Positions for Labour and Birth
Whether you’ve elected a public or private hospital, or have decided to give birth at home in your bed or using a birthing pool, we’ve compiled certain positions and movements that can help you alleviate pain and assist with the progression of labour.
How do I know if I am in labour?
Firstly, you should determine whether you are going into true labour or experiencing false labour (see Braxton Contractions). If you are not at full term (less than 37 weeks) don’t wait to find out or hesitate: call your doctor or midwife.
As for false labour contractions, they are typically irregular, unpredictable, and do not lead to progressive cervical dilation, as true labour does. True labour contractions are persistent and will not subside. They will tend to happen at regular intervals, then begin to increase in duration, intensity, and then frequency. Timing a few will help you find if you’re going into true labour; however don’t hesitate to call your midwife or obstetrician for assurance.
Once you’ve ruled that you have gone in labour, it’s important to keep in mind that the process is divided into stages: first, second, and third.
The first stage consists of three phases: latent and active labour, and transition.It’s easier to describe latent labour in reverse- it will end and progress into active labour once your contractions occur every 3-5 minutes and last 40-60 seconds, and your cervix has dilated to about 4-6 cm. These are just guidelines and every woman is different. Unless your healthcare provider recommends it, try to delay rushing off to the hospital until you have reached this phase. Also keep in mind that for most women in their first pregnancy, this stage will last 6 to 12 hours, some shorter or longer. So, you’re likely to be more comfortable at home for this part!
| First Stage of Labour | |
|
Divided into 3 phases |
A) Latent Labour
B) Active Labour C) Transition |
| Contraction Frequency | Every 3 to 5 mins |
| Avg. Contraction Duration | 40 to 60 secs |
| Cervix Dilation | 4 to 6 cm |
| Avg. Total Duration of Stage | 6 to 12 hours |
A) What to do during latent labour?
You may want to get as much rest as your contractions will allow, in preparation for the long process ahead. If you choose to snooze, do so on your side, so that your labour can still progress. Putting a pillow between your legs, as well as some support under your bump, can make it a bit more comfortable. Avoid laying on your back as this compresses major blood vessels and will make your contractions less effective.
On the other hand, you may feel restless and want to keep busy in between contractions—which at this stage will still be quite far apart compared to what’s coming. Being upright and moving during early (and active) labour, helps the baby to descend and has been shown to decrease the total labour time. Walking around and taking a shower (while you still can do so freely) may be the way to help you relax until things really pick up pace. If you have taken an antenatal class, try the breathing and relaxation techniques learned, and figure out what positions make your contractions most bearable.
B) Movements and positions during active labour
For women in their first pregnancy, active labour tends to go on between 4 and 8 hours; some shorter, others longer.Any time during the active labour stage if your contractions —whatever their timing— become so unbearable that you cannot talk through them: call your caregiver. They will likely recommend proceeding to the hospital or birthing centre at this time. Whether you’re at a facility or at home, allow your body to dictate what position is best for you. Remember— gravity is your friend, so try to remain standing or sitting upright as much as you can bear. Be active and keep moving. Take rests when needed, and importantly, remember to stay well hydrated and wee. Some positions to keep in mind:
On all fours
This is extremely popular as it tends to provide relief for back pain. Get on your hands and knees on the bed or the floor. Propping up some pillows underneath you to lean into can help with any wrist pain. If you’re at the hospital, raise and tilt up the head of the bed so you can prop yourself up over it, and lean in through a contraction.
Standing, walking, rocking
Many women prefer being upright and walking around or swaying. During a particularly painful contraction, you can lean against your partner or brace yourself against the wall to get through it. Again, this also helps your baby start descending into the pelvis, and can make your labour progress quicker compared to supine positions.
Sitting backwards
Straddle an armless chair or toilet, with a pillow against the back of the chair so you can lean into it with your belly. This will help with back pain while still keeping the pelvis open so labour can progress. This could be a good time to ask your partner or friend for a backrub.
