I Support Perineums

I have been talking with a colleague about birth position. She has recently become very irritated about women being forced to give birth on their backs. I'm afraid her irritation was precipitated by a discussion we had about my homebirth, a couple of years ago. I told her why I choose not to give birth in a bed, and prefer instead a standing supported squat. (I also gave birth on all fours once and another side-lying.) Since my friend is planning a second pregnancy in the near future, she has been examining these issues closely. "Why do we submit to that?" she demanded to know. I suspect its mostly because we don't know any better. We assume that all the things we are asked to do is for our safety or our baby's safety (and a lot of the time that is true). However, this one is purely for the careprovider. I haven't seen any research on it, but my hypothesis is that we put our perineums in jeapordy with the lithotomy position. It gives physicians and nurses lots of nice access, but mainly for the purpose of casually abusing the tissue. It is my ethical stand that healthy muscle or tissue integrity should not be compromised (ie. cut or severed) without medical provocation. The muscles and tissue of the perineum are made to stretch to accomodate the birth of a baby. Yes, there are times when tissue manipulation is warranted, but mostly lying down to give birth makes as much sense as lying down to have a bowel movement.