Labor is a physical and emotional event for the laboring woman. For the infant, however, there are many positional changes that assist the baby in the passage through the birth canal. Because of the resistance met by the baby, positional changes are specific, deliberate and precise as they allow the smallest diameter of the baby to pass through a corresponding diameter of the woman's pelvic structure. Neither care providers nor the laboring woman is directly responsible for these position changes. The baby is the one responsible for these position changes ~ the cardinal movements.
Upright positions or gravity positive positions are best for laboring women and their babies!Upright positions assist with the cardinal movements and, thus, can decrease the length of labor and the amount of discomfort the mother feels.These positions can also hasten the cervical dilating and effacing by keeping pressure on the cervix, much like pressing down on modeling clay.This also has a decreasing effect on the length of labor!
Changing upright positions every 20-30 minutes not only assists the baby in completing the cardinal movements, but also gives the mother a mission ~ something other to focus on besides the discomfort from the regularly occurring contractions.Changing positions can be coupled with using the restroom to empty the bladder.A full bladder has been known to partially or completely block the birth canal ~ adding to pain and pressure, impeding the birth and lengthening labor.
What upright positions are best? The mother’s body will guide her as to what is best.She can tune into how her body feels in regards to the baby and follow her instincts.It is important to note that during labor, upright positions should be alternated with rest, so the laboring mother has the right blend of rest and activity and does not overtire.
Standing is obviously an upright position, but one that during labor, takes a lot of energy.Standing at the nursery window, in conversation with family or friends or as a method of rest when walking with contractions is most useful.
Walking receives it’s own category because it is so important.Walking allows for movement of the pelvis during an upright position.Many women say contractions are less painful when walking.Walking could become tiring, but less tiring if a forward lean forward supported by partner is used – see below.
Forward leaning on a partner (such as with the slow dance), at the side of the bed leaning on a birthing ball, or in the hospital hallway on the railing can relieve some back discomfort either with a posterior baby or with late Transition Phase of labor when the baby is low in the pelvis.
Remember being in the 4th grade, going to a school dance and not wanting to dance with the boy?This is the perfect way to “slow dance” in labor ~ face your support partner, put your hands/arms around their neck and slightly lean away from them.Their hands may be placed on your back for support or light massage.This is fun with music, low lights and encouraging words!
While slow dancing or even alone, sway back and forth.This gently rocks the baby and encourages proper alignment in the pelvis and the cardinal movements.
If the baby is coming down at an angle, the term most often used is ascynclitic.When a baby is at an angle, there may be slightly more pressure than normal and a slower labor.Place a simple chair up against the wall (for support) facing you.Lift one leg and put your foot on the seat of the chair while remaining standing.Lean into the leg on the chair.Do this several times and then alternate the foot that is on the seat.Lunging either with the assistance of a chair, or simply lunging while standing can open the pelvis 1-2 cm and allow for the baby to correct the position.
Sitting can be a position, even if it is used as a resting position.Sitting maintains pressure on the cervix while giving the mother time to ease her legs and back.Sitting American Indian style with the legs crossed can also open the pelvis.
Rocking in the sitting position is similar to swaying while standing without the stress on the legs and it rocks the baby in the opposite direction (front to back vs. side to side).
Sitting on a birth ball
For extensive information on the birth ball and photos, click here.
Sitting on the toilet
Since we were potty trained as little girls, we have known to relax the pelvic floor when sitting on the toilet.That is exactly what needs to happen in mid-late labor!Sitting on the toilet supports our upper leg muscles and causes relaxation of the Kegel or pelvic floor muscles.Many birthing beds, stools and chairs imitate this same position.Will the baby be born in the toilet?If the mother listens to her body, the answer is NO.She’ll know in plenty of time to move back to the birthing bed!
All-fours and All-fours leaning
A detailed article about the benefits of the All Fours position and how it can relieve back labor can be found here.
If the mother is experiencing back labor, support partners may be taught to find the Rhombus of Michaelisor the important “spot” to apply counter pressure.First have the mother assume an all-fours position. Her upper torso may be supported by having her arms on the bed or floor. However, if she has had difficulty with carpal tunnel syndrome, she may be more comfortable leaning her upper torso on the Birthing Ball. The partner, standing behind her, finds the top of her pelvis by palpation. Once the location of the top of the pelvis has been established, the partner brings together their wrists, making a "butterfly" with the hands. Where the wrists come together, this is the Rhombus of Michaelis.
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