lithotomy...seriously?

elizabells, BSN, RN · Mar 7, 2006

I'm bumping this because I'm self-centered. Also, I really want opinions.

Marie_LPN, RN, LPN, RN · Mar 7, 2006

Lithotomy's pretty much how it's done where i work.

wdkasper · Mar 7, 2006

I had all 4 of my kids in the lithotomy position. With my 3rd I was trying to push while on my side because it was more comfortable for me, but the doctor made me change into the lithotomy.

Long Term Care Columnist / Guide · Mar 7, 2006

You mean they're still making women give birth in the dead-bug position despite all the progress that's been made in obstetrics over the past 15-20 years?? :madface: I thought the process had become more humane since my own childbearing years........guess not, at least in some hospitals.

Where I used to work, stirrups were almost never used in the birthing rooms; the beds were fitted with braces where the moms could put their feet and push against them when they needed support, but even these weren't mandatory. Nor did women have to lie down---they could sit up, squat, even give birth in the hot tub if they chose (and if the situation was appropriate).

But lithotomy? Not only is it degrading, it's the most uncomfortable and unnatural position I can imagine giving birth in, except maybe being hung upside down! I had two of my five children in this fashion---I wasn't given a choice in the matter---and I wouldn't recommend it to my worst enemy. For one thing, you're pushing UPHILL, and for another, it's far more likely that you'll need an episiotomy, because the stirrups are placed so wide apart that you're apt to tear if one isn't done (and some women do even when it IS done). Then there's the muscle soreness from being stretched out too far, and even orthopedic problems: I remember my right hip popping out of place while I was delivering our fourth child, and that hurt worse than the entire labor! My husband had to push the joint back into place just as the baby was crowning........like I needed THAT distraction. :uhoh3:

I'd like to see every OB-GYN who insists on the lithotomy position strapped into a pair of stirrups and forced to have a BM........maybe then they'd have a clue as to what they're making their patients go through. Phooey.:uhoh21:

I can't think of a single good reason, other than the convenience of the MD or midwife, to force mothers to deliver in this position.......it's barbaric.

epiphany · Mar 7, 2006

Hospital policy. Most of us know it was first invented to to remove bladder stones, and is now it's just convenient for the OB. We all are part of propagating harmful practices, and we try not to think about it, if it feels too big and insurmountable. The lithotomy position is the wrong position for laboring women.

elizabells, BSN, RN · Mar 7, 2006

Thank you! I was starting to think I was nuts! I think part of it is that this hospital has a 95% epidural rate, and they are HEAVY epidurals. Totally numb from the breasts down. Momma wants a bolus dose, momma gets a bolus dose as long as she's not showing signs of OD and FHR isn't in the toilet. And at this hospital, in the toilet does not seem to include repeated variable decels down to 60bpm. Pts at this hospital have expressed confusion that they are having ANY discomfort at all. Um, hi, you're shoving an eight pound thingy out of an opening normally the size of a pipe cleaner. It's gonna hurt! But mom asks, anaesthesia comes, glances at the strip, and tops her off. At that point, I'm not sure the moms could even be in any other position. I've had to hold women's feet IN the stirrups, let alone holding legs up to push. They just have NO muscle control with all the duramorph and whatever else they're getting. If I go into midwifery, I'm going home to California. New York births make me want to cry. Pit if she hasn't progressed in two hours, only been in active labor six hours at that point. Like I said, nasty drops in FHR down to 60. Oh god, she's been at 8/100/0 for two hours??? Let's pit her so hard she's complete and +2 half an hour later! And then let's start vigorous fundal massage and hard cord traction five minutes after babe is delivered! And we wonder at 3rd degree lacs and ruptured cords. God, can't imagine how THAT happened... Forty two percent C/S rate? Where did that come from??? Possibly the continuous FHR and toco from the moment she hits the door. Treating EVERY woman like a high-risk mom makes every woman a high-risk mom. I know I'm still "just" a student, but it makes me so sad.

[/rant]

Sis123 · Mar 7, 2006

Now there's some good critical thinking, and I mean that in a good way.

I think squatting might be good but just not sure about how to go about it. I know ladies in India stack a couple bricks on the floor and a midwife catches the baby (this is how the poor ones deliver, the rich ones do it western style) and have few problems. It seems to me that gravity would help alot in getting baby to move down...???

CEG · Mar 7, 2006

Don't lose all hope. I had my babies in upstate New York and no lithotomy position. In fact they had jacuzzi tubs for water births and I walked the halls for most of my labor. I think their epidural rate was 20%. And it was nothing special, just a normal community hospital. So maybe it's just the hospital (s) your class has their clinicals at? I had two babies in two years and I have yet to see a stirrup at all.

GooeyRN, ADN, BSN, CNA, LPN, RN · Mar 7, 2006

I had a baby in the southern tier region of new york in october. They were trying to get me to consent to pit as soon as I was examined! My water just broke 2 hours before and I was having contractions! I also HAD to deliver in the lithotomy position. Not the most east way to push...

elizabells, BSN, RN · Mar 7, 2006

Now there's some good critical thinking, and I mean that in a good way.
I think squatting might be good but just not sure about how to go about it. I know ladies in India stack a couple bricks on the floor and a midwife catches the baby (this is how the poor ones deliver, the rich ones do it western style) and have few problems. It seems to me that gravity would help alot in getting baby to move down...???

From what I understand, squatting is a great position for pushing but not so much for the actual delivery bc of the increased pressure on the perineum and tendency towards Valsalva. My mom had my brother and I kneeling on the bed holding on to the head, which was at 90degrees. She just had a great OB who was willing to work with her. One of the nurses I worked with on the LD floor was actually a community midwife in India, and she said she had never helped, or in her words, "made" a mother push until she came here. They just labor down all the way, push a couple times, and there you go. That's the same way I was born. Now, my mother is incredibly grateful the ABC in which we were born was in a hospital, because my brother had a triple cord and his 1mApgar was 2. Had he been born at home, he probably wouldn't have made it. But there has to be a compromise, you know? I also don't think I'll go for CNM in NY bc there was an incident at one of the hospitals with (and this is hearsay, so I won't name the hosp) OB docs signing off on things they hadn't done, that midwives weren't supposed to do (intervention-y stuff) and there was a bad outcome, big lawsuit, so midwives all over the city are being laid off. No one wants them here anymore.

SmilingBluEyes · Mar 7, 2006

Obviously having gravity work for you makes sense so: Squatting is excellent for pushing.......

So is standing and rocking while I rub mom's back.....

Being on all fours works great for persistent OP babies.....

Having a mom sit on a toilet is great while in labor....it seems to open up the pelvis and bring relief to some.......

I would agree: Anything but flat on her back (lithotomy) is best.

But when you have epidurals in use in excess of 80% of the labor patients as we do where I work, your options as a nurse are limited, severely. I have often had patients lay on one side or the other to push and our beds do have modifiable stirrups so we can simulate the "squat" position with moms in semi-fowler's position.

Personally, I have esp found w/OP babies or babies not quite in OA, pushing on the side is best, to get baby turned around and down....also the fine art of "laboring down" is a must-have when you have an epidural in use.

But like I said w/epidural use as common as it is where I work, not too many options exist, esp when legs are literally dead weight. It's hard to get creative when mom can't participate fully. We do the best we can.