Walk, Move and Change positions

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 This blog will join the many others in Lamaze International's Carnival Birth Blog, promoting Lamaze's 6 healthy birth practices. This one is #2.
This is a re-vamp and re-post from "Birthing positions and their effect on labor" posted earlier this month.



Walk, move, and change positions


This blog will discuss walking,moving around and changing positions throughout labor and why this is so beneficial.
Birthing positions will also be discussed. I am aiming to educate Aruban women especially, that they do have a say in choosing the position that eases the pain and facilitates the baby's birth.

In Aruba, especially when a women is under the care of an obstetrician, she is automatically put in the Lithotomy position. A Certain ob/gyn absolutely refuses to let you go in another position, such as on hands and knees because he doesn't want to have a rear-side view. With midwives however, there are infinite possibilities, and most if not all, aim to comply with your wishes, and even suggest alternative positions that help the labor along. Here are Birthing positions 101. Included are the advantages and disadvantages for the mother, fetus and birth attendant.

Moving around during labor is important and beneficial because

• When you walk around or move around in labor, your uterus works more efficiently
• Changing positions moves the bones of the pelvis to help the baby find the best fit through your birth canal
• Upright, side-lying, and forward-leaning positions allow plenty of blood flow to your baby, so he may be less likely to show signs of distress
• Actively responding to labor may help you feel more confident and less afraid. By feeling in control of your birthing process, you may be empowered and experience less pain due to less anxiety because of not being a "by-stander", so to speak, during childbirth.
• Research shows that moving freely in labor improves a woman's sense of control,may decrease her need for pain medication, and reduced the length of labor
  

Lithotomy Position
  










Advantages

Mother:

• Some women say they like the security of stirrups for their legs, particularly if they have used them    previously

Fetus :

• Easy to listen to Fetal heart rate

Birth Attendant :

• More control of birth situation

• Obstetric intervention easiest should it be necessary : forceps episiotomy, repair of lacerations, anesthesia     

•  More comfortable, less back strain

• Asepsis                

Disadvantages

  

Mother

•  Adverse affects on blood flow : The weight of the uterus compresses large blood vessels so as to decrease blood flow to the uterus and ultimately decrease oxygen to the baby.

• Less active participation with baby and birth attendant

• Stirrups can promote blood clots if legs are in them for a long time

• Decreased ability to push

• Sense of vulnerability

• Possible inhalation of vomit

Fetus :

• Changes in mother's blood flow can cause fetal distress or a depressed baby at birth
• Difficult for mother to see or hold baby after birth

Birth Attendant :

• Cannot easily interact with woman and is less able to elicit her cooperation

 
 Standing position






Adavantages


Mother :

• Reported improved uterine contractibility for First Stage of labor 
• Avoidance of negative hemodynamic changes  
• Can watch Birth
• May increase help of gravity

Fetus :

• 
  Uknown

Birth Attendant:

• Ease in interacting with women

Disadvantages

Mother :

• Fatigue
• Needs two supporters
• Hypothesized increased blood loss, uterine prolapse, edema of cervix and vulva

Fetus:

• May fall to the ground unless "caught"

Birth Attendant:

• Difficult to control baby's head and watch perineum 
• Difficult to assist with delivery

Sitting Position

      




Advantages 

Mother: 

• Shorter second "pushing" stage
• Most efficient for expulsive efforts
• Maintains some advantages from squatting ; increases pelvic diameter
• Easy to interact with baby and others
• Grunting may aid delivery

Fetus:

• Probably less negative hemodynamic effects than lithotomy thus less fetal distress
• Easy to listen to fetal heart rate

Birth Attendant:

• Good access to perineum for control of delivery
• Able to use interventions should it become necessary, such as episiotomy, forceps or pudenal anesthesia easily should it become necessary
  

Disadvantages

 Mother:

• Needs back support
• Might induce edema of vulva or cervix 

Fetus:

•  None

Birth Attendant:

• Some attendants may not want the mother's active participation in the birth

Hands and knees







Advantages

Mother:

• No weight on Inferior Vena Cava; thus probably less fetal distress
• Advocated for aiding delivery of shoulder 
• Useful for relieving pressure on umbilical cord if trapped or prolapsed 

Fetus:

• May be useful in rotating occiput posterior positions or in delivery of shoulders when they are "tight"

Birth Attendant:

• Good visualization of perineum and control of expulsion of presenting part
• Optimal control for breech delivery, according to some practitioners.

