Stand And Deliver
A few days ago, I exchanged a few e-mail with a Registered Nurse and midwifery student who comments here, mentioning a film I saw at the Human Behavior and Evolution Society Conference about modern-day hunter-gatherers who give birth standing up.
It seemed much easier and more efficient than the way we do it -- and hey, if you're a young mother, maybe you could do double duty: drop your kid while standing in line for concert tickets.
I asked whether she knew about it, and if so, what did she think? She wrote back:
Amy,Birthing upright: Absolutely. The lithotomy position -- that'd be flat on your back, legs in the air -- is the least physiological birthing position possible. You could only make it worse if you hung the woman upside-down. It's convenient for the physician, not the mother or the baby. Even "semi-sit", which is basically the lithotomy position with the mother half-sitting up (how most American women give birth), is not much better. These positions lead to longer pushing stages, more hypoxic babies, more use of forceps and vacuum extraction, more episiotomy, and more frequent and severe tissue damage to the mother. There are much better outcomes with the woman on all fours, kneeling, side-lying, squatting, standing...basically, get gravity to work with you, not against you. Providers are hesitant to encourage women to get in those positions because many of them haven't been taught to deliver babies that way, and it's harder, frankly, to cut episiotomies (using scissors to enlarge the vaginal opening- *shudder*). Also a woman who can't feel anything below the waist and who is hooked up to a couple machines isn't going to be able to maneuver much. I'm really glad that this information is starting to filter out into popular culture. A decade ago, who would have thought that Ricki Lake would be an effective childbirth activist?? Not me! It makes me laugh that the AMA and American College of Obstetrics and Gynecology (ACOG) is so infuriated about it ;)
Part of what drew me to your blog in the first place was the emphasis you put on understanding people's behavior through the lens of evolutionary anthropology. I was an anthro major in college and minored in biology...evolutionary and primate studies were my hands-down favorite classes. When I'm out of school I hope to pick that reading up again. It's a very interesting aspect of modern humans, and our culture in particular, that leads to this conflict between physical maturity and emotional maturity/readiness for independence: our prolonged adolescence. You have girls who are at peak physical readiness to bear children at 16 or 17, but are totally without the tools you need to keep afloat on your own in our culture, let alone raise kids. Graduating from high school, getting an associate's or bachelors, or work experience...and isn't the median age for women at marriage 25 now? To expect people to abstain until marriage is fighting against millions of years of evolution and it's a battle we're gonna lose. We can encourage young people to abstain for as long as possible, and act responsibly when they DO become sexually active, or we can watch abortion rates (legal and back-alley) skyrocket, as well as deal with the poor kids produced by teenaged parents. Talk about starting out in life with one arm tied behind your back, and society suffers along with the kids.
I tell you, every time I get a teenager on Depo-Provera, I feel like I've struck a blow for the country at large ;)







The Meaning of Life, The Miracle of Birth, Part One (lying down birth)
The Meaning of Life, The Miracle of Birth, Part Two (standing up birth)
and as a bonus: Every Sperm is Sacred
My kids were delivered through a midwife at a hospital, it was terrific, and while I will always think fondly of Governor (Moonbeam) Jerry Brown. (And I will always think fondly of Mike Royko too, who coined the name, Governor Moonbeam.)
With all these links, I am sure this is headed for the moderation queue. Pressing submit in 3, 2, 1, ....
jerry at September 9, 2008 1:29 AM
What if little Ashley or Jayden hits a rock with the soft spot?
Just sayin'. Never thought of that, did you, Little Miss Practicality?
Crid [cridcridatgmail] at September 9, 2008 2:04 AM
Hell, even back in 1983 when I gave birth, the hospital had some kind of weird chair in which you could give birth in that upright position albeit sitting with legs spread.
However, they only had one (then anyway, don't know now). Some of the pregos were clamoring for it; some (myself included) thought it might be an interesting concept but were skeptical and would have to know more, still others were like no way.
I think they started talking about giving birth underwater shortly after that too. Supposedly no pain and no blood. Sounds too good to be true to me and also wondered about water in baby's lungs. Really doesn't seemed to have taken off much.
And I kind of doubt that will either. I considered the chair but am shuddering at the notion of having to stay standing. I had absolutely no muscle tone after giving birth. I do mean none. I felt like jelly and couldn't even hold her. They offered but I was just laying there quivering unable to move and said if you put that baby in my arms, she's just gonna roll right out of them. Daddy held her to me. I'd have probably fallen and crushed her!
