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इतिहासातील जन्म देणाऱ्या माता

Although most women envision birth in a semi-reclining or semi-sitting position these days, there are many other possible positions in which to give birth.

In this illustration of the Kiowa Indian tribe from the North American plains, a helper in front blows into the mouth of a mother standing to birth, while the midwife catches the baby from behind. It is not clear what the blowing is for, but probably was used as a focus or distraction technique, to help with breathing techniques for pain relief, or as a symbolic "blowing in" of strength.



Squatting

Squatting is a position seen in a great deal of artwork from many societies, such as this Persian birth scene. The mother is on a very low birth stool but is basically in a full squat.

Check out this peaceful Filipino woman, also giving birth in a full squatting position (art credit: Alicdang of Sagada). 


Many tribal societies, from Native Americans to African tribes, have illustrations or statues of women squatting to give birth, like this pottery illustration from the Mimbres Pueblo tribe. Notice that the mother's knees are far apart.


In this Egyptian carving, the woman is squatting to push, while bracing herself on helpers and furniture of some sort. Notice her knees are closer together than in the other pictures. Many childbirth educators have observed that the back half of the pelvic outlet in the squatting position actually increases more when the knees are a bit closer together than farther apart.


This classic birth statue of an Aztec goddess pushing out her baby while squatting seems to reflect that. Her knees are not widely spread. Her face certainly shows the intensity of pushing!


Regardless of whether the knees are far apart or not, squatting is a position that is shown in a great deal of artwork from ancient or traditional societies, as in this illustration of a birthing woman from the Tonkawa Indian tribe of North America.



Supported Squatting

Some women find squatting too tiring to sustain during birth. Many utilize what is called a "Supported Squat" position instead. The most common way to help sustain a squat is to lean on something or to hold onto other people, one on each side.


In this South Indian carving, for example, a woman gives birth in a standing squat, holding on to women on each side of her. The midwife's size below shows her relative unimportance in the artist's mind compared to the mother. Notice that the mother is shown as the largest and most powerful figure in the carving, probably as a commentary on the power of the birthing woman.


In this ancient Greek relief, a woman is shown squatting on a birth stool with arms around helpers on each side while the midwife catches the baby from below.


In this carving from ancient Egypt, the mother also gives birth while holding onto attendants on either side. She uses a stool for stability but her position is very much a supported squat.




Kneeling 

A position very similar to squatting is kneeling. Birth art from many different cultures depicts kneeling for birth, either on both knees or asymmetrically with one knee up and one knee down.


Basically it's pretty close to squatting in many ways, except the mother is on her knees instead of her feet, and she is fairly close to the ground, as in this statue from Costa Rica.


Many Egyptian carvings show women giving birth in a kneeling position, like this one.


This illustration of a kneeling position, supposedly of Cleopatra, is also from Ancient Egypt. Notice that she is being helped to hold her arms up to give her some counter-force (more on that later).


It's difficult to tell the birth position in this Japanese illustration, but it certainly looks like she is kneeling.


And this pre-Columbian Jalisco statue also appears to use a kneeling position.


So does this statue from the Kraja people of the Amazon...


...and this African statue from Cameroon.


Many First Nation peoples from North America used kneeling positions for birth. This Inuit statue shows a mother and her birth support person behind her, both kneeling.


In this illustration of a kneeling position of the Blackfoot Indian tribe of North America, the woman uses a pole in the ground to help give her support while kneeling.


In this woodcut illustration of the birthing practices of the Comanche tribe, a series of poles were driven into the ground, outside a circular temporary shelter. The woman in labor would walk back and forth along this line of poles, kneeling and leaning forward onto a pole during contractions. Her labor support person would massage or give quick shaking motions to her belly during contractions (this is rumored to help encourage babies into more optimal positions for birth).

Sometimes she would go into the privacy of the shelter and squat over holes with hot stones (heat can be comforting in labor) and aromatic herbs. She might have given birth in any of these spots but she likely was in a kneeling or squatting position when she did give birth. 




