Best Labor and Birth Positions
The choice of labor and birth positions has a huge impact on a mother's comfort level during birth and how quickly and effectively her labour does or doesn't progress. The more options she has, the more prepared she is to handle her birthing experience.
Effective positioning can speed labor and reduce discomfort by aligning the baby properly, by reducing area-specific pressure, and by reducing unnecessary muscular effort.
For a hospital birth, the most-used birth positions are the lithotomy (flat-on-back) or C-position (resting on tailbone with body curled in the shape of a C). The reasons for using these positions have nothing to do with comfort or effectiveness for labor. Rather, they are used solely because they are convenient for doctors.
While they allow doctors easiest access, they are detrimental to birthing for many reasons. Foremost among these reasons is that the pelvic outlet is up to 30% smaller when a woman is in these positions. They also restrict a woman from freely moving and put greater pressure on the perineum, all of which can lead to other unnecessary interventions or complications like tearing, episiotomy, forceps delivery, or vacuum extraction.
In addition, the risks to the baby increase as well. Poor birth positions can decrease fetal heart rate or cause other types of fetal distress, which may lead to continuous or internal fetal monitoring, increased risk of shoulder dystocia/problems with presentation, or a prolonged pushing phase.
There is no need, absolutely no need, for a woman's legs to be pinned back during pushing. This is not only uncomfortable for the mother, but creates issues that otherwise wouldn't exist. When a woman's legs are held back, incredible stress is created throughout muscles that should be relaxed. The perineum is put under tremendous strain and is more likely to tear rather than slowly stretch as it should.
A woman truly doesn't need to "push" as is commonly believed. It is the work of the contractions to push the baby out. Rather, a woman should be encouraged to let her body do the work and breathe the baby down, concentrating on tensing the top of her abdomen as she breathes down through her body. She should not be holding her breath or tensing any part of the perineum. This allows the baby to slide down the birth path with little effort from the mother.
When her legs are held back, a woman is also at risk of developing symphysis pubic dysfunction if excessive, unequal force is applied to one leg over the other. The pubic symphysis is the location where the two sides of the pelvis meet at the groin. When too much pressure is exerted, these bones can separate causing excruciating pain for the mother and lasting effects after birth.
One mother I later worked with actually felt a "pop" as a nurse pushed too hard on her leg, but because she'd had an epidural, she didn't know what had happened until after the drugs wore off. She had to use a walker for weeks before moving to crutches. No mother should have to endure such unnecessary consequences from an overzealous nurse pushing too hard on a leg that shouldn't be pushed at all!
While this mother should have been enjoying her new son, she was in chronic pain from an unnecessary procedure. If that weren't enough, she's now doomed to future cesarean sections from the unneeded damage inflicted upon her body while birthing her first child.
This example isn't meant to scare mothers, but to bring home the reality of how unnecessary interventions cause problems in otherwise normal births. In short, I can't stress enough how using proper labor and birth positions can effectively reduce or even eliminate the need for most common interventions or complications in labor and birth.
Types of Labor and Birth Positions
There are five main types of labor and birth positions. It's important to note that most of these positions can be used for pushing, not just for labor. While some are definitely not glamorous, they get the job done.
These include:
Hands-and-Knees Positions
These childbirth positions, which include the "crawl" and the "full moon", are beneficial for back labor, turning a posterior baby, and for birthing a large baby.
Sitting Positions
Sitting positions let you combine the helpful force of gravity with relaxation. You can use a birth ball, rocking, or toilet sitting to rest while gravity helps labor progress.
Squatting Positions
Squatting positions are helpful in opening the pelvis to allow a baby to find the optimal position for birth. Squatting can be performed through use of a birth companion or a tool such as a squatting bar.
Side-Lying Positions
Side-lying positions are beneficial for resting during a long labour, promoting body-wide relaxation, and minimizing extra muscular effort. They are best used in the latter stages of labor since gravity isn't able to speed the process.
Vertical or Standing Positions
Vertical positions for childbirth use gravity to the mother's advantage. They help the baby drop into the pelvis and prevent pressure from being concentrated in a particular spot. They also allow the birth companions to apply other comfort measures easily. They represent the most underused birth positions.
References
Gupta JK, Hofmeyr GJ, Smyth R. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002006. DOI: 10.1002/14651858.CD002006.pub2.
Hunter S, Hofmeyr GJ, Kulier R. Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001063. DOI: 10.1002/14651858.CD001063.pub3.
Athukorala C, Middleton P, Crowther CA. Intrapartum interventions for preventing shoulder dystocia. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005543. DOI: 10.1002/14651858.CD005543.pub2.
Hofmeyr GJ, Gyte G. Interventions to help external cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000184. DOI: 10.1002/14651858.CD000184.pub2.Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD000051. DOI: 10.1002/14651858.CD000051.