07 Jun Powerful Positions & Marvellous Mechanics
The mechanism of Labour is a truly wonderful bodily function, started and steered by your baby in a natural birth. In a head down position, baby first enters the top/brim of your pelvis then further descends into your pelvis becoming engaged (fixed, rather than bobbing in & out) from around 36 weeks for first time mums. Some babies don’t fully engage until Labour starts when uterine contractions help complete this part of the process.
A woman’s pelvis is completely different from a man’s pelvis, being wider and flatter and ideally suited for childbirth. However, women do have different and individual pelvic shapes and sizes and there are many variations. The pelvis changes shape three times as the baby journeys down the canal, so this requires baby to make a few negotiations on the way down and out.
When baby decides the time is right, baby stimulates contractions which help him/her make a series of changes in position involving some flexion, some twists and some turns so baby can make his/her way down the birth canal in order to be born.
The pelvic ligaments soften and stretch to allow slight movement of the pelvic joints which increases pelvic space, making it easier for baby to pass through. Soft pelvic tissues and your perineum (the bit between your front & back passage) all have a part to play in getting baby into a looking down position (although some babies prefer to be born facing upwards). Baby’s skull bones slightly override each other, making it easier to fit this now larger pelvic space so birth is possible – all done without you thinking or knowing this is happening…what a partnership – an amazing process!!
Using upright and forward leaning positions during pregnancy, labour and birth hold huge benefits for mum, baby and birth outcome. It is something we have control over and can choose to use and practice as part of our daily routine. It’s not rocket science, but something you may not have given much thought to – yet it can make a very big difference to birth.
These better positions help maximize gravity in nudging baby down the birth canal. They open your pelvis to it’s widest, giving more space for baby firstly to enter your pelvis and secondly to leave it when birth is imminent. Your tail bone (coccyx) is moved nicely out of the way by baby’s head, giving baby even more room and making birth easier.
Positions for Pregnancy
The following positions direct a gravitational force which encourages baby to move down and around to face you, with his/her back outermost against your skin. This is an optimal position for baby to adopt (anterior baby position) and associated with an easier and quicker birth.
However, you cannot see inside your body, the shape and size of your pelvis, so we should acknowledge some babies may have to adopt an alternative position to best fit mum. There are no negative effects from practicing these pregnancy positions and baby will at the very least benefit from an improved blood flow. Please don’t be tempted to ask your midwife the position of your baby during pregnancy – just work with baby, trusting baby will find his/her most comfortable and better position – your baby knows best!
As your bump grows during pregnancy, your pelvis tilts forward and the curve in your back deepens to help keep you balanced. A hormone called Relaxin does exactly that – it relaxes and loosens the joints at the front and back of your pelvis, widening the joints and making more internal space in readiness for birth. Joint stability becomes affected, so posture in pregnancy is really important in helping avoid both backache & pubic pain.
Keeping fit with gentle exercise in pregnancy is really good for you – with an emphasis on gentle. Yoga and swimming are perfect choices as they provide an appropriate level of both physical and breathing exercise. These activities also increase the likelihood of your growing baby settling into the most usual and favourable position for birth.
Your footwear really matters and it’s a good idea to gradually reduce down from high heels at work, so you can keep your body more aligned as your bump grows. You may eventually feel more comfortable wearing a small wedge, although trainers will feel like bliss! Stand and sit straight with your head and body in alignment – as though someone is pulling on a string fixed to the top of your head (1st puppet move).
Sitting on a birth ball is a great idea as it tilts your pelvis forward and encourages you to pelvic rock (knees open & lower than hips). If it’s not practical to use your ball then sit on a firm dining room type chair or the floor – don’t spend long periods of time lounging back on soft, comfy furniture as gravity in this case draws your baby’s back to your back (posterior baby position) and is associated with a longer & less easy birth. If you want to rest, lie down on your side with your knees flexed comfortably, tuck a pillow inbetween your knees for comfort as this will help stabilize your pubic joint.
If you spend a lot of time sitting at work, try and walk around every half hour or so, offering to make the staff brews will keep you hydrated and give you a good excuse to spend time away from your desk. Lean forward onto a work surface/back of a chair and sway your hips in a circular (belly dancing) motion in your break or when you get to make a cuppa (in private of course) this gives the baby chance to move into a comfortable and optimal birth position (2nd puppet move).