Bottom line: given the trauma that giving birth is, I don't think we'll ever stop thinking about the methods employed.
Of course: use of forceps, vacuum extraction and episiotomy -- yep. longer pushing -- no way of knowing. tissue damage, etc. -- not that I know of but loss of blood to the extent that I needed a trasfusion.
Still don't think I would have opted to stand. (And, yes, I'm kidding about the falling; I know they would have held me up. Shudder.)
T's Grammy at September 9, 2008 6:17 AM
Childbirth got all crappy when male drs realized midwives were taking away a huge potential profit group. I mean, I'm all for pain relief, and c-sections when needed, and all the good medical intervention. And we're starting to get away from all the bad parts of the medical intervention. And yes, pushing the baby uphill is just idiotic.
And I think I've stated my huge, huge, huge pro-birth control stance before. I wish we could put depo in the water system!
momof3 at September 9, 2008 6:24 AM
I had both of my babies in the 90s - one in '92, the other in 95. Had a paridural both times (a partial epidural). I laid down when I first got to the hospital, and watched Bugs Bunny cartoons, but man, after the paridural wore off, I had to get up and walk just to ease the pain! I didn't give birth standing up, but kind of squatting, for both births, on the bed, holding a bar that the nurse put across the bed. I remember with #1 I was in hard labor about 3 hours; #2 was 45 minutes. The doctor came in, had a look and said "you're not ready yet. I'm going to go have some lunch, I'll be back." My mom and the nurse helped me deliver #2, I was holding her when the doctor got back. I just looked at him, and my mom said, "she was ready." o_O
Flynne at September 9, 2008 6:38 AM
"Childbirth got all crappy when male drs realized midwives were taking away a huge potential profit group."
It's a numbers game here in IL; malpractice insurance is driving doctors out of state, so the state is launching a huge campaign to try to keep them in. My old OB hired three NP/ midwives that she worked like rented mules for three years. She had them do all the labor and delivery work while she "supervised", peeping over their shoulders; they were cheaper for her to insure than herself. She billed me $3000 for 3 minutes of her licensed presence, after the midwife did all the time (5 hours) and effort. Earlier this year, my NP bid me farewell at my last office visit, told me why they were all getting out, couldn't take it anymore. Which is why I'm not going into obstetrics nursing as I had originally planned, if that's what's waiting for me.
juliana at September 9, 2008 7:22 AM
Why does this argument always come back to keeping kids on drugs to prevent pregnancy until they are 25.
Has anyone considered that we might be better served if an 18 year old was ready to be a productive member of society instead?
I'm just sayin'
brian at September 9, 2008 7:46 AM
"Childbirth got all crappy when male drs realized midwives were taking away a huge potential profit group."
It had always been crappy. Childbirth was always dangerous enough that there is a specific service in the Book of Common Prayer for welcoming women back to church after passing through the pain and dangers of birth. Women died for all sorts of reasons, including simple infections. Episiotomies? Pffft! Let'er rip. Midwives have a natural advantage over MDs just by virtue of MDs' orientation towards treating everything like a pathology, but midwives NEED the techniques and care that MDs offer when things go wrong, and with humans. they go wrong very easily. It makes you wonder how we got to be so populous. Have you ever watched a cat give birth? Piece of cake.
Jim at September 9, 2008 8:50 AM
"Has anyone considered that we might be better served if an 18 year old was ready to be a productive member of society instead?"
Easier said than done. AND that depends what it means to be a productive member of society. By age 18, most people have only a high school diploma. And, yes, I know, it's possible to be wildly rich and successful with only that, but every single friend I have who did NOT go the college route works at Starbucks or at a restaurant. Nothing wrong with that, but try raising a kid on THAT salary w/o health care benefits
I have a college degree, and I still need to work 2 jobs. My friend who got a more practical business degree is being forced by her company to get her MBA in the next 5 years (which she has to pay for).
What we have ended up with is college being the minimum requirement for MANY jobs (at least those with the benefits package you might want to raise kids). Sure, many trades are different. But, realistically, we can't expect everyone to go into a trade.
The receptionist job I worked for the first few months after college?--the description called for the classic 3-to-5 years of OFFICE experience/college degree catch-22. How many 18 year olds have 3 to 5 years experience or a college degree?
Even young people who are doing everything they can to be self-sustaining as soon as possible are not likely ready to do so until their 20s.