Hands and Knees Positions

Another position that was popular was a variation of the kneeling position. Today we call this the all-fours or hands-and-knees position, although the mother wasn't always completely on her hands and knees.


For example, in this illustration of an 1800s African-American woman from the American South, the mother labors while kneeling on the floor but leaning on a chair so she could rock back and forth during labor. Notice that the position of her legs is a bit asymmetrical.

A hands-and-knees position is different than the upright kneeling positions seen in the kneeling illustrations in the previous section. The hands-and-knees position is not an upright position, but rather a kneeling one with the mother at a significantly inclined angle.


Here is a Persian woman, using stones to help her assume an elevated variation of a position somewhere between the all-fours position and the supported squat.


In this small section of a larger painting from a temple in Bhutan, the mother gives birth on her knees and elbows (sometimes called a knee-chest position). This can be a particularly good position for a mother who is experiencing a really painful back labor.

Upright Sitting


A lot of ancient birth art showed women in a mostly upright, semi-squatting/semi-sitting pose, such as in this Roman carving. Note the position is far more upright than traditional Western semi-sitting positions.


Here is an illustration of a sitting position from a Tibetan temple. Notice how upright the mother is, even as the baby is coming out.


In this statue from Burkina Faso from Africa, the mother is sitting, but she is mostly upright. Notice that this baby is even coming out breech (not head-first)!

Semi-Reclined

Of course, some positions were more than a little reclined. They were usually not flat on their back like a lithotomy position, mind, but were a bit more recumbent than those above.


Here is an illustration from a Persian mirror case. The mother is a little more reclined in this one, but is not totally reclined either.

Here is a semi-reclined position from some Mexican pottery.

This statue from Costa Rica also is semi-recumbent, but without abducting the legs so far apart and elevated, like hospital positions often are. The back also looks a little arched (see below).


Here is a similar statue from Ecuador. Again, notice the more natural position of the legs, rather than having them lifted and strongly abducted.

Reclining

Although it is harder to find historical artwork of women giving birth in a very reclined position, there are some records of that position too.


This Cameroon woman from Africa is giving birth fully reclined on a "maternity couch." 


This illustration is of a French Canadian woman propped up in a mostly reclining position on a mattress over an upside-down chair. Notice, though, that her knees are not splayed or pushed back.

Note that even though semi-sitting, semi-recumbent, and reclining postures wereseen among older cultures, there were some important differences to the ones seen in many hospitals now. Their semi-sitting positions were often more upright than ours, and when they laid back, their legs were not usually as elevated and splayed as they are in most semi-recumbent and recumbent hospital positions today.

Asymmetric Positions

Another variation on these positions is the asymmetric position.

Having each leg on a different level (whether during a semi-sitting, reclining, kneeling, or all-fours position) makes one side of the pelvis higher than the other. This opens the pelvis on one side, making more room for a baby to turn from a less-than-optimal position. This can be a powerful tool in a non-progressive labor. 



Here is a painting, possibly from Finland, showing the woman sitting near the edge of a bed or stool. At first it looks like the usual semi-leaning back position. However, notice that one leg is up on a stool while the other is down. This makes it an asymmetric position.


This Indian painting shows a reclined woman giving birth on a bed, though her head is raised a bit. Notice that one of her legs is propped on the midwife's shoulder while the other is down, giving her an asymmetric position while lying down.


Many women who give birth quickly or unattended assume an asymmetric position naturally. This woman from Mexico assumed an asymmetric position (one leg up and the other leg down) instinctively in a recent U.K. birth that occurred so fast she gave birth on the lawn outside the clinic.

Birth Stools


Many women over time have used a a birth stool, as in the Ancient Greek carving above, because birth stools allow women to stand, squat, or semi-squat while actively pushing, then to sit back and relax between contractions.

If the mother stays seated the whole time she is pushing out the baby, a birth stool has the same disadvantages of the semi-sitting position (pushing the tailbone into the pelvic outlet and making it smaller). However, if the mother uses it to give support between shifting positions, it combines the best advantages of both the sitting and squatting positions.

