Know your options – maternal positions in labor and birth

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

 

 

Birth Your Way

“We experience birth so differently from the intimate spaces of our bodies and minds, it feels disingenuous to strike comparisons and place value judgments. Any woman who experiences the vulnerability of carrying a child in her body (or heart) and bringing it earthside is heroic in my estimation. This idea that there is a special medal danging on the tree for going without meds makes us undervalue ourselves and depreciate the ordeals we have endured. Loss moms, adoptive moms, cesarean birth mothers…We all open. We all tear, somewhere (body, heart, soul). We all both wildly embrace and struggle to embrace these experiences. It all takes courage and that courage is always worth celebrating.”  — Rachel Lorena Brown 

 

All to often we find ways to divide ourselves and our birth stories are no exceptions. We tell each other that if you had a pregnancy loss you are not a mother, if you chose pain medications you are weak, if you had a cesarean section you are a failure. We have all endured in our own way and do not deserve negative talk. We should instead find solace in our fellow POWERHOUSES, celebrate and support one another along each of our journeys for the road will be filled with enough obstacles.

For my POWERHOUSEs who chose to have a natural birth, thank you for continuing to remind us how strong and capable we are.

 

For my POWERHOUSEs whose precious gift was taken to soon, I keep you in my prayers. May you find comfort and healing with each new day. I exalt you for caring on.

 

For my POWERHOUSEs who chose to exercise your right to have pain medication I honor your choice.

 

For my POWERHOUSEs who carry the surgical scar of motherhood I applaud your bravery.

 

Our bodies and our memories will forever hold our stories. Your body is beautiful in every way!

 

To all my mothers and those trying to conceive, I SALUTE You!

Finding Your Voice

I have been told that “finding your voice” is one of the most important tasks when establishing the brand for your organization. I asked myself, how do you find your voice when so often we have been rendered voiceless. As a woman, mom, midwife and a minority I am passionate about all women and young ladies knowing and believing that they are beautiful, strong, and powerful beyond belief. This beauty, strength, and power comes from within and is outwardly expressed in how we care for our bodies and love the ones who have been entrusted to us. As a midwife it is my life’s goal to make a significant impact on lowering the infant and maternal mortality and morbidity rate within the United States and across the world. The voice of My Body Is Beautiful is to echo the voices of women and young ladies as they navigate caring for their bodies, pregnancy, postpartum, and parenting. It is our goal to empower them through education, mentorship, and advocacy; build a national network of support groups; and aid in lowering the infant and maternal mortality and morbidity rate through community engagement, information, and social action so that women can make informed decisions about their care.

I hope you carry with you this thought, “Our bodies are an amazing and complex asset, we are the most dynamic POWERHOUSE there is! We are capable, we are equipped, and we have been powering life since creation.”

Resource Library

National Vital Statistics Report Birth: Preliminary Report 2014

Author: ElleAnalise

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This report presents preliminary 2014 data on U.S. births. Births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented.

 

Selected Highlights:

  • The preliminary birth rate for teenagers in 2014 was 24.2 births per 1,000 women aged 15–19—yet another historic low for the nation. The rate was down 9% from 2013 (26.5) and has declined more than 7% annually since 2007.
  • In 2014, the overall cesarean delivery rate was 32.2%, a 2% decline from 32.7% in 2013. After peaking in 2009 at 32.9%, the rate remained stable for 2010–2012. The 2014 preliminary rate is the lowest since 2007.
  • The 2014 preterm birth rate (based on the obstetric estimate of gestation, as described in the Introduction) was 9.57%, down slightly from 9.62% in 2013. Preterm birth rates declined in 44 states and the District of Columbia from 2007 to 2014; the rates for 6 states (Hawaii, Iowa, Kansas,Montana, Nebraska, and North Dakota) did not change significantly over this period.
  • The 2014 U.S. low birthweight (LBW) rate was 8.00%, essentially unchanged from 2013 (8.02%).

 

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National Vital Statistics Report Birth: Final Report 2013

Author: ElleAnalise

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nvsrbirthfinaldatafor2013.pdf

This report presents detailed data on numbers and characteristics of births in 2013, birth and fertility rates, maternal demographic and health characteristics, place of and attendant at birth, and infant health characteristics. Selected Hightlights:

  • The birth rate for teenagers aged 15–19 declined 10% in 2013 from 2012, to 26.5 births per 1,000 teenagers aged 15–19, another historic low for the nation; rates declined for teenagers in nearly all race and Hispanic origin groups
  • The cesarean delivery rate, which had been stable at 32.8% for 2010–2012, declined to 32.7% of all U.S. births in 2013. Declines in cesarean deliveries were seen at 38, 40, and 41 completed weeks of gestation in 2013 from 2012
  • The preterm birth rate (under 37 weeks) declined again in 2013, to 11.39%. This rate has been dropping steadily since 2006, for a total decline of 11%. Preterm births in 2013 were down from2012 for non-Hispanic white, non-Hispanic black, and Hispanic births
  • The 2013 rate of low birthweight (less than 2,500 grams) was 8.02%, essentially unchanged from 2012 but 3% lower than the 2006 high (8.26%)

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Maternal positions and mobility during first stage labour - A Cochrane Review

Author: ElleAnalise

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It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour.

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Avoid giving birth on your back - Journal of Perinatal Education

Author: ElleAnalise

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avoidgivingbirthonyourback.pdf

Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities. There is discussion about current research and suggestions on how to improve the quality of the birth experience. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions,” published in The Journal of Perinatal Education, 16(3), 2007.

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Walk, Move Around, and Change Positions Throughout Labor - The Journal of Perinatal Education

Author: ElleAnalise

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movingaroundduringpregnancy.pdf

In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,” published in The Journal of Perinatal Education, 16(3), 2007.

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Northern Virginia Cesarean Section Rates

Author: ElleAnalise

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Two Virginia hospitals have some of the highest rates for C-section deliveries for low-risk pregnancies in the country. Your birth story is yours to hold for forever, be knowledgeable about where you choose to give birth. Unnecessary interventions in labor and birth can change your life forever. Take Back Your Story! Knowledge is Power!!

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Commonwealth of Virginia Low-Birth Rate Statistical Data 2014

Author: ElleAnalise

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The Healthy People 2020 objective is to have a low birth rate (under 2,500 g) of no more than 7.8% of live births. For 2013, the March of Dimes reported that the  US did not meet this goal having a low birth rate of 8%.  In accordance with the Virginia Department of Health statistical data for 2014 the Commonwealth of Virginia had a low birth rate of 7.9% of total births. Planning district 8 inclusive of Arlington County, Fairfax County, Loudoun County, Prince William County, Alexandria City, Fairfax City, Falls Church City, Mananas City, and Mananas Park City had a 6.9% low birth rate. Of these numbers African Americans have the highest percentage of low birth weight for the Commonwealth of Virginia as a whole and within planning district 8.