If they're having sex, drug 'em! Or throw some condoms at 'em.
sofar at September 9, 2008 8:53 AM
T's grammy -
Actually, water birth was great for a couple of women I know. The baby is still using the umbilical cord as it is brought up slowly out of the water (usually set to the temp of the uterus), so breathing isn't an issue - as far as the baby is concerned, it just got a bigger place to spread out more.
Unfortunately, mine were cut out of momma, because her body wasn't keen on natural birth. But given the option, water birth would have been it. And I wouldn't call water birth dead, the hospital the six year old was born in, had two birthing pools - the one the nine month old was born in had four water birthing suites. Indeed, we were told that if vaginal birth would be a possibility at all for the nine month old (unlikely from the beginning) it would have to be water birth.
The water birthing suites we visited here were designed for momma to be upright - the one's at the six year old's hospital, back in Michigan were not.
DuWayne - water birthing fan at September 9, 2008 10:37 AM
a couple'a things to think on...
The issue of when humans are ready to give pirth isn't the issue. The issue is that our societies are able to turn on a dime in terms of expectations and taboos. Human evolution is generally not. We reach a peak so early because for all those millions of years human life expectancy was roughly 35. At 17 years old you were middle aged, and to keep the species going... you needed to have kids. It is only in the last several hundred years that the expectancy has gone up. In 1900 the average US expectancy was only 47. CDC life expectancy tables
But by 1950 it was all the way up at 68. This changes the dynamic of what things you need to be and do at what stage of your life.
If your future lasts for 60 years after you turn 17, you will need a different strategy for life, than you do if your future is only 20 years. If you watch your children grow up and have their own children, there is a different expectation than if you barely get them to be self sufficient before you croak.
This is an idea that is seldon thought of when talking about the roles of age in our society. When you married right out of school [if you went to school] and lived in the same town as your family, probably did the same job as them too, this was much closer to how we evolved to begin with. But it isn't how we are growing now. Many people don't live near their families, and have dynamic challenging jobs, and live for a very long time indeed. This changes their perception. But their biology is still the same. It still thinks they may die at 35. If we looked at it that way, we might do things differently when talking to kids about procreation, AND we might develop new ways of preventing it until the timing is right. This is my beef with abstinance ed. This is not a moral hazard as much as it is a function of longevity, and a function of choice. The equation is far different if you choose to follow biology, than if you choose to partner late, and have children late [Or maybe never have 'em at all].
These are things we know but we don't know them. This is why we still think of 17 years olds as "children" when they clearly are not. The idea of extended adolescence is very valuable if we can figure out how to use it.
On the other claw the things about birthing... #1 son was had at home with a doctor attending in '94 in suburban Chicago. They had a whole practice devoted to this. We were uninsured at the time, and their program was designed so that you pay upfront during prenatal visits, so that by the time the kid comes, you are already paid up. The coolest thing wasn't that. It was that they did one thing that most people don't/can't think of.
They don't do home birthing for women who are higher risk.
Some moderately high percentage of pregnancies are fairly normal, and don't NEED the machine that goes "BING!" Midwife, having it at home and so on are good for that. The problem is that there is no guaruntee of anything. #1 son had the umbilicle wrapped 2x around his neck. The doctor smiles at me and says "this is about the time that a regular doctor freaks out and starts emergency proceedures, and cutting..."
At which point he calmly slipped his finger in behind the umb. and blooped it over the kid's head and out of the way. No cutting, no freaking out. This is experience. Midwife's do it all the time.
The problem comes on the one time when experience isn't enough, and you take the ambulance to the hospital. Perhaps the kid has some undiagnosed problem, and dies. Now everyone gets sued, and eventually people stop allowng it to be done outside the hospital, because of the potential downside. Even if that downside only happens in 1% of the cases, it becomes too much of a risk to many people. Once you get the insurance and the hospitals involved they have to used proceedures that minimize risk, especially for them. This is why the baby is had where the doc is in control, and the woman is in a semi drugged state.
This is also why #2Daughter was had at the hospital. It was all the insurance would pay for. AND they paid 2X as much... because those machines that go "BING!" are quite expensive.
SwissArmyD at September 9, 2008 12:37 PM
Swiss -
Sure, life expectancy has gone up. But the upper limit of female fertility hasn't.
A woman having a baby at 43 is high risk if it's her fifth. Insanely high risk if it's her first. Frankly, I'm surprised that an otherwise responsible woman would have put herself in a position to become pregnant at 43, given the risks.
So, we have people walking around at 17, hormones raging because the body wants to reproduce because it's still programmed to believe it's checking out in 20 years. The ability to reproduce is likely to be gone in 20-25 years, but our raging bag of hormones has a good 60 years to go.
