This seems rather strange. Some 30 years ago or more campaigners were already calling for birthing women to get off their backs. Janet Balaskas pioneered the Active Birth Movement in the early 80’s, and in 1982 thousands of women, led by another birth activist Sheila Kitzinger, marched on London to defend a woman’s right to birth in any position she chose.
And never mind the activists – there’s actually plenty of solid evidence that moving freely in labour and choosing your own position for delivery bring real benefits, as Margaret Jowitt, author of Dynamic Positions in Birth, explains:
“An active labour positions the baby in the best possible way to exit – she has a clear run to the outside world and is better able to manoeuvre around her mother's bones. Labour is shorter and less painful in upright positions, and gives baby a far better oxygen supply - because lying on the back cuts off part of the blood supply to the placenta. The mother does not have to push her baby out against the effects of gravity, and there is less need for intervention, epidurals, forceps, ventouse and caesarean section.”
And the benefits of giving birth more actively don’t stop at the physical. The bodily positions we choose affect how we feel in all sorts of life situations – ever been told that trick of standing up for an important phonecall? Standing, we feel assertive, whereas lying on our backs is vulnerable and potentially humiliating, argues Kate Evans, author of Bump: How to Make, Grow and Birth a Baby:
“Women are made to lie down and expose their genitals before fully clothed birth attendants who stand over them, directing operations. This is fundamentally disempowering. It could be particularly traumatic for a woman who has (as so many of use have) experienced sexual assault or rape.”
So, if we get off the bed, we can have faster labour, less pain, less interventions and feel more empowered – what’s not to like? And why the heck are so many of us still giving birth like this when the message that it’s not going to help us out has been shouted loud and strong for decades?
The answer, of course, is ‘culture’, in other words, ‘this is how we do things round here’, or as Kate Evans might put it, ‘monkey see, monkey do.’ Women often expect to give birth in this way as this is the most usual image they’ve seen of birth on TV, and caregivers might find it more convenient to keep things as they are – after all, this is how women ended up on their backs in the first place, as this position gives attendants the best possible view of proceedings.
“I wonder if doctors and midwives really trust women to be able to give birth without having feedback about how well they are doing,” says Margaret Jowitt, “and they have to be able to see to give that feedback. Certainly doctors can be disconcerted when they are called to a room and find the woman on a mat on the floor. The hospital culture itself labels any position other than on the bed as 'alternative'.”
In fact, the idea of giving birth without a bed is so engrained that some of us just can’t imagine doing so without one. When I planned my first birth at home (it didn’t end up being there by the way!), I told a friend, a mother already, of my plans to build a big ‘nest’ of cushions and blankets on the floor. She frowned: “But how will they examine you if they have bad backs?” she said, and got me worried, until another friend, also a mother, but a rather subversive midwife, assured me that they’d be ok as, “they don’t spend the whole labour with their fingers stuck in you, Milli”.
Joking aside, it is difficult to break with convention, and to wrap our heads around the idea that it doesn’t MATTER how our carers feel about our birth choices – we are the ones doing the amazing work of having a baby and we don’t need to protect their backs or their feelings.
This might even change the power dynamic of birth itself, says Cristen Pascucci, Vice-President of Improving Birth and author of VBAC Bans in America, “Were women to demand they get off their backs, we'd see a symbolic shift in women communicating, "I'm the one giving birth here, and I need you to support me - not manage me. Get on board or get out of my way."
However, there’s one big barrier to change – the bed, so often found at the centre of every delivery room. Although some hospitals and birth centres are trying to make adjustments to the way rooms are set up – offering birth balls, ropes, mats and of course, birth pools – in many, the bed still looms large.
The answer? You can challenge the norm, by turning up for your hospital birth with a yoga mat, birth ball, or – as I once did – a big bag of cushions for your floor nest.
If the idea of this makes you feel uncomfortable, you might first have to challenge your own perceptions and expectations of birth, and dismiss any worries you might have about your choices being inconvenient to others. In other words, as the birth activists of the 80’s would have put it, don’t take it lying down – and stand up for your birth rights.