Importance of upright birth positions and the CUB

By MeriBeth Glenn, Traditional Midwife, Pennsylvania

I'm very excited to talk about the importance of upright birth positions! Many births in the US are taking place with women, in bed, with pain management procured, legs on the foot pads and the woman on her back. (The good news is that we've managed to trade the stirrups for foot pads but we're still birthing on our backs.) In many birth scenarios, women aren't being offered a birth ball, squat bar or even the option to birth in a side lying position. She might be able to labor and even push in those positions, but when it comes time for the baby to actually be born, many women are moved from a slightly more upright position into a standard lying or semi-sitting position that's best suited to the care provider.
 
The back-draws to this standard birth position is mostly evident in the postpartum time frame and the next several years as women find themselves suffering from pelvic floor dysfunction, prolapse issues and incontinence issues. Suddenly urinary incontinence items are added to the grocery shopping list and sending your husband for feminine products is no longer the most embarrassing thing you've ever had to ask him to buy. They find themselves sifting through google searches of care providers, pelvic floor therapists, kegel exercise instructions, yoni eggs, and ad after ad of exercise instructors who promise great results for healing weakened pelvic floor muscles and the ability to jump on a trampoline again without having wet pants.
 
Potty training a toddler shouldn't be made more difficult by the willful defiance of the little tike who boldly points out that mommy still wears diapers. Is it really so much to ask that we be able to sneeze, cough or laugh without having to brace yourself with crossed legs and a quick, silent prayer that you don't make a public announcement of a very a intimate issue? Speaking of intimate issues: Why should we settle for intercourse being painful or excessively saturated by leaking urine? Talk about a mood breaker! Lining the bed with extra towels or having to change urine soaked sheets the morning after, doesn't exactly boost a woman's postpartum confidence levels into the super sexy range. Yet we have been dupes into believing that it's just part of post baby body existence.
 
In recent years, more professionals are becoming increasingly aware that women aren't just content to continue being the vessel by which their babies come earthside. We are individual participant in a very active and athletic body process that requires preparation, mindset, surrender, resolve and movement. This concept has been applied and even encouraged to the LABOR process since the uprise of childbirth education courses in the 1980s. There's been great strides taken in helping to promote more active postures in labor and into the pushing stage for both natural unmedicated births and births involving some pain management options. However, the mentality to maintain those upright positions through the birthing process is often over looked. The result is that babies are still pushed earthside “uphill” through the pelvic bones and musculature resulting in unnecessary added bruising and trauma to much of the supporting muscles in the pelvic floor.
 
So a woman labors upright for hours and moves her baby down. As it is time to birth her baby, she's moved into a semi-sitting position, gives another few pushes and her precious blessing is welcomed into the world. She wasn't on her back the whole time so why, 2 years postpartum is she having such a hard time with her pelvic floor health? To understand some of/a portion of/a part of why this happens we need to look at few key parts of the female pelvis.
 
*In the illustration below I've included the male and female pelvis for comparison. It's super fascinating! The male pelvis (top illustration) is “V” shaped while the female pelvis (lower illustration) is “U” or “O” shaped.

The sacrum or tailbone is that large set of bones that starts in your lower back and goes down the line of your butt crack. It's the bone that you are sitting on when you're in a semi-sitting position, leaning back with your feet on the foot pads. The female sacrum has this amazing ability to swivel and move front or back in any direction as much as 45 degrees. This is in comparison to the male sacrum that can only move front or back (no swivel ability) up to 25 degrees.  When a woman is sitting on her sacrum, it can't move and swivel like it should be able to to allow more room for the baby to move through the pelvis. When the sacrum can't move, that means everything else has to. Soft tissue trauma, muscle trauma, swelling and stretching become far more prominent and much more likely.

Another key player in the birth game is the small piece of cartilage in the very front of the female pubic bone called the pubis symphasis. (seen in the illustration above) In pregnancy, That small piece of cartilage softens as a result of the pregnancy hormone called relaxin. Because it is soft, the pubis symphasis has the ability to expand or contract to allow the front of the pelvis to open or shift, allowing as much as 2” of extra space or can even compress to allow a mild, momentary overlapping of the front pubic bones. (Think of it like a pair of scissors; open the scissors are able to have something large placed into them but closed, they over lap.) If a woman is sitting on her sacrum during birth, the job of the pubis symphasis not only includes the job of expanding and compressing but to pivot and rotate---something the pubis symphasis can't do. It's not designed to! The result again means more trauma to the soft muscle tissues of the pelvic floor. The bladder is more likely to be pulled downward, the colon and rectum more likely to be shoved downward and back. It's just messy.

​So what's the alternative? Upright birth! Keeping a woman in an upright birth posture allows the key parts of the female pelvis to do their own individual jobs and removes much of the excess trauma risk to the pelvic floor muscles and tissues. When the sacrum can move and pivot and the pubis symphasis can expand or compress, the female pelvis has a potential for as much as 3” or 4” more space in the pelvis to be added for birth! This means less immediate heavy trauma to the soft tissues and far less likelihood of of organs being pulled or pushed from their usual resting places. It's the difference between tripping and falling on the sidewalk in comparison to being pushed down a flight of stairs. Trauma is inevitable either way, but the depth and extent of the trauma of being pushed down a flight of stairs is going to be more significant. It's going to take more time to heal and you are probably going to have more long term effects from being pushed.

How can we help women birth while lessening the trauma likelihood of “being pushed”? I mean let's face it, birth is hard and staying upright in some situations can be nearly impossible (especially with some pain management options.) Hospital birth beds can be moved to accommodate many upright birth postures including the addition of a squat bar. Birth stools, Birth balls, Birth eggs,/peanuts and rocking chairs have been widely used in the past several decades to encourage upright labor and birth positions. The frustration with some birth stools was that some mothers don't appreciate the unforgiving discomfort of the wood or plastics that they're made of. The same with rocking chairs. Adding a few pillows or padding might help but it's not exactly like sitting on a cloud. Enter the birth ball or egg! Squishy softness that even moved and allowed women to sit comfortably supported while rocking or bouncing to help move their baby down and labor to progress. Or you can get in a hands and knees position and lean over the ball or egg to support your upper body. It's great place to catch a nap in between contractions. At least until you leaned too heavily and the ball started to roll. Not a fun way to get startled awake!

​So for the women who want the sturdiness of the stool or chair but the soft comfiness of the ball, there's The CUB Comfortable Upright Birth support. This nifty inflatable U-shaped seat allows a woman to pick a variety of upright positions for labor and birth. The height also works well for birth attendants to allow for visibility and monitoring the wellness of the mother and baby.  

(for more information about The CUB, click here!)

​Isn't it wonderful to have options! Upright birth coupled with well rounded, sensible postpartum recovery care, can decrease pelvic floor trauma and greatly reduce long term pelvic floor issues like organ prolapse and incontinence. When we know better we do better. If we can take some simple steps or add a few more labor and birthing support options to assist in promoting upright birth, we absolutely do better!