When driving or sitting for long periods, place a lumbar cushion or rolled up towel low in the hollow of your back to keep your back slightly arched, this will prevent you slouching, again avoiding tempting your baby into a back-to-back/posterior position. Have plenty of journey breaks to walk around.
Some daily hands & knees activity is great, adopt an ‘all fours’ position and crawl over to the TV to switch channels (3rd puppet move). You may be too young to remember Spotty Dog – he had the right moves – move forward on your right hand with your right leg/left hand with your left leg or simply wipe over your skirting boards, do some weeding, pair up socks (or is it only me that has an odd sock bag!) This type of activity will give your baby more room to move into his/her ideal position. 😉
Sleeping on your back as baby grows will make you feel sickly and faint as the heaviness of your growing bump presses on your major blood vessels. The comfiest position is to lie on your side with your knees bent (go off to sleep on your left side if possible). Tuck a pillow under your bump to help prevent backache and try to extend it to also support your waist (alternatively, you could use a pillow under your tum and a rolled towel under your waist). Position one or two pillows between your knees to help prevent pubic discomfort. If you prefer to be propped higher in bed, place a pillow vertically, to tilt you slightly to one side, preventing a flat back position.
Hey! He may say ‘where do I sleep?’ …hmm – don’t worry! believe me, men will find their spot – in my experience they can sleep anywhere!! – and you are a Princess!!
When you get the chance to sit down, have short periods with your legs up supported at the level of your hips by another chair or on a sofa. This is especially useful to stop nagging tummy aches in early pregnancy and will direct more blood supply to your baby. Even more beneficial if you drink & hydrate at the same time!
Dancing, strolling, taking the stairs are all good ways to keep you fit for labour and help your baby move around and down. Keep it gentle, low impact and ‘feel good’ to get your Oxytocin flowing – a nice beach walk, a picnic, a little shop & coffee – you get the picture!
Positions for Labour
Labour tends to make you restless, which is your body’s way of saying ‘move and change position regularly’. If you are calm enough to respond to your body then you don’t need to engage your brain and think any further – just go with it.
However, it is useful during pregnancy to understand how your body works and how you can work with it during this stage. This is particularly helpful if you plan to give birth on a Labour Ward, where the hospital bed often takes centre stage and has a very strong pull in drawing you towards it – resist – resist – resist!
Being upright and forward will make you feel more in control, more comfortable and you will find it easier to change position in response to your body’s needs. Your baby will be happier too as he/she is free to move around and down and has optimal blood and oxygen supply.
Gravity increases and equalises pressure on the Cervix, promoting effective contractions which help achieve good labour progress. Your pelvis has boney prominences and ligaments which the baby has to negotiate on his/her journey down the birth canal, it makes sense to work with gravity to help baby achieve this. Your tail bone (Coccyx) is moved out of the way by baby’s head, increasing the space in your pelvis. Your baby’s skull bones override, enabling the smallest diameter of the baby’s head to pass through the larger space made in your pelvis – clever or what!
Unless you get a real desire to adopt a particular position – try them all! Not only will changes in position help bring birth closer, but it also really passes time. Use it as a Labour Game and spend around 45 mins in a position and then change. It’s a good distraction, therapeutic and means you present different skin areas for stroking & massage, stimulating endorphin release (your body’s natural Morphine).
Although it will help everyone to digest this information during pregnancy and will help some to use as a labour activity, if you are Hypnobirthing and zoned out, quietly and happily doing your own thing, then it won’t be helpful to be interrupted. In this instance, PLEASE DO NOT DISTURB.
Strolling rather than high energy activity
Standing and rotating/swaying your hips
Standing and leaning forward onto a work surface/chair back
Kneeling and leaning forward onto a birth ball
All fours – hands and knees position, rocking back & fro or tail wagging (side to side)
Step up one foot on a stool/step and sway your hips if you feel the need
Side lying for resting with plenty pillows for support – under tum & between knees
Rocking chair, pushing off with a leg bent at knee and elevated against a chair/step
Slow dancing with your arms around your partner’s neck
Belly dancing, wiggling, swaying and rotating your hips
Gently bouncing on a birth ball
Lying or sitting on a bed is the least comfortable and helpful position for birth. If you have restrictions for some reason, discuss with your midwife going on your knees and leaning against pillows or using ‘all fours’ position on the bed. You can still be effectively monitored in this way, even on a birth ball.
