Let Birth be Born Again by Jean Sutton
Review written by Cristin Tighe
Jean Sutton’s book is enlightening and needed. Her approach, from the perspective of western birthing culture, and her concept of “optimal foetal positioning” is useful and eye opening. Her view is that the mix of the baby’s role in birthing, partnered with detailed anatomical knowledge, allows us to understand the optimal and easiest labor and birthing process, for both baby and mom. The theory is based partially on the view that “Successful reproduction… is built into every living thing on the planet. Humans are no exception.” (p. 12). She discusses that until the 1960s about 85% of babies were born, without major technical interventions, from the “vertex left occipital-anterior” position (p. 12), meaning head-down, facing back, with their spine to the left front side of the mother’s abdomen. Knowing this, the keys for easier labor, for many reasons (detailed in “The Basic Design” on p. 14-15), are antenatal knowledge and positioning; giving adequate time for the baby and the mother’s body to change through labor; and being able to be mobile during labor. She said, “Unfortunately, many modern practices in obstetric care have deprived women of the opportunity to utilise gravity and mobility in labour. Practices developed without a sound understanding of the anatomy and physiology of the normal have caused a whole generation of women totally unnecessary harm.” (p. 22-23)
Jean’s book is based on the concept of “informed choice by birthing families” (p. before I) which she describes as including – “provision of adequate and accurate information enabling”…people to “…choose the birth option that best suits;” “continuity of care;” and “improving the quality and safety of birth for the baby by the encouragement of optimal foetal positioning” (p. before I). In the book, she points out some interesting anatomical information. For example, the “cervix opens as an ellipse and not a circle” (p.14), so the front of the cervix actually stretches over the baby’s head while the back remains in the same place [this means Braxton-Hicks contractions will not change the baby’s position]. This means that the cervix faces back even more if the baby is not in the optimal position. Another important thing to know is that the “pelvis is widest from side to side at the top, and from front to back at the bottom” (p. 14), so the baby must turn 90 degrees to be born. Section 1 of the book lays out the optimal labor and birth process, given this knowledge.
Section 2 looks in detail at further anatomy, specifically the female pelvis (p. 32); the Rhombus of Michaelis (kite-shaped area of three lower lumbar vertebrae and sacral prominence) (p. 34) that must move back to allow the baby out; the foetal skull (p.34); varying pelvic shapes and how they impact birth process (p. 42)); and the shape of the baby’s neck (p. 54). Basic awareness of anatomy, coupled with encouraging mothers to lay on their left side (p. 183) and sit in positions that are more forward-leaning then reclined (p. 183) during the third trimester (as the baby is getting into a more settled position and the head is dropping), is key. Also, moms should know that arching the low back is good in pregnancy, so if low back pain occurs, it is better to wear supportive clothing then to tuck the tailbone (p. 91). These things are all important for the optimal positioning, and thus easier labor and birth -- The baby needs to be on the left side with his back to the mom’s front, and be head down “by approximately 34-36 weeks” since “very few babies turn in early labor” (p. 62). Further details are in Section 3, which describes Antenatal Care, including optimal positions for mom in third trimester, what moms need to know (p. 68), and how the angle of the pelvis and posture (p. 69-70) can help. Most significant is that “By 36/40 weeks of pregnancy, the baby should be getting settled in, ready for birth. Before then… the baby is free to change position… He needs to be properly positioned by 38 weeks.” (p. 76). Jean describes positioning, techniques and alternative therapies to help get the baby positioned correctly and moving through the birth canal during labor most efficiently.
More depth is given in Section Four (Success Stories), Section 5 (Occcipto Posterior Positions) and Section Six (Some Interesting O.P Stories). Then, Section Seven (Positions, Protocols and Pain Relief) focuses mainly on “How and Why Being Bedridden Reduces the chance of a Normal Birth” (p. 136). It gives creative ideas for what to do doing different stages, how to relieve pain, birth stools, and how technology can enhance or worsen labor. Section 8 looks at what to do when things go wrong, or the unexpected occurs. In the last sections, Jean described her work with women in a country maternity hospital during 11 years and how the intervention rate dropped from 40% to 10%. She suggests the work they did, including helping women understand how and why laboring out of bed is better, and the importance of antenatal and postnatal care, could be a model for how to share this knowledge with others to make informed choices. She suggests that we “…need to understand the birth process thoroughly ourselves and allow that knowledge to motivate and propel us into action” (p. 178). She encourages us to move forward with regard to respect, acceptance and a shift back to normal birth as the norm.
Jean’s background working at a rural hospital, as an engineer and trained nurse, and then as a certified mid-wife give her many perspectives from which to view the birthing process, and ground her theory in both extensive experience and practice. Her theory reveals why the more typical western birthing culture, and its interventions, often lead to a laboring woman being on her back on a bed, then lead to more interventions, and to unnecessary cesarean section births. Since birthing is an art and a science, her views, approach and theory validate further thought and research, and can only serve women who want to make informed choices about birth. It is interesting the book is written for midwives (p. 2), as the ideas would be useful for expecting parents and the medical community as well.
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