Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push

Inviting Newton to Visit the Delivery Room. The Role of Gravity During Childbirth

Throughout history, the upright position was the norm for most deliveries. However, due to cultural reasons, this practice was changed in the 17th century, and since then, the majority of deliveries have been conducted with the parturient lying on her back. The aim of this review article is to challenge the nowadays recumbent birth position and to emphasize the added value of gravity to the childbirth. Physiologically there is a strong argument for delivering in an upright position due to the significant role of gravity. The baby's presenting part does not move back between contractions as happens in today's recumbent position when due to the anatomy of the pelvis, the presenting part moves uphill. In this position, the second stage is shorter, and the signal for active pushing occurs spontaneously. It is recommended that any parturient should be informed about the risks and benefits of each birthing option to decide the birthing position that suits her.

Safe Childbirth: A Call to Action

Since the publication of Lamaze's Six Healthy Birth Practice papers in 2014, there has been increasing concern with the safety of the current maternity care system. A doubling of the maternal mortality rate in the United States and the continued high cesarean rate, as well as ongoing research that supports physiologic birth and identifies the risks of interfering with the physiologic process, has resulted in updated guidelines for care and has spurred advocacy efforts to transform maternity care. This article presents a number of these advocacy efforts.

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Maternity care in the United States continues to be intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy has decreased but is still higher than it should be. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This paper describes the use and effect of routine interventions on the physiologic process of labor and birth and identifies the unintended consequences resulting from the routine use of these interventions in labor and birth.