Blog by Anneliese Braunegg, student at Case Western Reserve University
Essay winner, USNA 287Q Gothic Science, SAGES 2015
Instructor: Dr. Brandy Schillace
Envision two women. Each is in labor, each is in pain, and each is accompanied by a professional caretaker who is assisting her in giving birth. Here the similarities end. The first woman lies on a hospital bed with her hair strewn across the pillows; she is accompanied by a doctor, and she is simultaneously pushing her baby into the world as he pulls on it with forceps. The second woman sits on a birthing chair that was brought to and assembled in her bedroom; her hair is strewn across the chair back, she is accompanied by a midwife, and she is pushing her baby into the world as the midwife guides her through the process (“Midwifery Chair, c. 1850”).
The first woman is giving birth in 2015. The second woman is giving birth in 1850 (“Midwifery Chair, c. 1850”). In the generations between the second woman’s labor and the labor of her great-great granddaughter in this hospital room in 2015, now the present day, many changes will take place in the medical world. In an “‘unexplained revolution,’” typical birthing practice will “shift from female to male midwifery practice,” and “the female midwife… castigated as a rustic or vilified as a witch,” will come to “serve,” at most, “at the pleasure of the [male] surgeon” (Schillace). Pregnancy and labor will come to be “treated [not] as a natural process [but as] a medical condition” requiring a doctor’s intervention. (“Birth Chairs, Midwives, and Medicine”).
The primary birthing method shifted from use of the birthing chair to use of the birthing bed, “not necessarily because [lying on the birthing bed] is the best position for birth but… [because] it is the most convenient position for [the] doctor,” as it allows him to view the baby more easily and use a device that midwives have not used, the forceps (“Effective Birthing Positions”). Thus modern birthing culture will be born, and while women would, over time, become doctors, and pregnancy would come, once again, to be viewed as a natural state, the main method of delivery remained the birthing bed–the birthing chair largely forgotten. This is the way the world is today; however, hospitals of the present should not dismiss the method of the birthing chair too quickly. Giving birth on a bed, though it is the modern norm, is neither the only viable birthing option nor always the best one, and the expansion of birthing options would benefit the large number of modern women who go to hospitals to give birth to their babies.
Today, when most people picture a woman giving birth, they picture the woman lying on the hospital bed; less often do people picture the woman sitting on the birthing chair. The birthing chair birthing method is still used, but is much less common. This imbalance seems to imply that giving birth on a bed is somehow safer or more efficient than giving birth on a chair; however, studies evaluating the effectiveness of birthing chairs have shown that the birthing chair is a satisfactory birthing method for most patients who use it (Liddell, H. S., and P. R. Fisher) and that the use of a birthing chair does not increase the health risk to either the mother or the baby and is therefore a safe alternative to the use of a birthing bed (Kafka, M., et al.). Additionally, studies contrasting the birthing chair and the birthing bed have found there to be “less transient cord compression in upright positions” (Cottrell, B. H., and M. K. Shannahan) such as that taken while seated in a birthing chair and have found that “patients who delivered in the [birthing] chair [have] significantly lower rates of episiotomy [surgical cutting below the vagina performed to aid delivery] and manual separation of the placenta” in comparison to patients who delivered in a birthing bed (Scholz, H. S., et al.).
While the birthing chair presents “minor disadvantages such as increased soiling of the chair” and, depending on the chair’s structure, “impedes operative deliveries from the perineal floor,” the advantages were determined to outweigh the minor disadvantages, and the suggested solution to the operative delivery impediment was not the use of a bed instead of a chair but instead a combination of the two into a birthing bed that can be shifted to accommodate all positions from sitting to recumbent (Schurz, A. R., H. Concin, and M. Kobermann). The results of these five studies indicate that while the birthing chair can safely be used as an effective alternative birthing method the birthing bed. In addition, because the less conventional birthing chair birthing method has been found to be a viable, potentially advantageous alternative to the birthing bed method, it would be beneficial to explore further the advantages of other less conventional birthing methods that exist.
