State of the art

After many years of systematic childbirth medicalization, a great deal has been done, in facility-based delivery locations, to limit the physicians’ intervention in child delivery, limiting it only when specific clinical indications makes their intervention necessary [7]. Hence, a great deal has been done to handle the newborn and child delivering women with greater respect and to better manage all the extrinsic factors of child delivery in order to reduce negative external interferences that could influence labour performance [6].  

New guidelines have been, thus, developed to improve the assistance and support of the medical professionals in the  labour and delivery room and to illustrate ways of rendering the child delivery environment more welcoming, more respectful and more comfortable [3].

Furthermore, it is suggested that childbearing women move freely during delivery, to choose and to adopt any position they wish, since it positively influences delivery [9]. Breaking loose from the  mandatory  lithotomy position for a physiological delivery was the great challenge in the 1970s and has, therefore, concentrated the attention on free movement during delivery.
Highlighting that women must be “active” and, that is, free to choose whatever position they prefer during delivery, was an achievement of the 1980s and the 1990s [2] [8].
However, the conquered freedom did not result in the acquisition of a technically correct position to facilitate child delivery to the point of guaranteeing brief time span of labour, much less pain, less perineal lacerations and a more positive impact on the newborn’s and mother’s health: this is Taddei Smart Birth’s area of research.

As a matter of fact, it is hypothesized that women in child delivery, left on their own and free to deal with childbirth in an “active” manner, know how to naturally find their own most comfortable position to deliver their children; the only conditions that make this happen are that  woman have to disengage themselves from “every form of  rational control” and have to abandon themselves to their sensations and to their own instinct, key factor in this vision of physiological child delivery [11].

However, letting the child-delivering woman choose which position to adopt does not actually imply that woman carry out child delivery properly from a technical point of view, and consequently, in the most possible efficient and efficacious way. This would mean taking into consideration only partially and approximately the physical and biomechanical aspects that can really improve child delivery and which cannot be found in mere instinct.

Last century’s “widely disseminated and marketed” postural approaches concerning childbirth are still a benchmark for those who are involved in natural childbirth [1]. Nonetheless, the positions in child delivery suggested by these approaches are based on “basic movements women spontaneously turn to during labour” (pp.116) and, to this day, the ability of these approaches to improve child delivery have not been demonstrated [2].

However, recent biomechanical studies on child delivery positions focus on studying (and evaluating) some of the  parameters which are always based on those of these approaches [5]. Nevertheless, the results of these studies are uncertain, poorly relevant, partial or even void. This leads to the conclusion that other research hypotheses need to be formulated which will allow us to accurately foresee delivery performance, as already is done for any sports event [4].

(7) (OMS-WHO)
) (Goer H., Romano A. (2012). Optimal care in childbirth: The case for a physiologic approach. Seattle, WA: Classic Day Publishing)
(3)  (Bestetti, Reaglia, Spandrio – Fisiologia della nascita, 2016, Carocci Faber, Roma)
(9) (Regalia, Fumagalli, Nelli, Nespoli – Pro-Muovere il Parto, 2004, IRIS, Monza)
(2) (J. Balaskas – ‘Manuale del parto attivo’ – RED, Como 1983)
(8) (M.Odent – ‘Ecologia della nascita’ – RED, Como, 1989).
(11) (Verena Smith – ‘Venire al mondo e dare alla luce’ – Urra, Milano , 2005)

(1) (Atwood RJ. ‘Particularl posture and related birth behavior’ 1976 – Acta obstet gynecol scand)
(2) (Balaskas p. 116)
(5) (Desseauve, D., Fradet, L., Lacouture, P., Pierre, F., (2016) “Position for labor and birth: State of knowledge and biomechanical perspectives”,
European Journal of Obstretics & Gynecology and Reproductive Biology, n. 208 (2017), pp. 46-54.)
(5 bis) (“Position for labor and birth: State of knowledge and biomechanical perspectives”, pag. 52)
(4)(Deesauve, Lacouture, Pierrre, ‘Birth is like a marathon’ revisiting childbirth by using sports biomechanics approaches, 33rd international conference on biomechanics in sport, 2015, Poiters)