Women are often surprised to learn that one of the top ways to avoid a c-section is actually just to move around in labor.
Gravity-friendly positions (aka being upright) can help the baby descend, and movement (walking, rocking, etc) helps the pelvis open. Labor is dynamic. The baby is moving down and out, the pelvis is opening and the uterus, which is now the largest muscle in your body, is contracting.
When you look at many labor and delivery rooms (bed, tv, etc) the implication is hop in that bed and lie down. But to be perfectly still and on your back doesn’t make sense in labor. For one thing, lying on your back during contractions (and even at the end of pregnancy for that matter) can be very unpleasant. For another, the baby actually has to move uphill to get out. Birth works so well that this happens all the time, but you can imagine that labor might be more efficient if mom can sit and stand and rock and lean and squat and walk.
Often, laboring women want to move– not in some fancy yoga class or aerobic way, but just in a very simple, instinctive way. Leaning forward can take pressure off the lower back and help the baby into a good position for pushing. Rocking back and forth is very common among women in labor; they’re literally rocking the baby down. During the pushing phase, it makes absolute sense to get into a pelvis-opening position such as a variation on a squat. There can be an incredible urge to bear down– not unlike the need to make a bowel movement but about 100 times stronger. So, given that feeling and that real need to push, why would you then lie down? The impulse is to grab something for support and squat to help engage the muscles and open the pelvis and pelvic floor. Moving in labor can also help take the edge off the pain and pressure.
Now, this all sounds so great and lovely right? The problem is that having free range of movement in labor is not always possible. If you are given medication– to induce or speed up your labor or an epidural to take the pain away– you are required to be in bed and monitored the whole time. But if you’re not medicated, and there’s no concern, mom should be able to move into whatever position she wants to be in. Still some hospitals and care-givers leave mothers on the monitors unnecessarily.
The American College of Obstetricians and Gynecologist’s (ACOG) official policy is that intermittent fetal monitoring is just as safe and effective as continuous monitoring. Their recommendations are that mom get a 20 minute baseline strip– which means you are monitored initially at the hospital for 20 minutes– then once every 30 minutes for one or two minutes in first stage, and every 15 minutes in second stage, as long as everything looks normal. That’s not a ton of monitoring. Despite this, hospitals use outdated protocols such as keeping mom monitored the whole time or more than the recommended amount, even in the absence of any concern.
If you’d like to be able to labor “free range” for at least some of the time, here are some tips:
– Choose a care-provider who is open to movement in labor and during pushing and has a low percentage of continuously monitored patients.
– Take a childbirth class to learn the huge range of gravity and labor-friendly positions.
– Have a good, knowledgeable person with you to help you with positions and give you the support you need.
– Stay home in early labor.
– Try lots of less invasive pain-coping techniques first before, or in place of, pain medication.
– If you do get an epidural have someone help turn you from side to side every 30 minutes to help with baby and pelvis positioning.
To read more about the recommendations for Free Range Labor, check out a press release issued yesterday from Lamaze International titled, “Women should be wary of routine policies that confine women to bed, increase risk for injury.” I think free range is a great term, and I hope it takes off. We need to see more women roaming the halls of labor and delivery wards.