Kneeling delivery has been preserved in America for more than 2000 years as gathered from artistic representations of pre-Columbian Indians. The Tumaco-La Tolita culture flourished on the border between present day Colombia and Ecuador; although it was extinct by the time the Spaniards arrived, the people left a huge collection of pottery artefacts that have been extensively studied. Many disease representations have been found among these pottery figurines.1 We report here on a piece depicting the birth of a child (fig 1), with our own artistic representation for clarification (fig 2). The piece shows a delivery in a maternal kneeling position, with a man behind the woman. Two pieces of equipment are placed around the neck of the child. Studies show that 62 out of 76 non-European societies give birth in an upright position.2 Van Patten3 described a squatting position as common in Mexico before 1600 and Lopez et al4 stated that a Mayan glyph depicting a pregnant woman lying on her back is an indication of supine delivery position. Our own observations in eight extant Indian groups in Colombia5 show that the supine position is used by three groups (Cuna, Arhuaco, Guane), squatting is used by two (Guambiano, Uitoto), kneeling is used by another two (Waunana, Pasto) and squatting and/or kneeling by two more groups (Embera, Sikuani). Kneeling position at birth has therefore been followed in this region for more than 2000 years.

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Figure 1 Tumaco-La Tolita Pottery figurine depicting a kneeling delivery.

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Figure 2 Artistic representation of the pottery figurine.