Lithotomy position
The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving pelvis and lower abdomen. References to the position have been found in some of the oldest known medical documents including versions of the Hippocratic oath (see lithotomy), the position is after the ancient surgical procedure for removing kidney stones, gall stones and bladder stones via the perineum. The position is perhaps most recognizable as the "standard" position for child birth: the patient is lain on the back with knees bent, positioned above the hips, and spread apart through the use of stirrups.
The position is frequently used and has many obvious benefits from the doctor's perspective. Most notably the position provides good visual and physical access to the perineal region. The position is used for procedures ranging from simple pelvic exams to surgeries and procedures involving, but not limited to reproductive organs, urology, and gastrointestinal systems. New observations and scientific findings, combined with a greater sensitivity to patient needs have raised awareness of the physical and psychological risks the position may pose for prolonged surgical procedures, pelvic examinations, and, most notably, child birth.
Lithotomy position and childbirth
As a birth position, it has been popular in the past with obstetricians as it allows a good view of the birth process. However, the position is not conducive to a smooth labor as it constricts the birth canal, puts pressure on the coccyx, prevents the fetal ejection reflex from occurring, and does not allow the mother to move during the process, therefore increasing pain in labor. During labor, the position appears to cause compression of the main maternal blood vessels including the vena cava, thereby reducing the flow of blood to the infant. Restricted blood flow frequently results in higher rates of morbidity and mortality for both fetus and mother. [1]
Additionally, since the lithotomy position essentially "fights gravity" leading to a less active birthing process. Passive birthing, which often requires more invasive medical interventions, is associated with increased trauma to both infant and mother, may lead to serious birth complications. [2]
In Western countries the use of the lithotomy position for active labour has seen a decline in recent years. One notable exception, however, is the United States, where the lithotomy position remains common practice despite solid scientific support [3]. Many attribute the use of the lithotomy position, named after surgical procedure to remove kidney stones and bladder stones, to a centuries-long trend towards the medicalization of birth. [4]
Lithotomy position, prolonged surgical procedures and circulatory complications Some studies have found a significant relationship between prolonged surgical procedures with the patient in the lithotomy position and a circulatory complication known as "compartment syndrome" [5], "...a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space." [6].
Lithotomy position and pelvic exams
Patients have reported feeling a loss of control and increased sense of vulnerability when examined in the lithotomy position because they cannot see the area being examined. Other, equally effective positions have been suggested for examinations of conscious patients [7] and [8].
The lithotomy position affords physicians and surgeons with easy and helpful access to the perineal region, lower abdomen, and pelvis and is widely used in both surgery and examinations. Of all the medical uses, the lithotomy position, whose ancient roots come from the treatment of the painfully ill, has logically received the most scrutiny of late in association with childbirth, the only condition listed herein that is not an "illness".
See also
References
Citations
[1] Anema J. G. ; A. F. Morey, J. W. McAninch, L. A. Mario and H. Wessells Complications related to the high lithotomy position during urethral reconstruction The Journal of urology (J. urol.) 2000, vol. 164, no2, pp. 360-363 (42 ref.) ISSN 0022-5347. Abstract available at [9]
[2] Cohen, Stephen A., MD and W. Glenn Hurt, MD Compartment Syndrome Associated with Lithotomy Position and Intermittent Compression Stockings Obstetrics & Gynecology, 2001;97:832-833. Abstract available at [10]
[3] Johanson, Richard, Mary Newburn, and Alison Macfarlane Has the medicalisation of childbirth gone too far? British Medical Journal 2002;324:892-895, published 13 April 2002 [11]
[4] Bachmann, Gloria, M.D. 2001 The Importance of Obtaining a Sexual History. UMDNJ Robert Wood Johnson Medical School New Brunswick, New Jersey. [12]
[5]Seehusen Dean A. et al, Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial British Medical Journal. 2006;333:171 (22 July), doi:10.1136/bmj.38888.588519.55 (published 27 June 2006) [13]
External links
- Lithotomy Position. Information and research on the use of the Lithotomy Position in Childbirth
- [14]. Includes information on the relationship between episotomy and complications and the use of lithotomy position.
- [15]. Citations are somewhat outdated, but contains information about the rationales behind using lithotomy position.