The benefits of upright and active labour and birth to women, babies and a healthy labour are uncontroversial and well established – and yet women are still so often confined to the bed in obstetric units.
Women who are welcomed into a midwife led unit, on the other hand, tend to have rooms where the bed is not centre stage, and instead the standard birth support equipment lends itself to upright, kneeling, squatting or forward leaning positions for labour and birth. Access to a birth pool is common, as are slings, birth couches, mats and balls.
Walk into most obstetric units and the untrained eye would have a hard time recognising it from any other hospital room. Machines, cables, bleeps and flashing lights and of course, in the centre, the bed. We spend 1/3 of our lives lying down in bed. When we are admitted to hospital for any other reason than to give birth, we lie down in bed. There is every psychological reason to automatically go to the bed and lie down when we’re admitted in labour – and every physiological reason not to!
By taking away the focus of the room from the bed and towards ways to support active labour and birth we know that we can shorten labours, help with babies’ positioning, reduce the need for pain relief and have more positive births. It is therefore not only a real worry that women who are birthing in the obstetric unit so often don’t have the automatic access to the low cost, high value equipment which supports this, it actively causes harm by reducing and limiting the woman’s ability to move in labour.
We call upon the commissioners and managers of obstetric units to consider the ways that their birth units can have the best of both worlds – the low-tech, high impact equipment which helps women to remain active, and the high-tech, high impact equipment available if necessary, but ideally easily accessible but slightly hidden, eg behind a screen. While, clearly, hospital birth pools can’t be plumbed into every obstetric unit room, there’s no reason why each room can’t benefit from a HiLo Birth Chair, or something similar. This simple piece of equipment is perfect for supporting active birth in every room in the obstetric unit. Fast and easy to clean, small footprint for even the smallest obstetric room, the HiLo Birth Chair provides excellent support for multiple labour and birth positions including upright breech birth. It supports normal human birth physiology and biomechanics while permitting extremely easy access to the woman in order to offer monitoring of all kinds, and all other tests and checks which can be performed without the woman lying down (ie almost everything). The reduction in the use of anaesthesia, caesareans and other expensive interventions1 that are likely to come from using the HiLo Birth Chair in each obstetric room will mean that it will quickly pay for itself. Indeed, just one avoided caesarean covers its cost as well as stopping that woman from possible life-long complications from major surgery.
We need to move away from an either/or situation for women. It shouldn’t be that only women on the MLU can access evidence based equipment that can reduce costs for the Trust, reduce interventions for the mother and baby and increase the chance of each mother having a positive birth. Obstetric units can benefit from this equipment too – saving money and having better outcomes for women and babies.
- Cochrane Review, “Mothers position during the first stage of labour” https://www.cochrane.org/CD003934/PREG_mothers-position-during-the-first-stage-of-labour