, but he was King so he could do what the hell he wanted) and asked the obstetrician if he could place Marie Antoinette on her back with her legs extended to facilitate his wishes. 

The obstetrician realized that this position made things much easier for him - he didn't have to stoop down and look up at the woman, which was not only difficult physically but socially demeaning. So he continued to use this position for delivering babies, and other obstetricians picked up the practice quickly. 

I don't think there was actually a law concerning this, but I could be wrong. In any case, this position has continued to be favoured by obstetricians and used in many hospitals. Midwives continue to favour letting women assume whatever position works best for her.

I can only conclude then, for lack of other evidence, that laboring on one's back is mostly for the convenience of the doctors rather than for ease of passage for unborn child and mother. 

One could argue that maternal death rates have dropped since Louis and Mary Antoinette’s time (though they are actually on the rise in America) so we must be doing something right. I credit this to advancements in infection management and also surgical interventions when necessary, more than ‘advancement’ in birthing positions. 

Just because historic rates of maternal death were much higher in the past they are today does not mean we should not consider historical practices and birthing positions when thinking about labour. 

Our bodies are cathedrals, beautiful works of art. Let's not make this the status quo:

Additional Resources:

While writing this post I came across a book entitled Labor Among Primitive Peoples  by George Julius Engelmann MD that includes some amazing diagrams of traditional birthing positions. It is available in it’s entirety thanks to the power of Google Books! 

TheBusiness of Being Born

SpinningBabies