Book Review by Sally Carter
Dynamic Positions in Birth (2nd edition) by Margaret Jowitt is published by Pinter and Martin and costs £12.99
Dynamic Positions in Birth was an informative and at times compelling read.
As a doula, I understand the physiology of childbirth and the relevance of active, upright positions during labour and birth. This book has helped me to have a better, far deeper knowledge and understanding of the biomechanical and scientific theories behind why birth might unfold in the way it does and how the development of mankind and the medical profession has influenced and birth practices, & not always for the better.
I enjoyed the chapter on “Birth Furniture through the ages” which gives a timeline of the use and development of birthing stools, chairs, and other furniture for birth which then lead to the modern obstetric bed. “Research Evidence” was also fascinating. This chapter discussed the pros and cons of observational study and clinical trials. The section on the Cochrane reviews of these studies was particularly interesting.
“Cochrane proposed that treatment based purely on medical opinion (or preference) should be replaced by treatment based on clinical research evidence obtained through randomised clinical trials (RCT’s).”
This led me to consider the amount of seemingly opinion based recommendations that are reported being given to women/birthing people nowadays, even though healthcare professionals should be using evidence based research to support their recommendations, ensuring women/birthing people are making informed choices. A lack of time and willingness to fully support informed decision making leaves us back in a place where medical preference often supersedes the individuals’ preferences.
Jowitt’s visual models of the balloon and trampoline are also helpful in considering the actions of the uterus.
I found the later four chapters more easily accessible and informative when it comes to describing the passage of the baby through the pelvis and what Jowitt sees as how we can “make birth better”. For instance, she recommends that Midwives not only suggest changes of position, to the woman/birthing person, so that they can tick the box that they’ve done so, but that they actively encourage and support them to adopt upright positions. This is also when she revisits the importance of changing the emphasis in birthing rooms from the bed to other pieces of furniture or equipment that would support upright birth, and also to support midwives to be more physically comfortable and able to facilitate upright birth.
This book could be viewed as a feminist text (after all, isn’t birth a feminist issue?) with its references to the history and development of mankind and the birthing process. How once the patriarchy became involved and birth was seen as a way to profit and build stature within society for men, the voice of the woman/birthing person became supressed, and they were coerced to ignore and go against their natural instincts. For this, I applaud Jowitt.
However, I am a little disappointed in the hetro-normative narrative of the book – especially when the topic itself would lend so beautifully to a more gender-neutral and inclusive use of language. If you are going to “update” a work for the 2020 population, then surely you have a responsibility to make it as inclusive as possible?
I also found it quite hard going at times. I would say this is a book for birth workers rather than for the expectant parent audience, although anyone who is pregnant and has a more academic background might also find it informative. It certainly contains some very important messages about the power of position in labour and birth, and how reclaiming physiological birth would be empowering and beneficial to not just parents and babies, but also to our midwives and the maternity system as a whole.
Overall, I found this book to be very informative. It raises important issues, especially around upright birth being the physiological norm, and how understanding how different positions in labour can significantly affect birth. These are facts which are acknowledged by lay birth workers and midwives who wish to “be with” women/birthing people and that the medical maternity world needs to wake up to.
Sally Carter is a Nurturing Birth Doula. Click here for the link to Sally’s Nurturing Birth Directory entry.