What is the Evidence for Pushing Positions?
By Rebecca Dekker, PhD, RN, APRN
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Here is some food for thought about the evidence for pushing positions and what positions are easiest, fastest and safest for mothers and their babies, from Hypnobabies mom, Rebecca Dekker, PhD, RN, APRN, who is a medical researcher and the author of Evidence Based Birth.
Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in bringing the baby down and out. Also, when a woman is upright, there is less risk of compressing the mother’s aorta and thus a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012).
However, despite these proposed benefits of pushing in an upright position, most women in the U.S. give birth either lying on their backs (57%) or in a semi-sitting/lying position with the head of the bed raised up (35%). A small minority of women give birth in alternative positions such as side lying (4%), squatting or sitting (3%), or hands-knees position (1%) (Declercq, Sakala et al. 2007).
It is thought that most women are encouraged to push in a lying or semi-sitting positions because it is more convenient for the care provider. When women are lying or semi-lying in bed, it is easier to access the woman’s abdomen to monitor the fetal heart rate. Care providers are also more comfortable with the lying or semi-sitting position because this is how many of them are trained to attend births (Gupta et al. 2012). This caregiver preference for non-upright positions has persisted, despite the fact that current major obstetric textbooks state that it is beneficial for women to push in upright positions, especially for first-time moms (Kilpatrick and Garrison 2012). Read the rest of this informative artice HERE.
