Re: Position
From: Anna Meenan, MD (annam@uic.edu)
Thu Jan 20 13:04:23 2005
And the name of your medical consultant, as I did not see an MD, DO,
CNM, RN, or CPM after either of the two names at the beginning of the
first post.
--
Anna Meenan, MD, FAAFP
At Thu, 20 Jan 2005, Braun, R. Daniel wrote:
>
>Would you be so good as to provide us with your name, not the
>organizations?
>
>R. Daniel Braun, MD
>
>"If everyone likes you, you're doing something wrong."
>
>Kinky Friedman
>
>I believe a self-righteous liberal or conservative with a cause is more
>dangerous than a Hell's Angel with an attitude.
>
>Andy Rooney
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>National Brachial Plexus/Erb's Palsy
>Sent: Thursday, January 20, 2005 1:37 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Position
>
>Positioning for Prevention
>
>What image comes to mind when you picture a birth in a hospital?
>
>Most people see a picture of a woman on her back, with her legs raised
>or perhaps in stirrups. That is the perception that the technological
>model of birthing has transfixed into our mind's eye.
>
>The obvious problem is that by lying on one's back or by sitting
>semi-reclined on one's tailbone, the space of the pelvic outlet (birth
>canal) may be reduced by up to 30%. By adopting a traditional hospital
>position that is convenient for birthing professionals, one unknowingly
>reduces the space the baby has to enter this world.
>
>There is no medically sound reason to give birth on one's back, and
>there is every reason to give birth in a safer position that works with
>female anatomy and physiology, in a way that women's bodies were
>designed.
>
>It is so easy to open up the birthing canal to help ensure a safer
>passage for the baby, and to reduce the risk of injury to the mother's
>body as well.
>
>By simply rolling over to one's side, which can be easily accomplished,
>even with an epidural, allows the sacrum the freedom to move back as the
>baby is passing through.
>
>What is most important to remember is to get the mother off her back!
>
>Changing positioning during the first and second stages of labor can
>dramatically reduce the incidence of shoulder dystocia, and thus
>eliminate the resulting complications Risks of Traditional Positioning
>
>With positions that close the birthing canal, such as lying down, there
>may be increased risk to the baby of:
>
> * increased need for forcep or vacuum delivery
> * broken clavicle/collarbone
> * excessive bruising
> * pressure on baby's neck vertebras
> * excessive head molding
> * compression of umbilical cord
> * stress on baby
> * poor position/angle of the fetus in relation to the pelvis
> * brachial plexus injury
> * broken humerus
> * disruption of the baby's oxygen supply
>
>and increased risk for the mother of:
>
> * less effective contractions
> * labor slowing and not progressing
> * possible increased hypotension & pregnancy-induced hypertension
> * ineffective pushing
> * may lead to illusion of cephalo-pelvic disproportioin due to
>reduced pelvic diameters from poor positioning
> * increased risk of need for Cesarean section
> * strain and tearing to the mother's tissues
> * episiotomy
> * back pain
> * fractured coccyx/tailbone
>
>Janet Balaskas, the recognized pioneer of natural childbirth and author
>of "Active Birth" reiterates the danger of being in a supine position:
>
>"In the semisitting position the mother's weight rests on her coccyx and
>the pelvic capacity is reduced." "In the semireclining position the
>sacrum is immobile and the pelvic outlet narrows." "Your coccyx is
>designed to move out of the way as your baby's head descends. Sitting
>on your coccyx during birth restricts the pelvic outlet and can also
>lead to dislocation of the coccyx, which can be extremely painful for
>months after the birth."
>
>The sacrococcygeal joint, the joint between the sacrum and the coccyx or
>tailbone, also softens in pregnancy; it is designed to swivel backwards
>to widen the outlet of the pelvis as the baby emerges. Of course, this
>is impossible if the mother is sitting on her coccyx. Benefits of Proper
>Positioning
>
>Opening the birth canal by using positions that support a woman's
>anatomy, will decrease the risk of possible trauma to the baby and
>mother's body. .Moving around during labor and using birthing positions
>such as left side-lying, hands and knees, upright, squatting, etc. offer
>several benefits:
>
> * increased comfort
> * reduced pain
> * an enhanced sense of control and involvement in the birth
> * more effective contractions
> * better progression of labor
> * baby more likely to descend in an optimal position
> * work with gravity instead of against it
> * better blood and oxygen supply to the baby
>
>Beyond these advantages, there are equally important effects on the baby
>and on the progress of labor. Changing positions during labor can change
>the shape and size of the pelvis, which can help the baby's head move to
>the optimal position during first stage labor, and helps the baby with
>rotation and descent during the second stage.
>
>Swaying motions such as walking, climbing stairs, lunging, and swaying
>back and forth are especially helpful with this.
>
>Movement and upright positions can help with the frequency, length, and
>efficiency of contractions. The effects of gravity can help the baby
>move down more quickly. Changing positions helps to ensure a continuous
>oxygen supply to the fetus.
>
>"There is evidence to suggest that if the mother lies flat on her back
>then vena caval compression is increased, resulting in hypotension. This
>can lead to reduced placental perfusion and diminished fetal
>oxygenation. The efficiency of uterine contractions may also be
>reduced". (Humphrey et al. 1974, Kurz et al. 1982)
>
>Changing position can also reduce the length of labor. Mendez-Bauer and
>Newton
>(1986) state that duration of labor from 3 to 10 cm cervical dilation
>was about 50% shorter in patients who alternated supine and standing
>with standing and sitting positions.
>
>Another positive outcome from positioning is the reduction of the use of
>episiotomies and fourth degree tears. Since there will be less
>dystocias, doctors will not feel inclined to cut the perineum, to give
>more manipulation room. These have been done for many years without
>anatomical reason, but more so for legal record.
>
>An ideal position would include:
>
> * opening the pelvic outlet as widely as possible
> * providing a better fetal position with a smooth path for the baby
>to descend through the birth canal
> * using the advantages of gravity to help the baby move down
> * giving the mother a sense of being safe and in control of the
>process
> * and most importantly, decreasing the risk of injury to the baby
>and to the mother
