Today’s primary resource for learning about childbirth is to watch Birth Day or A Baby Story on TLC. Once in a while you will see a “natural” childbirth on one of these shows, but for the most part they are made out to be emergencies with women writhing in pain, lying on their backs, and their doctors have to come in and rescue their babies. Now, the next time you see an episode where the mother is sitting in a chair, walking around, or kneeling in the tub, see if you can tell the difference in the way these labors seem to go. Although the mothers are obviously working hard, in some amount of pain, and anxious for the labor to be over with, most of the time the active mother’s babies are happier, there are less emergencies, and the delivery itself usually requires less active management on the part of the doctor. And this is no coincidence.
“Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour,” according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found. Women who have a baby in the posterior position (what frequently causes “back labor”) have nearly a 90% chance of turning their babies in labor if they remain upright and moving during much of their labor. Shortened labor, less pain, and better positioning of babies are just a few of the benefits of remaining active during labor. Here are some others: increased comfort to the mother, as well as distraction and an enhanced sense of control. It can also help to relieve the sense of being overwhelmed. Other benefits include reduced likelihood of tearing (if in an upright position while pushing), less fetal distress, and a reduced incidence of low maternal blood pressure (this can happen if mom is lying on her back or even semi-sitting).
Why does being active keep things normal? Pelvic bones are not inflexible. They are actually made of a few bones held together by flexible cartilage. When the mother remains upright and active, her bones are constantly moving and adjusting. This means that her baby, who needs to move it’s head quite a bit to rotate down and through the pelvis, is getting help from his/her mother to be able to mold and flex his head and neck to be born. Being active not only makes this process easier, but faster. With direct pressure from the baby’s head on the mother’s cervix, she will also dilate and soften her cervix easier than if she were only lying down or sitting in bed.
As for the pain, it is not usually completely removed by being upright, but a woman’s pain threshold can be increased this way, and pain from certain positions (like being on her back) can be removed. Lying on one’s back in labor really is the most painful position for a couple different reasons. One, when her uterus contracts it tilts forward, so if she is lying on her back her uterus has to tilt up and forward and the harder it has to work to remain efficient, the more pain it causes the woman. Second, lying or sitting ontop of a surface prevents the mother’s pelvic bones from moving, and constricts the space within the pelvis, both actions make it more difficult for the baby to mold and descend through the pelvis (often this situation mimics a case of “baby too big for pelvis” when really the mother just needs to get out of bed). This of course is not only difficult for the baby, but more painful for the mother.
Although most women will need some encouragement from a knowledgeable person (such as a doula) during labor on choosing helpful positions, they also tend to adopt positions or movements that will help them without being told how to do them. For instance, hands and knees is a very common position that laboring women will try without suggestion, simply because it feels right. And the positions that “feel right” are probably the best ones for them to use. In this case, pain directs women to choose positions that not only feel better but are also beneficial for the progress of labor and the health of her baby. If good progress is not being made, changing positions, or trying different movements, every 20 or 30 minutes may help to get things moving again. I very strongly recommend that if you can’t buy any other books about childbirth, that you pick up these three books: Ina May’s Guide to Childbirth by Ina May Gaskin, The Labor Progress Handbook by Penny Simpkin, and The Birth Partnerby Penny Simpkin. Ina May’s Guide will give you some great ideas on creating an environment that encourages freedom of movement and great progress in labor, and the other two have wonderful drawings of positions that you can try during normal labor and during any complications that might arise. Here is a website with a few good examples of positions you can try in labor.
So happens if you choose not to get out of bed, or if you are restricted to bed by your risk level, complications, or pain medications? It is more difficult to get the benefits of movement when you are restricted to bed, so it is helpful if you can stay out of bed as much as possible. Frequent trips to go pee in the bathroom are a help if you are given no other excuse to get up. Sometimes it is better for you or the baby if you do stay in bed, although realistically this doesn’t happen very often. If your doctor or midwife asks that you stay in bed, first ask why they are saying this. Then, ask how strict this rule is, since there might be leeway. For example, if you are supposed to get frequent heart rate monitoring, you may still be able to get off the monitor and out of bed for 20 minutes every hour. If you must stay in bed, like if you have a high-dose epidural, ask the nurse to help you switch positions every half hour or so to encourage good progress. You can sit up, lie on each side, try the exaggerated side position, hands and knees, and others. The Penny Simpkin books I mentioned above all have very good drawings describing these positions and how they can help you to dilate more quickly, or to help move the baby if he/she is not positioned well.
What you can do to ensure freedom of movement in labor:
1. Exercise during pregnancy to build your stamina for labor. Brisk walking and the breast stroke while swimming are two of the best and safest exercises you can use.
2. During early labor, REST as much as you can, drink water to quench your thirst, and eat carbohydrate and calcium rich foods.
3. During active labor, take a sip of water after EVERY contractions, and try to eat nourishing food to keep up your body’s energy. Sometimes labor slows down just because a woman isn’t hydrated, she’s too tired, or she hasn’t eaten all day. If you are well nourished with food and drink and labor still slows down, consider taking a rest before going for a walk. Don’t be afraid to give your body a break during labor. If you and your baby are tolerating labor well, there is no reason to rush the birth.
4. Talk to your doctor or midwife about staying upright and active during labor. Ask them in what situations you would have to stay in bed, and ideas of how you can stay active even if complications arise (eg. rocking in rocking chair, sitting on a birth ball, or sway-dancing with a partner next to the bed so you can stay on the fetal monitor).
5. Read books and visit websites (preferably with a person who will attend your birth) to get ideas of positions you can try. If you can, bring one of these books (like the ones I mentioned above) to your birth place so that if you forget them you can look up some fresh ideas.
6. Hire a doula. She can remind and help you to keep up your energy, to encourage you and reassure you that what you are experiencing is normal and that you are doing a good job, and physically support you in different positions so that you don’t get tired too quickly.
7. Don’t worry about trying to find the “right” position. Just do what comes naturally, do what feels good, and chances are you will be doing just what you should be doing. Stay out of bed unless you are tired and need a rest. Even when you are in bed you could still adopt a hands and knees position, or get on your knees and rest on the back of the bed (when the head of it is raised). There are so many options, so pick your favorites, use one of them for a while, then try another one.
Here is a University of Toronto study that shows what happens when the hospital bed is no longer the “focal point of labor”.
