Daily Archives: February 5, 2016

Know your options – maternal positions in labor and birth

 

Back to bed is the only way to go for newborns but not for pregnant mamas! More times than not in most health facilities in the US women labour in bed. While this is convenient and necessary for some mamas with complications studies have suggested that there may be adverse effects on labor progress, uterine contraction and placental blood flow. It is however evidenced that upright and walking positions reduces the need for epidural, length of labor, and risk for cesarean birth. Upright and walking position have not been shown to be associated with adverse effects to mothers’ and infants’ wellbeing or an increase for interventions. Based on these facts, it is recommend that mamas in low-risk labor  be informed of the benefits of upright positions, and encouraged and supported to assume the position(s) of their choice.

Why does being mobile and upright in labor help, simply put GRAVITY!!! Gravity aids in the fetal head moving into the pelvis. As the fetal head is applied to the cervix the regularity, strength and frequency of contractions are intensified aiding in cervical dilation and fetal decent. Being mobile and upright in labor also aids in the “good stuff” getting to baby (ie. appropriate placental perfusion and fetal oxygenation). When laying flat on your back the uterus has the potential to compress important abdominal blood vessels negatively affecting maternal circulation and blood flow to baby. When the maternal circulation is compromised  this can in turn effect maternal and fetal status and labor progression. In addition, mobility and position changes in labor is a pain management technique which support the natural physiologic process.  Evidence shows that women who are upright and ambulatory during labor have a shorter duration of labor, are more likely to have a vaginal birth, are less likely to have a operative birth, less likely to have a cesarean birth, less likely to have an epidural, and neonate less likely to have admission to the NICU.

“Women need to feel that they can labor in a supportive environment that decreases their fear of pain by supporting their ability to cope with the pain of labor, including having the freedom to walk, move, and change position throughout labor.”

Gravity also plays a role during birth.  Kneeling, squatting and standing all take advantage of gravity to assist mamas in delivery of the baby. Side-lying, semi-reclining, hand-and-knees do not take advantage of gravity but provide increased relaxation and allows mamas to rest effectively between contractions. For those having back pain, especially due to positioning of the baby, hands-and-knees position provides relief and maximizes the dimensions of the pelvis like standing or squatting. When birthing in the side-lying posing the decent of the presenting part is slowed reducing perineal tearing.

Throughout labor and birth, mamas benefit from frequent position changes. Ideally, mama’s positioning should be self-determined. Be knowledgeable about your birth rights, ask questions when not clear, and make informed choices about your birth!

 

DiFranco, J. T., & Curl, M. (2014). Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push. The Journal of Perinatal Education, 23(4), 207–210. http://doi.org/10.1891/1058-1243.23.4.207

 

Lawrence, A., Lewis, L., Hofmeyr, G. J., Dowswell, T., & Styles, C. (2009). Maternal positions and mobility during first stage labour. The Cochrane Database of Systematic Reviews, (2), CD003934. Advance online publication. http://doi.org/10.1002/14651858.CD003934.pub2

 

Ondeck, M. (2014). Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor. The Journal of Perinatal Education, 23(4), 188–193. http://doi.org/10.1891/1058-1243.23.4.188