In mainstream practice, the little birthing team is often squeezed between rigid professional attitude and an unhelpful and uninspiring physical birthing environment. It turns out that these are, for the most part, miraculously overcome by directing attention to the obstetric hardware used in the physical reality of modern-day obstetrics.

Mainstream current childbirth practice revolves around the obstetric bed. It is the dominant physical feature of the vast majority of birthing rooms, and its presence dictates the whole conduct of the birth.

With few practical alternatives in sight, the woman has little choice but to get up onto the bed. Since she can barely get on and off by herself, any attempts at nurturing self-reliance in the soon-to-be mother are undermined right from the beginning. The close resemblance to other hospital beds does nothing to inspire confidence that the birth will proceed without misadventure.

In any medical or surgical ward, patients with (say) gross ascites adopt a sitting position in bed to minimize respiratory embarrassment. Women in a labour ward, however, with the largest of intraabdominal masses and ostensibly breathing for two people, end up in a recumbent or semi-recumbent position on the obstetric bed — with their pain exacerbated — and then we ask them to breathe properly!

Lying on an obstetric bed militates heavily against any attempt to implement respectful interactive engagement to optimal effect. It is hard for the woman to see herself as occupying any but a subservient position in the enterprise of childbirth. Interaction with a woman on the bed is at best a limping two-way dialogue, at worst a monologue, occasionally interrupted by a moan, howl or vomit.

Being suspended in mid-air runs counter to the woman’s instinctive inclination to get as low as possible once the presenting part is free of the bony pelvis: she is not grounded in the whole process, and she is unable to follow through with her natural expulsive effort just when it is needed. Instead, she is coached to push the baby upwards against the pull of gravity with all her might. When finally the baby emerges, first to see and touch it are the attendants, who will tell the mother “what she’s got”.

Out of touch with her instincts, experiencing increased pain and engaged only precariously with her attendants, it is no wonder that the woman finds it difficult to get the benefits of relaxation and maintain control and ownership of her birth. The woman could hardly be better primed for the well-described “cascade of obstetric intervention” and even possible litigation.

While the obstetric bed might be useful for some specific obstetric scenarios, these are the exception rather than the rule. To use it routinely as the default environment for childbirth is to place a huge obstacle in the path of practising truly holistic midwifery.

So why has it been possible for the obstetric bed to get such an unchallenged stronghold on mainstream midwifery?

Well, childbirth mostly occurs in hospitals which operate on the assumption, explicit or otherwise, that Childbirth equals Surgery. Such an equation may seem preposterous at first, but consider the transitive conclusion from the relations: Childbirth equals Obstetrics and Obstetrics equals Surgery. This tacit acceptance dictates almost everything about our treatment of women in childbirth. Instinct-based, natural positions are viewed suspiciously and pejoratively dubbed “alternatives”.

Is it any wonder that women in childbirth feel disempowered?