In the birth centre at the woman’s booking-in visit we discuss the usefulness of changing positions in labour. Women often have the opportunity to view a birthing room prior to labour when booking in or on Parenting Education Tours. They get to see, and are encouraged to try, sitting on the BirthRite Seat.

In the first stages of labour, as the cervix is dilating, changing positions is a pain-relief strategy. In the second stage of labour, changing position can assist maternal comfort and help the woman’s pushing efforts to be as effective as possible. The BirthRite Seat is one of our main options.

A mat is provided as soon as the labouring woman arrives. I generally leave the choice of second stage position up to the woman. The most popular choice is kneeling, leaning over the bed. If a woman has been in this position for 30 minutes and the head is not well on view, I ask her how she is feeling and would she like to try a different position and I suggest the BirthRite. Some women will ask for the BirthRite as their first choice. The seat is always on view in every birthing room.

Some women having their first baby, who are particularly concerned that they may have their bowels open, sit on the toilet and push for a while. I suggest if they feel comfortable like this, why not take a few steps back to the bed and sit on the BirthRite.

Some multiparous women may get “caught out” sitting on the toilet, realising that the baby is coming. If they cannot or will not move, we get them to sit on the front edge and put a pillow at their back. Some midwives quickly move the BirthRite adjacent to the toilet, and the women have been able to make one sidestep and sit on the BirthRite, which makes for easier access for the midwife.

Some multiparous women are hesitant about second stage. They know what is coming and what they need to do; they have the body sensations to push yet they hold back. The BirthRite is useful because they cannot put off any longer the moment of letting go and pushing, once they are seated on the stool.

First-time mothers are assisted in focussing on pushing when using the BirthRite, probably because of its similarity to the toilet seat and the letting-go, pushing-down-the-pelvic-floor action, which is more familiar in this position.

I discourage mothers with vulval varicosities and women with previous third-degree tears from using the BirthRite because it is more expulsive. Side-lying is preferable in these situations.

When women are using the BirthRite, I encourage them to stand at regular intervals, say 15 to 20 mins, so that the perineum remains relaxed. If I do notice that a perineum is getting oedematous, which can happen when baby’s head takes more than 45–50 mins to come on view, I suggest a change of position, then return to the BirthRite. Using these guidelines, I have never had a woman sustain a third-degree tear on the BirthRite. I do not instruct women how to push, but encourage them to follow their body sensations.

I find the BirthRite superior to imported models and the earlier wooden models, because it is slightly taller and because of the way it supports women’s thighs: the mother’s bottom is not on the stool, just her thighs. Yet her bottom does not sag down unsupported because her hips are adducted just the right amount. The BirthRite’s sloping seat reduces perineal congestion, and the stainless steel handles provide excellent leverage for the pushing mother.

From a midwife’s point of view, vision of the perineum is good. The seat is wide enough for clearance of hands and forearms as we support the baby being born, following the upward curve of the woman’s vagina and into the mother’s arms. Our midwives like it also because it is hygienic: there are no joins to trap body fluids, and the surface can be disinfected with our standard cleaning agents.

I like the BirthRite. I used it myself for the birth of my second baby four years ago.

At our hospital, more than ten thousand women would have used the BirthRite at some stage during their labour and birth.

— Janette Beverley
Hospital Midwife of 15 years