What's screwed up is our priorities. I think it far, far better for people to be producing offspring in their early 20s rather than term papers and theses. Well, female people, anyhow.
As I've said before, if you really want a family, you ought to make that your priority because by the time you get your career nailed down you're almost out of time. But you've got the rest of your life to work.
God, nature is SO sexist.
brian at September 9, 2008 2:36 PM
"God, nature is SO sexist."
Male sexual prime is 20 (ish) and female prime is late 30's to 40 (ish).
The great cosmic joke.
juliana at September 9, 2008 2:48 PM
Juliana, I don't mean to give you a hard time with this, but am sincerly interested in your insight. How old were you when you figured that out?
Crid at September 9, 2008 7:13 PM
I have always wondered about the standing vs. lying down birthing methods. It seems much more logical that standing/squatting would be preferable. Squatting at least puts outside pressure forcing the baby out without solely relying on muscle.
Lying on one's back seems like it would make it much more difficult.
Couldn't they just make delivery that help keeps a woman reasonable upright? It doesn't seem like it would be too tremendously difficult.
flighty at September 9, 2008 10:08 PM
'A woman's prime' meaning enjoyment of sex, perhaps, but reproductive 'prime' is earlier.
crella at September 10, 2008 3:38 AM
>>Hell, even back in 1983 when I gave birth, the hospital had some kind of weird chair in which you could give birth in that upright position albeit sitting with legs spread.
Same memory here, T's Grammy.
I was lucky (in 1990) to be at one of the best maternity hospitals in the south of England. The tour of the birthing unit included giving us all a glimpse of that "weird chair", as if it was a device some drippy hippie mother might want to use - then we were all briskly hustled to view the standard beds where we were obviously expected to obediently do our stuff on our backs!
Jody Tresidder at September 10, 2008 8:29 AM
There used to be, probably still is, I suppose, a thing called a birthing stool. Basically a wide stool with a hole in it. If I'm ever batty enough to have kids, that's the way to go. Gravity: the same reason half the world squats to shit.
By the way, ever worked with a rural Russian? They clamber up on the toilet and squat over it. I had the hardest time figuring out why there were footprints where your ass goes.
And sexual prime in women now is not the same as reproductive prime. It's a construct of our views on sex. It takes most women until they're 30-40 to stop caring about what everyone else thinks and to get tired of shitty sex. The hot years in the beginning of marriage are when women are still roused enough by the idea that they're wanted. Once that thrill is over, sex declines. That's my theory anyhow.
christina at September 10, 2008 2:19 PM
Hey Crid-
Depends on what you mean by "figuring it out"; Certainly, my perspective has matured over the years (just my perspective, not me as a whole, LOL) so it's taken awhile for it to all come together. Kind of like reading a book that's been a favorite since childhood, and it seems different every time. The book isn't different, I am.
Had lots of women's studies back in my first round through college. This wasn't just a bunch of politics and history, but also a great deal of women's reproductive health covered (Good school, not a lot of bra-burning feminist rhetoric but actual practical issues). Covered research on hormonal changes, thinning tissue walls, etc, and the ramifications. I was 19, hearing about the whole "cosmic joke" whilst surrounded by a bunch of horny college guys. I'm thinking, "Okaaaayyy...whatever THAT means...?"
Flash forward to today when I'm thirty-mumble years old. Married fourteen years. Three kids. Dittos to a portion of what Christina had to say just before this: to stop caring what everyone else thinks and being tired of a "sub-par" sex life. There are so many other variables though; what exactly is it that makes a woman feel like she's in her sexual prime? Some women that reach prime age may feel unattractive after kids, are sick of their husbands/ Sig. O's/ BF's, are no longer emotionally let alone physically intimate, feel run ragged, etc. etc. etc. They lose their groove. Then there are others who take care of themselves, actually LIKE their H/SO/BF and are treated well by them in return, maintain both intimacies, therefore are not afraid to ask for what they want, and find that the groove can keep getting better.
So, for many it can be a great cosmic joke, since it's something we as a culture are not very good at talking about. Some of us can really miss out, thinking it all has to fit within the confines of a rigid structure; one must be young, beautiful, low-body fat, and single to have satisfying chick-a-bow-wow. However, am loving that the concept is getting some press with the "Lady Cougar/ MILF" identities. Not exactly the most sophisticated examples, but it shows the willingness to at least talk about it.
IMHO. I could be wrong. *grin*
juliana at September 12, 2008 10:13 AM
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