Yesterday’s Observer (7/5/2017) had a heartrending piece about traumatic childbirth. The comments section confirmed that the author was not alone. There were accounts dating back 30 years or more of appalling injuries which remained unresolved to this day, damage to the genital tract, broken marriages, crippling damage to the bony pelvis. A veritable tsunami of untold human misery was unleashed by this brave woman’s words. Most of the comments were from damaged women and for every one that contributed there are probably a hundred or even a thousand who continue to suffer in silence.  The physical trauma was often compounded by the way that the emergency was dealt with, people rushing into the room, doing what they had to do to rescue the baby but ignoring the woman herself. Such treatment can lead all too easily to PTSD, a consequence of unescapable stress.

I took a deep breath and responded in the comments section, talking about prevention. I thought it would help if every woman had a midwife she already knew who was there for her alone, that when something untoward happened she was given emotional support, that at least one person in that rapidly filling room was keeping her in the picture, walking the journey alongside her.

The other means of prevention concerns the iatrogenic damage caused by the central position of the bed in the obstetric labour room.  The obstetric bed is the one thing in the labour room that has never been subjected to a clinical trial and I believe it causes untold damage to women by limiting maternal and fetal movement. There is profound ignorance about how labour works. I am shocked by the lack of interest in the biomechanics of birth, the fact that it took centuries for obstetrics to even consider that turning a woman from her back to all fours might be a good way to resolve shoulder dystocia.

There seems to have been little basic research into the biomechanics of the uterus since the middle of the last century when a consensus was reached that contractions emanated from a pacemaker near the fundus of the uterus which then acted as a piston pushing the fetus downwards towards the exit.  Modern labour management considers little but clock time, and recording the fetal heart rate and contractions from just one point on the uterus – which is in fact a hollow 3D biological shell capable of starting contractions more or less anywhere in its main body. Hospital obstetrics fails to consider that both the mother and her fetus can move to allow the fetus to wriggle around to find the best position for negotiating the birth canal. When the piston of the uterus is augmented by artificial oxytocin, forcing it to try and push out a baby through a bent birth canal – and uphill at that – is it any wonder that babies get ‘stuck’, that mothers sustain these fearsome injuries in the process?

We have to learn how the biomechanics of birth work and act on that knowledge. It won’t prevent all injury but it would be a step in the right direction.