Ladies….please be seated. Or why a birth stool can make a difference for women and midwives during labour and birth
I recently supported a woman who chose to give birth to her first baby at her local hospital.
When I got to her home, Jessica was in advanced labour choosing to remain in the bathroom and hopping on and off the toilet to help with the intensity of contractions. By the time we arrived at the labour ward and were shown into a room she had a strong urge to push. Brilliant! Jessica walked around swaying her hips, sat on the loo in the en-suite bathroom, leant against her husband and the walls for support. Mother and baby were well and the expectation was for birth in due course. Time passed and Jessica was now obviously in active 2nd stage of labour. She pushed hard. Baby was well. Mother was well. Time passed. Jessica continued to push and there were encouraging signs that birth would likely happen soon.
I was mindful of the NHS midwife feeling tense; the ticking clock, ‘guidelines’ etc
The curtains which formed a screen over the door twitched, the door opened and closed and I heard murmurings of voices.
‘I’m so tired, I just need to lie down!’ Jessica exclaimed. How many times as midwives have we heard women say this during labour? I certainly did when I had my babies. It’s normal, it’s vocalising to those around how you feel, that you’d like it to stop soon please and welcome your baby. I reassured and encouraged her to carry on, remain upright and not get onto the bed which loomed larger than life in the centre of the room.
‘Have you got a birth stool?’ I asked the NHS midwife.
‘No’ she replied.
I immediately left the room, returning within 5 minutes with a birth stool I had in my car. When I re-entered the room I have to say I was flabbergasted! Jessica was on her back on the bed with her legs in stirrups in a position called lithotomy (sometimes called a stranded beetle position). And she had a CTG (fetal monitor) on.
I gently and quietly encouraged her to get off the bed and sit on the birth stool which she did with support. And within a very short space of time, a healthy beautiful baby girl was born and passed straight into Jessica’s arms. You can read Jessica’s birth story here http://www.kentmidwiferypractice.com/birth-stories-home/files/jessica-birth-story.html
So what’s the deal with birth stools?! What are they and why are they such a brilliant aid for women and a clever resource for midwives.
A birth stool (or chair) is a device which supports a woman in a physiological upright position during labour and birth. Women have always found physical support from friends and relatives laps during labour; the birth stool is just a practical enhancement of that. Birth stools are low generally about 20-25cm of the ground to allow the woman to brace her feet against the ground and often have arms rests or hand holds for grip to provide extra leverage during the expulsive stage of labour.
Birth stools have been around for millenia when birth was ‘women’s business’ and before male doctors dominated. Birth stools are seen globally. They are mentioned in the Bible and pictured on the walls of palaces in ancient Egypt. Women are seen giving birth in supported upright position in Asian, African and Native American art.
So why are they brilliant for women? Because women do not lie down on their backs when they’re in labour! When women are free to choose, they move around stay upright and change position often. The availability of a birth stool is another way of supporting a position change whilst remaining upright. The evidence from research clearly demonstrates the benefits of upright position with 6 randomised controlled trials so far (Lawrence et al 2009) showing a reduction in length of labour, less use of drugs to control pain and greater maternal satisfaction. Women who are flat on their backs are also more likely to have inventions like episiotomies and instrumental birth (De Jonge et al 2004).
And what about midwives… what can a birth stool do for her? A midwife can influence positions women adopt in labour (De Jonge et al 2004a). Her role is to facilitate a normal birth and provide as many ‘props’ as she can to help a woman remain upright (Shallow 2003) And how much more satisfying for a midwife to support a woman birth her baby normally in an upright position instead of being an obstetrician’s assistant in a forceps delivery? Many midwives are likely to be unfamiliar and lacking in confidence in use of a birth stool, do not know when to suggest women try it or don’t even know where it’s kept! Watch Virginia Howes demonstrating the use of a birth stool here https://www.youtube.com/watch?v=RrXR7dK4Y2k
I did a quick ring round to another 7 local obstetric units in the South East and only 2 had birth stools in the labour ward. Some of the midwives I spoke with said they sometimes borrow a stool from the birth centre if there’s one attached to the unit. That’s pleasing to hear but not ideal as this means that women attending the birth centre would be denied use of it. The availability of a birth stool (or not) could mean the difference between normal vaginal birth and possible instrumental delivery by forceps or ventouse with all the side effects of that for women.
Many midwives have their own birth stools, women can buy them but any lowish stool, adapting two chairs and the good old toilet work well too!
So I would like to see ALL birth environments have a birth stool available (not just Birth Centres or Midwifery Led Units) and ALL midwives embracing their use enthusiastically to help support women in upright positions and increasing normal births.
De Jonge A, Teunissen T, Lagro-Janssen A (2004) Supine position compared to other positions during the second stage of labour: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynaecology, 25:35-45
De Jonge A & Lagro-Janssen A (2004a) Birthing positions: a qualitative study into the view of women about various birthing positions. Journal of Psychosomatic Obstetrics & Gynaecology 25:47-55
Lawrence A, Lewis L, Hofmeyr J et al (2009) Maternal positions and mobility during the first stage of labour. Cochrane Systematic reviews. Issue 4.