If you’re in a birth pool, you will find the buoyancy of the water helps you change position naturally and easily. Water feels so relaxing and supportive.
Positions for Birth
Maintaining these same upright and forwards positions during birth is really important for breathing baby down and out. During this stage, you should choose positions that use gravity to its maximum to keep contractions efficient and help your baby birth.
Using these better birth positions will open and increase your pelvic size and space.
Just before birth you will often feel an increased restlessness and naturally change position to the one you find most comfortable. Very few women naturally choose to lie down as this position is the most uncomfortable and the most difficult for birth – sitting on your coccyx is painful & pushing a baby uphill requires an awful lot of energy.
Films & TV often portray traditional bed lying position as the most common position for birth, therefore a lot of first time mums think this position is the one they’re expected to adopt – NO – definitely not – not at all!
As labour approaches the intense pressure and breathing down stage, it is useful to use a kneeling or ‘all fours’ position. This works more gently with gravity and is associated with less vaginal/perineal trauma (stitches).
So, you’ve recognised birth is close and you’re getting ready to birth your baby & oops your contractions disappear! This is nature’s way of giving you a rest and making the necessary hormonal changes to enable your baby to enter the world. Enjoy the moment, rest and hydrate. Soon you will get overwhelming happy pressure in your bottom, a ‘second wind’ (not the smelly kind) and hey ho you’re in business!!
If you become tired, sitting on the toilet or a birth stool can help you remain comfortably upright, promoting effective contractions. Gravity is a very good friend of yours in helping you birth right now – just breathe down with it.
Kneeling on a mat/bed, leaning forward against a ball or back rest
Kneeling, leaning on your partner with your arms around his neck (can be uncomfortable and hard work for your partner)
‘All fours’ in hands and knees position. Your midwife may ask you to lower your head towards the bed mattress to help baby birth (knee/chest position). This allows your pelvis to increase to it’s largest diameter. You may feel a natural urge to do this.
Squatting isn’t really a natural position for most women today. However, supported squatting such as on a birthing stool works well and doesn’t require the same level of fitness as squatting independently. To achieve better control and lessen perineal trauma, it’s helpful to lean forward off the stool into a kneeling/’all fours’ position as the baby’s head is emerging ready to be born.
Standing gives the most gravitational force, which may feel good to get things started, but as the baby’s head is emerging you may want to slow the progress by adopting a more controlled ‘all fours’ position to breathe baby out.
Side lying is a useful resting position and a more favorable bed birth position. In this position, the baby’s head is still able to push the mother’s tail bone (Coccyx) back out of the way to increase the pelvic space for birth (this is a normal, painless action). Some mothers who have suffered pubic problems and pain may choose this position for birth to control the extent to which they open their legs during birth. A wedge can be used between your knees to widen legs sufficiently, but keep them supported and protected from over extension.
Look around your birth room for things that can help you maintain these better positions. Birth Centres have slings, grab bars, birth stools and bean bags, all of which will help steady you and conserve energy. You can improvise in the Labour Ward by using the bed table, the bed end or by raising the level of the bed. You will probably have access to a birth stool here too and can take your own birth ball in with you.
You will feel more natural in using different labour and birth positions if you can dull down the lights (improvise and take your shades to wear if you are birthing on a Labour Ward and low lighting isn’t possible). It’s hard to keep still if you’re listening to music so take headphones for your phone/MP3 player and have a playlist that you’ve prepared earlier – rock & sway the time away.
It’s just as important to birth your placenta easily and quickly in order to prevent excessive blood loss. Positions play an important part during this stage too. During a physiological 3rd stage you will generally remain attached to your baby by the umbilical cord until your placenta is expelled. This means you are holding your baby in skin-to-skin, so using the pre mentioned better positions can be a little restricted.
Kneel on a mat/bed or sit on a birthing stool so gravity encourages placental separation and it can just plop out while you are admiring your little man/lady.
So the final thing to remember and perhaps use as a mantra is UFO – Upright, Forward and Open and that should do it perfectly. Happy birthing!!