The most effective of these other less conventional birthing methods include the birthing bar that attaches to a bed, the birthing stool, the upright sitting position, the kneeling position, and the curled side position, and each of these methods and positions presents certain advantages for the woman in labor (“Effective Birthing Positions”). These advantages include expanding the size of the woman’s pelvis (birthing bar and birthing stool), taking advantage of gravity to help push the baby (bar, stool, and upright sitting position), providing physical support for relaxation between contractions (bar, upright sitting position, kneeling position, and curled side position), and protection from back pain and vaginal tearing (kneeling position for the former and curled side position for the latter) (“Effective Birthing Positions”). Evidently, a variety of valid birthing methods exist. However, even though these methods present certain advantages to a woman in labor and even though, in the case of the birthing chair, research was performed as many twenty years ago indicating that the method is a positive one, the bed birthing method remains the primary birthing method made available to and used by laboring women. It is time that these studies’ suggestions be effected and that hospitals make information about and access to birthing chairs available to pregnant women, and it is time that other alternative birthing methods be scientifically examined and, if also found to be valid, also be publicized and made available.
Some birthing centers do, in fact, offer some of these alternative birthing methods, and it is noteworthy that these methods are available not only at birthing centers specifically designated as alternative but also at some mainstream hospitals. A well-regarded example of such a hospital is MIT Medical, of the Massachusetts Institute of Technology in Cambridge, Massachusetts. In addition to offering the traditional option of giving birth on a bed, the hospital states on its website that it “alternative birth experiences are also available, including birthing chairs, birthing balls, hypnobirthing, doulas, and water births” (Patient Services: Obstetrics and Gynecology”). The fact that MIT Medical presents these options on its website is important; in order for effective birthing methods currently considered alternative to become accepted as mainstream, it is vital that established, well-respected hospitals embrace these methods and clearly state their availability. In doing so, hospitals make the labors of more women safer and easier, as they become better able to accommodate the needs of all the women who come to the hospital to deliver a child.
No two births are exactly alike. The uniqueness of each birth makes it vital that hospitals pay attention to the fact that giving birth in a bed, while the most common method of birthing, is not the only viable option and not always the best one. Hospitals like MIT Medical have taken a positive step toward addressing non-bed birthing methods, but even at MIT Medical, such methods are still presented as “alternative,” misleadingly implying that they may be less reliable than the bed birthing method (“Patient Services: Obstetrics and Gynecology”). Doctors and midwives should therefore continue to expand their knowledge and provision of different birthing practices and, just as importantly, make available to pregnant women and their partners information about the variety of safe, effective birthing options that exist. In doing so, they will ensure that both the woman in the bed and the woman in the chair will be in those places because they have chosen to give birth there and that they have chosen those places because they made the informed choice that those birthing methods are the best birthing methods for them.
“Birth Chairs, Midwives, and Medicine.” University Press of Mississippi. UP of Mississippi, n.d. Web. 6 Feb. 2015. <http://upress-test.hpc.msstate.edu/books/63>.
Cottrell, B. H., and M. K. Shannahan. A Comparison of Fetal Outcome in Birth Chair and Delivery Table Births. N.p.: n.p., 1987. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3140301>.
“Effective Birthing Positions.” Taking Charge of Your Health & Wellbeing. U of Minnesota, Aug. 2009. Web. 6 Feb. 2015. <http://www.takingcharge.csh.umn.edu/activities/effective-birthing-positions>.
Kafka, M., et al. The Birthing Stool–An Obstetrical Risk? N.p.: n.p., 1994. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/7988858>.
Liddell, H. S., and P. R. Fisher. The Birthing Chair in the Second Stage of Labour. N.p.: n.p., 1985. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3862405>.
“Midwifery Chair, c. 1850.” Dittrick Medical History Center and Museum. Allen Memorial Medical Library. 11000 Euclid Ave, Cleveland, OH 44106-1714. 27 January 2015.
“Patient Services: Obstetrics and Gynecology.” MIT Medical. Massachusetts Institute of Technology, n.d. Web. 6 Feb. 2015. <https://medical.mit.edu/services/obstetrics-gynecology>.
Schillace, Brandy. “On the Trail of the Machine: William Smellie’s ‘Celebrated Apparatus.'” Dittrick Museum Blog. Case Western Reserve University, 4 Apr. 2013. Web. 6 Feb. 2015. <http://dittrickmuseumblog.com/2013/04/04/on-the-trail-of-the-machine-william-smellies-celebrated-apparatus/>.
Scholz, H. S., et al. Spontaneous Vaginal Delivery in the Birth-Chair versus in the Conventional Dorsal Position: A Matched Controlled Comparison. N.p.: n.p., 2001. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/11603105>.
Schurz, A. R., H. Concin, and M. Kobermann. Experience with EK-Birthing Chair (Author’s Transl). N.p.: n.p., 1981. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/6915863>.