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1. It is high time that labouring on back is outlawed
When you want to understand the logic behind something, delve into its history.
When I was in medical school, I never understood how women took such
uncomfortable positions during labour. Lying on their backs or reclined on the chair
(at a high-end hospital), with their legs up in the sky or hung in stirrups. This is a
disturbing image and probably that's one of the reasons that in India they do not
allow the husband/ partner to be in the labour room.
I also had an interesting conversation with my maid who is 50 and has 4 kids. She
delivered in her village and she distinctly remembers squatting (like sitting on the
Indian toilet) and the baby coming out. She also prides over the fact that she had no
tears or stitches for any of her births. I was intrigued. So, as any inquisitive mind
would do, I delved into the history of it.
It's storytime!
Before males were allowed in the field of gynaecology, midwives were assisting
childbirths everywhere. They followed a more instinctual birthing technique. They let
the mother choose how she wanted to give birth while they just assisted the process.
Slowly, as males started entering the field, these things changed.
Up until the 16th century, births were only done by midwives. The only males in the
birth process were the surgeons (who were called butchers at that time) who were
called in for complicated births (Image 1). Slowly the males started infiltrating the
whole birth scenario.
Francois Mauriceau of France was the first one to introduce a reclining position for
births without any evidence backing it (Image 2). The aristocrats of that time
preferred the lying down position as well because the mothers could cover their
faces or be sedated through the whole process. So the female was reclined on the
chair with the curtain between the doctor and her. The doctor didn't have to see her
face and could perform the delivery without any interference. In addition, this position
made it easier for them to give episiotomy (the Cut) which was again administered
because it was considered safe (without any solid evidence to back it up). Once this
practice was common in Europe, it also became popular in America. And slowly, the
instinctual birthing positions were replaced with the lying down position without any
scientific backing. And from there began the systematic medicalization of a beautiful
natural process. Thus started the medicalization of birthing practices and the birthing
instincts were broken down bit-by-bit
Five top reasons why Lithotomy position is very damaging

2. 1.It restricts the movement of the coccyx and the sacrum. During labour, the pelvis
moves to create more space for the baby to come out. This is achieved by the
sacrum and the coccyx moving backwards. When we lie down, we restrict this
movement causing less space in the pelvis and these cases are falsely diagnosed as
CPD (cepahalo-pelvis disproportion) and taken into c-section.
2.Labouring on the back is against gravity. The baby is coming up instead of going
down along with gravity. Hence, the mother has to put more effort into this process.
3.Putting your legs up restricts the blood flow to them. This increases the chances of
cramps and fatigue. So when the mother is considered unable to labour because of
these reasons, they are taken for a c-section.
4.Damage to the Ulnar nerve in the hand. When the woman holds both her legs so
tightly, there are chances of damaging the nerve in the hand. This can cause wrist
pain, swelling and restriction of movement.
5.Higher risk of perineal tears and anal sphincter injury (which can cause faecal
incontinence, pain, discomfort and sexual discomfort)
Yes, in some cases lithotomy is indicated (depending on the position of the baby and
requirement of episiotomy) but it is never universal. Now it is high time that we adopt
safer birth practices. A lot of countries including the UK, Ireland, the USA, and
Australia are claiming back their midwifery birth practices slowly. A lot of changes
have been incorporated in their guidelines as well. For example, Episiotomy is no
longer routine and given only if it's indicated; Hospitals are more open to giving
different birthing positions; water-births are becoming commonplace etc.
As a doctor who has seen how childbirth has changed in many countries, I say it's
time we in India change it too. And this will not happen unless we women educate
ourselves more on what we are getting into.
References
1. https://www.ncbi.nlm.nih.gov/pubmed/23281859
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600206/