Aust NZ J Obstet Gynaecol 1992; 3 2 2: 104

Why Deliver in the Supine Position? Gautam N. Allahbadia: MD, FCPS, DFP, DGO, DNB (New Delhi) and Pratibha R. Vaidya: MD, FCPS, DGO, DFP Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Bombay, India

Summary: This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.

George Engleman (l), Professor of Obstetrics in the Missouri Medical School, published a treatise in 1935 on his observations of ‘labour among primitive peoples’. In it he stated that ‘the care with which the parturient women of uncivilized people avoid the dorsal decubitus position is sufficient evidence that it is most undesirable for ordinary cases of confinement. ‘More recently, other obstetricians and midwives (2) have suggested potential benefits from the so-called ‘physiological positions’, including a reduction in the duration of labour and a reduction in the need for episiotomies and forceps deliveries, together with an improvement in the condition of the neonate. Yet the majority of women all over the civilized world labour and deliver their babies in the supine or semirecumbent position in a hospital bed. There is little doubt that this arrangement is the convention that most women expect, even in our society. It also makes it easier for the midwife or doctor to monitor both fetus and mother, and since safety has a priority in obstetrics, it will require more than anecdotal observation to dramatically change current practice. Atwood (3) stated that delivery is easier for the mother in the squatting position because the same expulsive direction and same muscles used for defaecation are used for expulsion of the fetus. Further Russel (4) stated that this position enlarges the dimensions of the pelvic outlet and enables the patient to bear down to the greatest advantage. In this position, there is adduction and flexion at the hip. This causes a separation of ischial tuberosities and increase in the bituberous diameter. Atwood (3) in advocating use of the squatting position also stated that gravity aided 1. Lecturer. 2. Professor and Head of Department.

Address for correspondence: Dr. Gautam Allahbadia, 262, My-Nest, Wadala, Bombay-400 031, India.

the expulsive efforts, placental transfusion occurred automatically and this position also prevented the supine hypotension syndrome. Thus we embarked upon this study to examine if the squatting position increased the efficiency of parturition, was not detrimental to the outcome of mother or baby and hoping that our patients gradually would prefer squatting during delivery.

MATERIALS AND METHODS Our study was conducted during the period January, 1990 to December, 1990 at the Lokmanya Tilak Municipal General Hospital, Bombay. Our control group was comprised of 100 patients kept in the supine position throughout labour. The study group was comprised of 100 patients kept ambulatory in the first stage of labour and encouraged to adopt the squatting position during the second stage. We had no special equipment like ‘birthing chairs’ or special delivery cots. These patients were made to squat on the usual delivery cots. All primigravidas in the control group were given prophylactic episiotomies. Initially for the first 22 cases (primigravidas) in the study group no episiotomies were given but with the high incidence of perineal trauma encountered, the remaining 20 primigravidas were given a prophylactic episiotomy at which moment they had to lie down in the supine position temporarily. No support was given to the perineum at the time of delivery of the baby in women in the squatting position. All patients were made to lie down during the third stage of labour. All patient were selected at random irrespective of their age, parity, height, weight or expected baby weight. All patients were full term (37 weeks’ gestation or more), with adequate pelvis, vertex presentation and no medical, surgical or obstetric disease. Labour was monitored clinically and the duration of the first and the second stage of labour along with complications if any were studied. When the patients in the study group were ambulant in the first stage only clinical monitoring was

GAUTAM N. ALLAHBADIA AND PRATIBHA R. VAIDYA

Table 4. Mode of Delivery

Table 1. Age Distribution ~~

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Age group (years)

Number of patients Supine position Squatting position

Why deliver in the supine position?

This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely us...
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