Birth stool from about 1580

Here is an illustration of a birth stool in use in Europe about 1580. The use of a birth stool was extremely common in many European cultures.


Here is another birth stool birth from Europe, about the same time period, and the mother is even plus-sized!


Birth stools of various sorts have been very popular throughout history. Sometimes the care provider would bring the birthing stool with them to births....


...while other birth stools were family heirlooms, handed down through the family.


Often birth stools were close to the floor and without arms, but sometimes they were full-on chairs with backs, sides, and footrests, as in this European illustration.


Each type of birth stool has advantages and disadvantages, and some midwives and doctors had birth stools custom-made for them based on their preferences.

Image from the Wellcome Trust of the U.K.

In this more recent Greek illustration, a woman is held by her husband on a birthing stool, while the midwife crouches before them on a low stool.

There are many, many other illustrations of births on birth stools available. In the interests of space I will not post them all, but if you are interested you can find many additional images.


If you didn't have a birth stool, sometimes you improvised your own version. Lap-sitting on someone's lap was another very popular alternative, as shown here in an early American illustration. This position was very common among the settlers along the frontier.

The husband sat on a chair, and another chair was placed on its front on the floor in front of the first chair to support the mother. This created a sort of poor woman's birth stool. (Alternatively, a sheet was placed over the husband's lap to create a sling for the mother to sit on.) The birth attendant sat on a smaller improvised stool in front of the mother. The husband helped support the mother as she shifted between semi-sitting, semi-squatting, and standing positions.

Standing Positions

Standing and walking during labor is extremely common in many cultures, but women often shifted position for the actual final pushing out of the baby. However, birth while standing up did happen at times too.



For example, in this illustration of a birth scene from the Western African tribe of the Wakambas, the mother gives birth standing up, attended by 3 other women.


In this relief carving from India, the mother is assisted to birth in a standing position by helpers on either side.


In this image from Angola in Africa, the mother is shown giving birth standing. (Statues in certain African cultures were often given elongated forms.)


In this illustration of the Kiowa Indian tribe from the North American plains, a helper in front blows into the mouth of a mother standing to birth, while the midwife catches the baby from behind. It is not clear what the blowing is for, but probably was used as a focus or distraction technique, to help with breathing techniques for pain relief, or as a symbolic "blowing in" of strength.


Here is a similar scene from the Sioux Indians [some sources list it as being from the Iroquois]. The woman holds onto someone in front in a half-standing/half supported-squat while the midwife catches the baby from behind. Some accounts say that the tall supporter role in front was often given to a young bachelor male of the tribe, rather than the father. Presumably this was so that the father could see his baby be born, and so that young men developed an understanding of the potential consequences of sex!

Positions Using Counter-Force

Many women over time have found that having something to actively pull or push against while birthing the baby was helpful. Thus many traditional birth positions combined squatting, birth stools, kneeling, standing, or other positions with a way to let the mother utilize a counter-force.


For example, as this "Pioneer Birth Scene" illustration shows, women would often sit on their husband's lap to imitate a birth stool, half-stand or pull against someone in front of them during a contraction, then lean back and rest on their husband between contractions.


Some cultures used a rope tied to a tree or a cloth tied to something, as in the above illustration of an African American woman from the South. This helped the woman to be in a standing squat position. The rope helped support her weight so her legs wouldn't get as tired.


Here is a Sioux Indian woman from North America, using a rope tied around a tree to pull against for sideways counter-force.


In this illustration of Oronoko Indians from South America, the woman uses a sling and her helper to help support her semi-standing, semi-dangling squat position.


Here is another illustration of a dangling position, this time using a rope to help the woman relieve the pressure in a kneeling position. In this illustration of a scene from Mexico, the labor helpers are using their hands to massage and shake the woman to try to reposition the baby during a difficult labor.


This South Indian carving also shows the mother putting one hand down on a support and the other hand pulling on a vine or some sort of rope to birth her baby in a supported squat position.


Sometimes pushing away from something feels better. In this carving from Peru, the mother sits back against someone in the semi-squatting position. In that way, she can lean back and use counter-force the other way.


