This week, I have had babies on the brain. I think this might have something to do with the fact that I spent a large part of the weekend with a very good friend who is heavily pregnant with her first child. We spent a little time talking about her plans for the birth. The aim is to give birth at home, and my friend also remarked that her desire is to stay as upright as possible during labour. While it is customary in the UK for women to go through labour lying down, my friend believes that standing and squatting are far more natural and appropriate positions during the birthing process.
This conversation was still fresh in my mind when earlier this week I came across a report on a review of maternal position during labour. One of the outcomes assessed was the length of the first two stages of labour. Stage one is said to start when the cervix is 3 cm dilated, and ends once it is fully dilated. Stage two starts at this point and ends with the birth of the baby. Typically, the first stage of labour lasts about eight hours in women giving birth to their first child, but lasts about half this length in subsequent labours.
The review in question was conducted by scientists from the Cochrane collaboration (an international group of scientists specialising in systematic reviews of health-related interventions), and was published last week.
The review of 21 studies found that being upright during labour’s appeared to reduce the duration of the first stage of labour by about an hour. Maternal position did not seem to affect the length of the second stage of labour. Neither did it appear to influence the mode of delivery or other outcomes related to the well-being of the mother or her baby. However, in addition to appearing to reduce the length of the first stage of labour, being upright was also associated with a 17% reduced risk of having epidural analgesia.
The authors of the review concluded: There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers’ and babies’ wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour. You can read more about this study and its findings here.
Could being upright be associated with a 17% reduced risk of having epidural analgesia because it went so much faster or more comfortably that it was too late to get an epidural? That happened to my sister, she wanted one but when she asked for it they said it was too late. I don’t know if she was upright or not but my family has a history of short labors.
Well, when I had my baby (12 years ago) I actually begged them to let me change positions and get more upright. I was very overweight and in full labor when the doc (in sympathy, it was her first-ever baby delivery) decided to put me on a full dose of Pitocin because I wasn’t dilated enough. My body was mindlessly screaming without me and I passed out and quit breathing for a minute after each contraction a few hours in; fortunately that didn’t start until about 6 hours in and I had the baby 24 hours after my water broke and it all began. I remember looking at my husband and saying, “I am never. Doing. This. Again.” They say people forget the pain of childbirth but I certainly haven’t!
Anyway, at some point an older doc was in there and I was asking him why I couldn’t sit up, maybe walk around as I’d tried to do earlier (before the contractions got too bad) and he told me it was better for me to do so, but that for insurance reasons they were required to keep me on my back and hooked up to so many monitors there were cords everywhere. By the time it was over I was begging them for a knife so I could do my OWN caesarean the pain was so unbelievable. Apparently nature arranged it so no matter what the pain, you stay alert (for fairly obvious survival reasons)… there is no escape.
Just to be annoying, my ex’s new wife had three children in about 12 minutes each. It was “mildly uncomfortable for her.” {imagine the unprintable comment here…}
Anyway, it stayed with me that the whole reason I couldn’t do what I knew and felt and begged would be right for me during labor was because of insurance — ironically, even when that technically contradicted health.
Which is probably why in all the ancient cultures where women took prominence in the birth process (read no men doctors!)they used ‘birthing chairs’ where delivery happened in an upright position.
The Active Birth movement has been teaching this at least since the 1980s. Informed by studies (scientific and anthropological) and – most importantly in my view -women’s experience, Active Birth methods demonstrate that being upright and mobile in labour can shorten it and also provide more pain relief. I always understood that lying on our backs makes examination easier for medics – but for labouring women!
To me it is common sense: being upright means gravity can assist the baby coming down and there is less pressure on the spine.
http://www.activebirthcentre.com/
Working with rather than against gravity makes a whole lot of sense.
Some hospitals were little more than production lines back in the eighties/nineties: when a friend was giving birth, something like 20% of white women and 80% of black women had caesarians, almost certainly to move them through fast. 🙁
Hi, I walked around all the time i was in labour and just was on the bed for about 15 minutes. I had the TENS machine on me while I walked so the pain was not so bad, but not my first.
At long last after many long years! I remember arguing with a very unsympathetic midwife when I had my first baby 29 years ago. I desperately wanted to stay upright during the birth and particularly the last stage, my entire instinct was ‘upright and force of gravity will help’. I just knew that it was the right way to go about it. She was having none of it! Result was a far longer labour and more pain relief required as I was forced to lie down like a side of beef on a bed! However 2nd labour with a sympathetic midwife who let me lead the birth myself with her there for help as necessary. Shorter, faster and less pain relief. Enough said!!!
The best thing to do if you are attending a birthing woman, or you are one yourself is to not put any expectations on your position. It is very important to listen to yourself and be in the position you feel is necessary. I learned this lesson myself having my 6th baby. Normally I deliver hands and knees and certainly expected to do the same. I was having terrible pain from my bladder being pushed against my pubic bone and had to pee two drops every 2 minutes. I ended up delivering on my back, (the baby’s head was in a funky position) and being a birth snob, I was more surprised than anybody else. I absolutely agree with this article, but just wanted to point out that every position has it’s place.
Raylene
Agreed.