Safe Childbirth; The Three Essentials

William Withering (17 March 1741)

“…This simple measure would obviate the need for interference during labour, thus eliminating puerperal sepsis and preventing birth injuries, which were a major cause of mental defect. 46 In Safe Childbirth Vaughan laid down the "three essentials" for successful childbirth: round pelvic brim; flexible joints; and natural position for birth, by which she meant squatting. Childbirth was a "gymnastic feat", and women could prepare for it by taking the cue from their primitive sisters.…”

“…46 Vaughan's ideas were popularised in the 1940s by the growing army of obstetric physiotherapists who were claiming natural childbirth as their territory. In the 1950s, however, the safety and efficacy of her methods were questioned and squatting fell into disuse.…”

Review article

“…Cross-cultural and historical analyses reveal that for centuries upright positions (standing, kneeling, squatting, sitting, semi-sitting) have been largely preferred to recumbent position by practically all cultures [5,29,49,68,87]. The use of recumbency is a relatively new acquisition in obstetrics; actually the vogue of recumbency during labor goes in parallel with the establishment of obstetrics itself in the late seventeenth century.…”

“…It has been also pointed out that the convenience of the practitioner may have played a paramount role in the selection of the position of the labouring women [1,5,9,12,13,20,24,27,30,37,40,45,50,51,64,69,74]. [5,29,48,49,68,71,72,87] contemporary obstetrics has largely restricted her to bed [79].…”

“…Custom has greatly influenced our present obstetrical care, perhaps more than our scientific knowledge [5,12,40,26,49,52,58,68,71,73,78,79,85,87]. This paper intends to review some of the factors that determined our traditions in this regard and also briefly reviews the recent scientific findings that challenge some of our present routines concerning the obstetrical management of the first stage of labor.…”