March 12, 2004

Optimal Foetal Positioning?

The Midwifery Unit has not yet opened in Drogheda. When I last wrote about their plans it was hoped that it would have been operational around the middle of last year, but the time taken for decisions at the highest political levels have delayed its opening. The proposal has now made it to the top of the “urgent health initiatives” list and so its implementation is expected in the coming months. The midwives are still hanging in there, clearly impatient for its to be started, but happy about the prospect of finally having more say in the overall provision of maternity services in this area.

During the workshop today, the topic of OP labour, i.e. where the baby is positioned in a posterior position, came up. One the group members, midwife who has travelled all the way from Saudi Arabia, mentioned that in Saudi, the rate of OP labours is very low, in the region of 5 - 10% overall. Midwives in western countries have noted a huge increase in OP labours over recent years and anecdotally note that around half of all labours seem to begin with the baby in this less favourable position. It is thought to be due to the changed lifestyles of many western women: sedentary lives, little exercise and sitting in reclining positions, often with feet up, especially during the last weeks of the pregnancy. Many theories around “optimal foetal positioning: have been offered, together with strategies for preventing or even curing the problem.

When asked about these low rates in Saudi, this midwife said that she thought it was because of the way that women sit during their pregnancies - on floor cushions and frequently squatting. Saudi women are very sedentary, she reported, and tend to view pregnancy as an illness that requires rest. They exercise very little and even though they are not allowed to drive, they try not to walk anywhere either. However, when they get together, especially with other women, they often squat, perhaps sharing “tea and dates” as a social pastime.

This is interesting, because to is the direct opposite of many of the theorists who suggest that squatting during pregnancy is a cause of poor foetal positioning and resultant OP labours. They recommend that women avoid ever having their knees above their hips when sitting, and recommend either using birth balls or ergonomic chairs that position the knees below the pelvis. Squatting during labour and birth are also not recommended.

Women in many parts of the word squat to rest and to use the toilet. They give birth like this as well. We know from work done on the pelvic floor muscles, that squatting enables the pelvic floor muscles to relax completely (which is why squatting for defecation is so effective, particularly for constipation) so it makes sense that it would also work well for birth.

Once again, we need to be wary of dogmas and dictums when it comes to advising pregnant women. It makes sense to encourage pregnant women to take some exercise such as walking or swimming because of its general health benefits. Spending a lot of time sitting on chairs will often cause pubic symphysis pain which is a clear message to get up and move. Yes, we are more sedentary these days and we know this has health implications. No-one would suggest that Saudi women should avoid squatting in case it made their baby turn into a posterior position, so perhaps we can learn something from this as well. I will be talking about all this some more with this midwife - it is so interesting to have the opportunity to learn from other cultures.....

Posted by andrea at March 12, 2004 03:53 AM