After three very different labours, I was hoping my fourth and final one would be the holy grail of labours – one where I stood, rather than lay, where my baby was delivered in a couple of hearty pushes.
My first labour was a standard 12-hour affair, with the usual suspects – pacing through contractions, vomiting after inhaling the gas and then becoming exhausted. I had no further pain relief because I had internalised all the agony and was too scared to give the gas another go before asking for something stronger.
Lying on my back on the bed became the most attractive option but it took three hours to push that little poppet into the world, and that was with the help of the vacuum hose and those mighty tongs, otherwise known as forceps.
Labour number two was heading for half the time; six hours from first contraction to fully dilated and ready to push, but the curve ball was thrown when the midwives discovered the baby was in a breech position. Emergency C-section was added to my labour history.
By my third labour, I was introduced to a whole new world of acronyms – the VBAC (Vaginal Birth After Caesarean). With a supportive team around me, I delivered my son vaginally, although the three hours from start to finish, with an hour and a half of pushing, was an experience in intense pain I hadn't known about. I knew I was alive that day. Again, a pushing stage done on my back.
Maybe I was a slow learner but it wasn't until I delivered my fourth baby, that I finally realised birthing upright was my answer to the quicker second stage of labour I'd been fantasising about. The second stage of labour is what the Royal Women's Hospital describe as "the period from when the cervix is fully dilated to when the baby is born".
My daughter was born in three hours and a couple of pushes as I leant over the bed. Awkward position for the midwife to monitor, and I had to help hold my baby's head so the staff could prepare for the speedy exit but as far as labours go, it was a dream. I recognise that being my fourth labour, my body also kicked in some great muscle memory which assisted the more efficient birth.
You don't have to chat to many mothers to realise that a very common position for women in stage two is on their backs. Why? Because they are often exhausted, sometimes have epidurals which restrict movement, and sometimes because it is a convenient position for midwives to monitor bubs and get access to the area.
Unfortunately lying down is not the most natural position for a baby to move down the birth canal.
Upright positions have a lot going for them, if it is something you can achieve. According to Evidence Based Birth, "upright positioning … helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis' often leading to a shorter second stage".
Dr Rachel Reed, Midwife and Senior Lecturer in Midwifery at the University of the Sunshine Coast, says it's not so much about standing but about instinctive birthing behaviour.
"If left to birth instinctively (without disturbance and instructions) then women generally birth in an upright position, leaning forward eg. all fours – this makes sense as the pelvis functions best in this position. Gravity and the curve of the interior pelvis and vagina are downwards."
In some cultures, squatting is also favoured but I didn't have the steely quad muscles required to hold me in that position for long enough.
So, if we instinctively birth standing or squatting, how did labour end up as something we do lying down?
According to Dr Reed, birthing while on our backs began when birth moved to hospital settings and "care providers wanted to 'observe' and manage the 'delivery' of the baby."
There are also common references in media and movies with women on their backs while giving birth. It seems birthing on the back has become a cultural norm over time. The bed being the centre point in a birthing room may also contribute to the decision to lie down.
Dr Reed adds, "midwives have started to instruct women into 'alternative' birth positions eg. standing, etc. in an attempt to change this cultural norm and reduce interventions. Yes – birth is quicker in an upright position however, birth works best in an instinctive position… which for some women may not be upright."
I was elated to finally get my dream labour in a standing position, which was supported by my midwife. I recognise we can all have ideals and preferred birth plans but ultimately a priority on maternal and foetal wellbeing will be what drives our deliveries. Upright or not.