In this illustration of the birth traditions of the North American Pawnee tribe, the mother leans back and pushes against someone else while in the squatting position. The person behind her provides both stability and something to push against when needed. [Again, blowing on the mother seems to be part of the tradition of some Plains Indians. Aromatic smoke to the belly or perineum was used by several other indigenous peoples.]


In this Andamanese labor scene, the woman is in a supported semi-sitting position, but she uses her feet to push against a wall for more leverage. [The Andamese were a tribal people who lived on the small islands between India and Burma. They are nearly extinct now.]


Some cultures used a stick to dangle from, as in the illustration from Mexico above and also this African illustration from Angola. In this one, the mother stands with her back pushing against a tree, and also dangles from a stick placed at an angle to the tree. In this way, she gets counter-force both from behind and above.

Arched Back

Dr. George Engelmann, a physician who wrote a book in 1884 about birthing practices around the world (from which many of these illustrations are taken), notes that dangling or upright kneeling positions were common among many tribal peoples, and nearly always involved a change in the direction of the body's axis as the birth neared.

In other words, many women changed from leaning backwards to leaning forwards, or from leaning forwards to leaning back. This probably helped work the baby down through the pelvis or created more room for the cardinal movements of birth (turns and twists a baby must make to successfully navigate through the pelvis).

The Semi-Sitting Position in the hospital. Note the mother
is encouraged to curl forward into a "C" position
In most hospitals, women are encouraged to round their backs forward and put their chins to their chests to assume what some call the "C" position. This is thought tohelp the baby move towards the more roomy back section of the pelvic inlet, negotiate the curves of the pelvis, and make more room for the baby engage and move down. And indeed, many historical birthing positions make use of a forward-leaning (if more upright) tilt.

Yet many women instinctively try to change their axis and arch their backs in the opposition direction instead, especially at the last moment as they are pushing the baby out. Historical art shows several examples of this instinct.


Notice that in this statue from the Congo, the woman is in the common semi-sitting position, but she is arching her back strongly. As noted, in the hospital this is often discouraged and women are told to curl forward instead..all with the best of intentions. Yet arching the back may help move the sacrum and tailbone out of the way, tilt the public symphysis, and help create more space for the baby to move or for the shoulders to turn when needed.


In this variation on the Aztec squatting statue from above, note that the mother throws her head back and seems to have more of a slight arch to her back than a rounded forward back like hospitals recommend.


If you look closely, this ancient Cyprus birthing scene shows the mother lying back and arching her back somewhat. Certainly she is not curled forward into a "C" position. Although this is right after the birth of the baby and she could just be lying back to rest, her position suggests that this is how she actually pushed out the baby.


Sometimes women get in some seemingly strange positions while pushing, as in this Italian illustration. Lying back and dangling the legs over the side of the bed is one of these, but in some obstetric texts this position was listed as another remedy for shoulder dystocia (where the shoulders get stuck). 

In the above and below illustrations, this extreme position was recommended especially for "corpulent" women as a way to get the weight of the abdomen off of the uterus and birth canal, an old variation on the "fat vagina" theory we still hear spouted today. <insert eye roll>


Obviously, take that one with a grain of salt. Women of size successfully give birth vaginally in many positions, and many women of different sizes try to arch their backs as they are expelling the baby. Likely there is more to it than such simplistic stereotypes.

However, that doesn't mean that this position is not potentially useful for other birth situations. In fact, a German doctor named Gustav Walcher described a similar position over a century ago. The website, Spinning Babies, has a whole page devoted to Walcher's Position, with several illustrations and historical details.

In Walcher's Position, the woman is scooted to the edge of a high bed, arches her back, and lets her legs passively hang over the edge of the bed and dangle. If a high-enough bed is not available, extra cushions or a trochanter roll (such as those used in yoga or massage) are put under her hips to create the needed angle of arch. This is supposed to be an excellent position for helping a high baby engage into the pelvis and to open up the pelvic brim. They also note that the position is sometimes used for breech births or for resolving shoulder dystocia.

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