Stands up for birth.

For centuries, women have been active during labor. Upright postures and movement throughout labor are often a woman's natural choice. It is only in recent history that medical practice has resigned women to static, reclined positions in labor. With this approach, slow and painful labors, cases of celphalopelvic disproportion, and fetal distress are common. Although these issues can sometimes have a pathological origin and constitute a real need for medical intervention, they are often resolved quickly with a change in maternal position.

During pregnancy the opening of the uterus, the cervix, is a thick, tightly closed barrier between the delicate in utero environment and the real world. Labor begins as the cervix opens. This dilation and thinning is aided by a well flexed baby's head massaging away at the tissues of the cervix (Singing-tree, 127).

This is where upright positions and active movement become vital. Pressure applied evenly to the entire cervix--i.e., a baby pressing a broad, firm area across the cervix--will facilitate complete opening. Malpresentation can keep a baby from descending into the pelvic outlet and, at the least, slow things down. Studies have shown 25 percent shorter labors for morns who stay upright (Lauerson, 437).

Constant motion, especially pelvic rocking, can gently wiggle the baby into a favorable position. Pelvic rocks are a beneficial exercise to do throughout pregnancy. Walking up stairs is another great way to move things around in labor. The simple act of walking uses gravity and aids flexion and descent.

During the second stage of labor, the baby descends through the bony pelvis and out of the vagina. Most women have ample room for even a large-headed baby. Homebirth midwives and other natural birth enthusiasts have abundant triumphant stories of eight- to eleven-pound babies being born vaginally. There are unfortunately more stories of women, who, after being ordered to bed, "just couldn't push their baby out."

A woman's pelvis is made of four bones that are joined together by "a network of cartilage and ligaments" (Varney, 730). This means that the pelvis is not a rigid structure. The symphysis pubis (pubic bone) and the sacrococcygeal symphysis (butt bone) are flexible. Yet a woman confined to bed cannot maximize this flexibility. Hands and knees and squatting positions can actually open the pelvis an entire centimeter.

Labor is just that, labor. But the energy of birth is by no means unbearable. Many women want to remain alert and unmedicated during their labors. This is an individual choice that should be supported. Lying down during birth is often the sabotage of natural birth plans. If a woman is allowed to move in accordance with her own rhythms, she can often slip into a position that minimizes pain and maximizes the effectiveness of labor. If a baby is pressing a bony part into the sacrum, a hands and knees position can alleviate the pressure/pain.

According to A Guide to Effective Care in Pregnancy and Childbirth, contractions are more painful and less effective when a woman lies down. Women who are allowed freedom of movement in labor use less pain medication and less oxytocin for augmentation. The authors assert that studies confirm fetal well-being is compromised by the supine position as well (Enkin, et al. 204-205).

You've no doubt heard the saying "I'm not going to take it lying down." A birthing woman confined to bed is literally in no position to take control of her birth. Psychologically, being active during birth is essential. When a woman lies down and gets connected to the myriad of hospital devices, she loses her identity. She is no longer talked to, she is talked about. She is no longer monitored. Her charts are filled with numbers from readouts. Her voice becomes lost in the din of mechanized information.

Women today want to make their own choices in childbirth. Many birthing couples strive for a natural birth without drug interventions. For these couples, upright positions can be a valuable tool. While maintaining a sense of autonomy, a woman who is active during labor increases her chances for her dream birth. The innate power of a woman is amazing. Her ability to yield and maneuver the energy of birth is miraculous. Left to move as she pleases, she will forge her own unique path to a natural and fulfilling birth.

References

Ekin, Murray, Marc J.N. Keirse, Mary Renfrew, and James Neilson. 1999. A Guide to Effective Care in Pregnancy and Childbirth. Oxford University Press.

Lauersen, Dr. Neils H. 1985. The Complete Guide to Fertility, Pregnancy and Childbirth. Childbirth with love. Berkley Book.

Oxorn, Henry. 1980. Human Labor and Birth. Appleton-Century-Croft.

Singingtree, Daphne. 1993. Birthsong Midwifery Workbook. Eagle Tree Press.

Varney, Helen. 1987. Nurse Midwifery. Blackwell Sceintific Publications.

--Shannon Ciaramitaro is an ALACE-certified childbirth educator. She and her four children live in Memphis, TN. Along with teaching childbirth classes and homeschooling her kids, she owns her own small business, www.mamasprout.com.