Positioning mattering

“Space, time and matter are mutually constituted through the dynamics of iterative intra-actions” (Barad 2007:181).

These entangled intra-actions seem to be illuminated in Obstetrics.

In a classroom session this week I observed junior students’ representations of the birthing phenomenon in a collection of their free drawings. Their images reflected the controversial topic of positioning in labour, foregrounding widely held beliefs and assumption that mothers give birth from a supine position.

Similarly, a couple of the participants in my research project have centred a bed in their drawings, placing a woman lying in a crook position, as indicated in the image above (drawn on my iPad using the Pastels App). The bed appears as the focal point for the birthing process and associated procedures.

Yet there is evidence to suggest that mobility and alternative positioning facilitates the birthing process. However the bed remains an important apparatus especially with the medicalization of labour where regular monitoring of the foetal heart is prioritized. It is easier to manage this and other measurements when women are horizontal.

The choice of positioning in labour remains contested as a result of many influences. There are conflicting views in terms of mobility during the different phases of labour. What I hear from my midwifery colleagues is that walking, sitting and finding alternative positions is preferable for the health of the foetus and the mother. An innovative initiative in Peru has shifted practices in maternal healthcare to accommodate cultural beliefs. This has led to a significant drop in maternal mortality rates. Previously, when the horizontal position was forced onto women in labour, the indigenous women chose to stay at home for their birthing experiences despite the many associated risks particularly in rural areas. In their homes, these women could adhere to their cultural tradition of vertical positioning without the fear of opposing forces at public health facilities.  Since the Health Ministry in Peru adopted new policies that facilitate alternative positioning, more women are attending the facilities resulting in reduced mortality rates - a valued move in governmental support towards health promotion and respect for women’s rights. http://its.uvm.edu/Vertical%20Birth/Vertical%20Birth.html

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.