Congratulations, you found out you are pregnant and are now planning all of the things - what will the baby’s room look like, what’s the best carseat, bottle, carrier, etc. You’ve probably planned it all...but have you thought about what positions you want to move in while in labor? We’ve all seen the TV show and movie where a woman is on her back, feet up in stirrups (the lithotomy position) and pushing as hard as she can, but did you know the position you give birth in can affect your rate of perineal trauma and tearing? In fact, giving birth in this position “may have been adopted to make it more convenient” for providers without looking at the effect it has on mothers. So let’s take a look at some of the common birthing positions that may be helpful for the mother during labor.
Walking, Standing and Leaning in Labor
Upright positions, whether it is walking, standing or leaning have been shown to decrease the second stage of labor or the pushing stage. The upright position has also been associated with a reduction in assisted deliveries and episiotomies. This is important because a long second stage of labor and assisted deliveries have both been associated with greater risk of third and fourth degree perineal tears.
How to prepare during pregnancy: WALK! Spinning Babies recommends walking daily and building up to 3 miles a day at a pace where you can still hold a conversation. Don’t let that number scare you, if walking hasn’t really been your exercise of choice in the past, that’s ok. Smart small and work up to three miles!
Kneeling, or All-Fours (Hands-and-Knees) While in Labor
The all-fours position has been associated with less pressure on the perineum (cough, cough, that means less likely to produce tearing, avulsions and prolapse), and gives the provider a good visualization of what’s happening. (1) An added bonus is that it has significantly higher rates of intact perineums, first-degree tears (lower rates of 2nd, 3rd and 4th degree tears) and lower rates of episiotomy.
How to prepare during pregnancy: There are a few positions that are great that mimic this. First, just breathing in quadruped (all-fours), you can also do bird dogs, lunges, quadruped with your arms resting on an exercise ball and tripod movements. All of these will help you build strength and endurance in your arms and can help you feel more confident while in labor.
Sitting and Squatting While in Labor
If you’ve taken a childbirth education course, you’ve probably learned about how the toilet can be your best friend in labor. Not just because you have diarrhea (which fyi, is pretty common in early labor) or because emptying your bladder gives more room for the baby to descend (it does, so make sure you use the loo while in labor), but because the position helps open up the pelvic floor muscles to allow the baby to descend if (s)he is already engaged. In a relaxed position, the deep squat may decrease pain, labor time and decrease the need for cesarean by utilizing gravity to help the baby descend. One important thing to know is that squatting during the second stage of labor has been associated with increased risk of 2nd degree tears (and lower rates of 3rd and 4th degree tears) and blood loss. If squatting is your movement of choice, you can sit squat, use a squatting bar (available at some hospitals), utilize your partner to do a supported squat, or sit on a birthing stool.
How to prepare during pregnancy: Squat. Squat to the pot, squat to pick your kid up, squat to do laundry, squat when you drop something on the floor, squat to your chair, squat, squat, and squat. Ina May recommends 300 squats a day but I understand that isn't possible for everyone. Instead, everytime you go to sit down practice your squats and if you have a little extra time, add 5-10 squats every time you sit down or stand up. When squatting, try to keep your toes straight or slightly turned inward to help open the pelvic floor and relax the booty. If you feel tension in your hips, doing a little squat therapy may help ease that tension.
Side-lying While in Labor
Lying on your left side has been shown to “reduce perineal trauma, avoid performing an episiotomy and achieve an intact perineum” even in first vaginal deliveries. (1) There are a couple of options to lying on your side- you can lie with a peanut ball or support between your knees, or you can put pillows under your feet to help your knees come together and your feet to go outward. This move actually opens the pelvic floor allowing more space in the pelvic outlet for the baby to descend and make its way to the outside. Many women note this position is beneficial because it allows her to labor in a more relaxed state and conserve energy in those marathon labors.
How to prepare during pregnancy: Rest smart. This is another fabulous recommendation from Spinning Babies because how you rest matters too. Are you using your pregnancy pillow to basically practice your kung fu moves in your sleep? If so, changing up how your rest in a chair, car and even on a couch or bed can ease the tension on the ligaments in your belly. This can help with baby's position and help you mentally prepare for laboring in a relaxed position. So go ahead, use this as an excuse to take a 20 minute nap and practice your labor position.
Moving in Labor with an Epidural
An epidural can take out some of these movements (like walking) but with a few modifications, even a mama with an epidural can benefit from different laboring positions. One thing to note is the strength of your epidural. If your epidural is strong, you may want to ask your provider to turn it down so you can have more control over the position you are in.
One movement you can do with an epidural during labor is lying on your left side. The amazing Penny Simkin came up with the Roll-over Technique which helps the mama and baby get into a better position to labor. If you can still move with an epidural, it's possible that with a little help you could get into throne's position, supported squat or even to a birthing stool. For some mamas, if the epidural is light enough they are able to get on hands-and-knees to birth the baby. More often than not, you can also utilize the peanut ball to help open the pelvic floor.
How to prepare during pregnancy: When was the last time you just sat and were present in your body? Maybe you like to multi-task or avoid checking in with how you are feeling. If that sounds like you, practice sitting or lying on your side. Notice how you feel, if you have any aches or pains, notice your breathing. Preparing for this one by preparing the two things you have more control over in labor: your breath and your mindset.
What If I Labor on My Back?
Whether you have an epidural or not, if you find yourself laboring on your back there are small things you can do to help relieve pressure/tension on your pelvic floor.
Place towel rolls under your ischial tuberosities (the bony parts under your butt) or off the sides of your sacrum. This will allow better posterior sacral movement during delivery and can relieve pressure on the pubic symphysis.
Place a small pillow under your low back to help keep your back in extension and open the pelvic floor.
You can limit the lithotomy position (think knees to your chest) by pushing with your feet still flat on the table. This is especially helpful if you are experiencing lightning crotch during pregnancy or delivery.
Are These Positions Safe for Mama and Baby?
In comparison to lying on your back, all of these upright positions have been shown to have fewer abnormal fetal heart rate patterns and no clear difference in admittance of babies into the NICU. That means that in general laboring and giving birth in one of these positions is equally safe for the baby as the mama on her back. It may even be more beneficial for the mother to reduce the risk of perineal tears and prolapse to give birth in an alternative position. One thing that can help is to try to move frequently, every 30ish minutes during labor to help the baby descend.
If you are wondering what the best position to give birth in, it’s the one that your body chooses. Sometimes our minds and our bodies try to compete because we think we “should” labor in one position. Listen to your body, trust your body and most importantly, trust that your mama instinct is already on point.
References:
DOI: 10.1002/14651858.CD002006.pub4.