Medics may have positively encouraged Western women to labour on their backs – let’s face it, it’s easier for them to see what’s going on – but that’s not how it always was, or indeed how it should necessarily be. Upright birth is still the norm in many traditional societies, and since the advent of the Active Birth movement, founded by Janet Balaskas in the 1970s, women are being encouraged to use a variety of positions during labour.
While it’s wise to think about positions before the big day, and practise a few to see how they feel, it’s not wise to make a definite decision in advance, as you don’t know how things will go. Important considerations include how fast and efficient your contractions are, the position of your baby, and what stage of labour you are in. You’ll probably find it pays to go through several positions on the day, adapting as you go. A few props may also be useful, such as a beanbag, birth ball, or stool. The following are the most widely used.
Standing and walking
When? During the first stage, probably before you’ve decided to head for the hospital.
Why? It keeps you mobile, and you’re using gravity to help your baby’s descent and the dilation of the cervix. Whether you’re standing or walking, you may find you need to lean against a chair or be supported by your partner during contractions. You may also feel the instinctive need to sway your hips in a kind of dance.
When not to? If your labour is long and slow, you may find this tiring after a while. Also, it’s not advised in the second stage as pressure from the head may increase your risk of tearing, and in the third stage, the placenta may separate too quickly.
When? At all stages. During the earlier stages you may wish to lean forward, while in the third stage you may find it more comfortable to lean back. At the second stage, sitting on the toilet could help you to push (this may be slightly Pavlovian…).
Why? You’re upright but resting more than when standing, so you’re still giving gravity a helping hand, and helping your pelvis to open. If you use a birth ball, you’ll find it virtually impossible to sit still, but this is a good thing, as mobility during labour is vital. If you use a normal chair, you’ll probably find it more comfortable to face the back of the chair. Alternatively, a rocking chair could be comforting and the rocking action will keep you mobile.
When not to? If you have bad piles, the pressure of sitting on them won’t help. If you feel that your movement is restricted, find an alternative or move around between contractions.
When? Can help you when the contractions get stronger at the end of the first stage. Also good during the second stage as the pelvis is open.
Why? Again, let gravity be your friend. Kneeling can release tension in your back, making it useful if your baby is posterior and you are suffering from backache. Kneeling and swaying your hips can also help speed up a slow second stage. If you try half-kneeling, half-squatting, you may feel more stable, and may even be able to guide your baby out yourself.
When not to? May not be suitable for a rapid second stage.
When? Ideal for the second stage when you are trying to push your baby out. Probably too tiring for the first stage. Often used for a breech birth.
Why? Your pelvis is open to its widest, making it easier to push effectively. Tends to intensify contractions. You can either lean on the side of the bed, go forwards on to your hands, or let your partner support you from behind.
When not to? Can get uncomfortable after a while, especially if you are not used to squatting. If the baby’s head is large, you are at risk of tearing.
Lying on your side
When? Good during the first and second stages, especially if things are progressing well and you are tired.
Why? Unlike being on your back, your sacrum is free to move and the baby’s weight is not affecting your circulation. It could help slow things down if labour is progressing very quickly, and if you need to stop pushing for a while. It could also prove helpful if your baby’s head is big.
When not to? If things are going slowly and you need a helping hand from gravity.
When? Suitable for all stages.
Why? It’s stable, you have full freedom of movement so you can sway and rock to your heart’s content, and it can help immensely during a back labour (where your baby’s spine is parallel to yours), in some cases it can even help the baby turn to a more beneficial position. You can rest between contractions by laying forwards or slow down the pushing stage by pushing your bottom into the air (this will give your vaginal tissues time to stretch, and may prevent tearing).
When not to? Your midwife may not recommend this if you have high blood pressure.
For further information visit www.activebirthcentre.com or www.lamaze.org.