C) The third phase of labour: Transitioning
Luckily, this will be a much quicker phase of labour than the other two. Transitioning will occur for most, in about an hour. Often times, your cervix will dilate from 7cm to 10cm and the baby will fully descend— it will soon be go time. During this phase of labour, it may be impossible to move on your own in order to deal with the pain of the contractions, so ask your midwife, partner, or nurses to help you get into a more comfortable position.
Second stage of labour: giving birth
In this stage, your cervix will have fully dilated. Although it’s common for your midwife or obstetrician to coach you and have you push through the contractions, listen to your body and tell them how you feel. It can be a good idea to let your uterus do the work on its own, unless you really feel the urge to push. Some positions helpful for this part are:
Birthing stool
If you are in hospital, it’s likely that you will have chosen a facility with a birthing stool. They are a chair that is quite low to the ground, allowing you a natural squatting position while supporting your weight. They frequently have hand grip bars on either side, for control and holding onto as you bear down through a contraction. If a birthing stool is not available, you can alternatively sit on the toilet, with a towel stretched over.
Squatting
Similarly to the birthing stool, if you still have the strength to support yourself, you can get into a squat position. There may be a squatting bar available at your facility, or you can hold onto the footboard of the bed if there isn’t one, or if you’re having a home birth. Grasp the bar or end of the bed to help you sit into a squat. This position opens up the pelvic floor, and you can push throughout the contraction. Alternatively, you can hold your partner (or midwife’s) hands and lower yourself into a squat, using them for leverage. This can feel more supportive and allow you to really concentrate on the push. A few grunts can help along, too.
On all fours
This provides a roomy exit and relieves back pain, and thus lessens the need for an epidural. It is also less likely to cause tearing or the need for an episiotomy (surgical cut to enlarge the opening just before birth). You can be on your hands in knees, or sit on your knees with your legs open. Try this one before you head into labour, to see which variant is most comfortable for you. Some will even recommend using a birthing or exercise ball to lean into.
Giving birth in bed
If you are too exhausted to be upright or your midwife has you in bed due to medical complications, it’s highly recommended to avoid lying on your back. Unless you’re getting help from stirrups, try to be semi-prone and lay on your side. Your attendants will monitor the baby’s heart, to see which side he prefers, and will assist you to get into position. Better yet, try kneeling on the mattress, or on top of a pile of pillows. The more upright you can be, the lesser your risk of assisted birth.
Now it’s important to note that you may not be able to try out all of these positions during your labour. You may be in the hospital, tethered to an IV or monitor, or you may have elected a home birth using a birthing pool. You may have received an epidural which will render your lower half numb. Ask your birthing attendants what positions are safest and most effective for you, depending on where you are giving birth and your medical condition.
If you’ve had an epidural
You may want to delay this, or ask for a walking epidural, as you will be bedridden after receiving the full dosing. Try to stay active as much and long as possible before option for the needle. Again, flat on your back is the worst position to be in after an epidural, and can reduce oxygen supply to your baby. Although you are numb from the waist down, your midwife or partner can help prop you up with pillows and wedges. You can even ask them to help hold one of your legs as you push through a contraction. Semi-prone, with your partner bracing your top leg is often the most comfortable and effective after an epidural.
Third Stage: Delivering the Placenta
Congratulations, you’ve given birth! You will likely be exhausted from delivering your baby, and pretty preoccupied with his arrival, that this stage may seem to go by very quickly. Although you’re likely collapsed on the bed by now, a more upright position will help you deliver the placenta. Depending on how the labour went and your baby’s vitals, you may be able to delay cord cutting until you’re birthed the placenta. If you are in good health, you may even be allowed to breastfeed with the cord still attached. This will release oxytocin and promote your uterus to firm and contact naturally, and often the placenta will slide out as you rise to a more upright position.
Going into labour and giving birth can be scary and exhilarating. It’s recommended to take an antenatal class, and practice a variety of labour and birth positions throughout the late stages of your pregnancy. Knowing which positions help you the most and how to get into them ahead of time, will help you feel more confident and in control when the time comes to birthing your baby.
