OB/GYN Wonders Why Americans Give Birth In Bed

A few years ago I visited Dar a Luz, the only free-standing birth center in New Mexico. It looks nothing like the towering urban hospitals I have spent my career working in. Nestled into a valley at the outskirts of Albuquerque, Dar a Luz is more like an earthy homestead. At the perimeter, a wood fence surrounds a sun-drenched courtyard with a rock garden and a footpath that expecting mothers pace while in labor.

Inside the birthing rooms are bathed in the same natural light, with open spaces designed to encourage continuous movement. Beds are in the corners of the rooms rather than the central feature. Abigail Lanin Eaves, the executive director of the birth center and a certified nurse midwife, explained that, at Dar a Luz, her patients arrive in labor walking—and usually stay that way until after the baby is born. The beds are for resting afterwards, rarely for labor or the birth itself.

Each year approximately 20,000 Americans choose to give birth out of bed, which usually requires giving birth out of hospitals. According to the CDC, centers like Dar a Luz have become 83% more popular over the last decade. Yet millions of Americans still choose to give birth bed-bound, on their backs, with their knees up, legs spread, feet in the air. I attended the deliveries of thousands of babies before I ever wondered why.



As an obstetrician/gynecologist, this position is familiar to me. It maximizes exposure to the pelvis during office examinations and gynecological procedures. By extension, it seems to make sense for childbirth as well, particularly from my perspective as the doctor. The work of being on call on the labor floor can be grueling, a constant race from one bed to the next. Having the people I care for remain in bed allows me to sit down, optimize my lighting, and limit the strain on my back and my eyes.

But while convenient for me, few unmedicated people would choose to labor this way. In the absence of anesthesia, it would be too uncomfortable. Movement is an instinctive way of coping with the discomfort of labor. Remaining upright also appears to facilitate labor progress and, aided by gravity, descent of the baby in the birth canal. By contrast, MRI studies suggest that on-the-back positioning may significantly narrow the baby's pathway through the pelvis.

However, in the presence of anesthesia, standing and walking throughout labor is challenging if not impossible. Turning off the body's pain receptors requires disconnecting our nerve endings from our perceptions, a process that can remove our ability to move, to remember what happened or both. Anesthesia works by blunting our most fundamental instincts. This dilemma places our desire for comfort at odds with our desire for control.

Medical Xpress