I love it when the episode starts with a birth; it energizes me and puts me in the frame of “the next hour we are with the midwives!” I hope that readers watched the main character of the episode Hannah giving birth in an upright position and thought “hmmm, that is really interesting how she is doing that in an UPRIGHT position and not laying down in the bed”. Well, in case you were one of those folks, let’s just extoll the benefits of being in an upright position to birth. 

First and foremost, gravity is on your side in an upright position! Common sense should tell us that if you want something to come down and out the best position to be in is one that encourages movement in that direction, rather than on one’s back and parallel to the floor. Being upright also assists the baby in maneuvering its way through the pelvis in the best position.

Second, the forces of birth (i.e., contractions) are more efficient when a woman is birthing upright. Maximal blood flow to the uterine muscle is unimpeded (as opposed to when lying on one’s back which compresses the major blood vessel to the uterus – the aorta). Not compressing the aorta translates to optimal blood flow to uterine muscle which results in maximally useful contraction forces. And finally, no surprise here – it FEELS better for women to be off their back and being upright. Women report less pain when pushing and giving birth in an upright position. If you want to learn the history of when women began lying down for birth, read about King Louis XIV’s influence at Is King Louis XIV The Reason Why Women Mainly Give Birth Lying Down? (IFLScience).

Ok so let’s move on to what I am guessing may have been a very confusing topic from the show. Hannah, the teenager who gives birth at the top of the episode, is told after the birth that it is her parents who really have the power to say what happens to the baby to whom she has just given birth. What is confusing in the U.S. is that State laws apply, and, in some States, a pregnant teenager is emancipated if age 16 or over. Emancipation means essentially that the teenager is no longer under the control of their parents. What is even more confusing is that, again in some jurisdictions, emancipation may be in force only during the pregnancy, and then not after. In some places teens are considered medically emancipated during pregnancy, meaning they can make medical decisions for themselves and their unborn children, but that doesn’t necessarily extend to legal emancipation where they could make their own legal decisions. All very complicated to be sure and doesn’t seem to have improved all that much since the show’s time period.

I have to say, my favorite part of the episode was that of Sister Monica Joan and the stray dog she named “Nothing”; two kindred souls who found each other at just the right moment. One of the reasons I love her is she subscribes to the same edict I find myself living by (especially in the midwifery world) – “sometimes it’s better to ask forgiveness than permission.” Sister Monica Joan rocks…