Disadvantages

Mother:

• Very tiring : Bean bags and pillows useful for maintaining position or for rest between contractions                      
  
• Difficult to interact with baby and birth attendant, but can turn immediately after delivery and hold baby
• Cramps in arms and legs

Fetus:

• Difficult to monitor baby unless one uses fetal scalp electrode ( which will leave a beautiful bald spot for ever on your baby's scalp)

Birth Attendant:

• Must reorient landmarks and adapt hand maneuvers for delivery
• Usually turn woman to recumbent position for delivery of placenta, repair of lacerations and rest

Dorsal Recumbent 

 Advantages

Mother:

• Less tension on perineum
• Less pressure on legs
• No stirrups, thus less likely to develop thrombosis

Fetus:

• Easy to listen to fetal heart rate

Birth Attendant:

• Easy access to perineum
• Able to do pudendal anesthesia or episiotomy easily should these become necessary
  

Disadvantages

Mother:

• Same blood flow changes as lithotomy
• Difficult to participate in birth
• decreased ability to push

Fetus:

• Fetal distress can occur because of restricted blood flow 

Birth Attendant:

• Cannot easily interact with woman
• Forceps delivery more difficult to do since there is less counter pressure on fetus

Lateral Recumbent





Advantages 

Mother:

• Corrects or avoids adverse hemodynamic effects of lithotomy position
• May prevents some perineal tearing because of less tension on perineum
• May help to rotate occiput posterior presentations
• May be helpful in relieving a Shoulder dystocia 
• Comfortable for many mothers and conducive to resting in between contractions

Fetus:

• Promotes maximum uterine blood flow and thus fetal oxygenation

Birth Attendant:

• Conducive for controlled delivery
• Preferred by some British practitioners

Disadvantages

Mother:

• Least efficient for expulsive efforts, this may be desirable to avoid a precipitous delivery (delivering in an unusually quick amount of time) for a repeat mother
• Needs someone to hold leg up for the delivery

Fetal:

• More difficult to listen to fetal heart tones

Birth Attendant:

• Some practitioners consider this position akward
• Unable to see and interact with mother as easily, cannot see her face directly
• Difficult to repair episiotomy or use forceps in the event that these would become necessary
  

  Squatting Position

Advantages

Mother:

• Good expulsive effort: shorter second "pushing" stage
• Pressure of the thighs against the abdomen may aid in expulsion by increasing intra-abdominal pressure and promoting longtitudinal alignment of the fetus with the birth canal
• Improves pelvic bone diameter. Anteroposterior diameter of outlet increased by 0.5-2 cm :Transverse diameter is also increased ( opening of vagina made wider with less perineal trauma and tears as a result)
• Avoids adverse hemodynamic effect of lithotomy
• Facilitates interaction with birth attendant and baby and others present

Fetus:

• Promotes fetal descent and rotation

Birth Attendant:

• Some visibility of perineum
• Maternal effort is maximized in accomplishing the birth

Disadvantages

Mother:

• Legs can become fatigued, especially if woman is not supported
• Uterine prolapse may be more likely due to strenuous bearing down effort
• May promote increased perineal and cervical edema (swelling)
• Rapid descent and expulsion of fetus may be accompanied by vaginal and perineal lacerations
• Increased blood loss possible

Fetus:

• Rapid expulsion may result in sudden reduction in intracervical pressure and cause cerebral bleeding in the brain of a premature infant whose skull bones are not yet firm.

Birth Attendant:

• Cannot intervene easily in this position to help control the expulsion of the baby or to administer an episiotomy or pudenal nerve block should these become necessary
  

Partner Tip

During active labor, some women have a hard time deciding how they want to move. The media has ingrained in most women a sense of "capture" and "helplessness" during the birthing process and so they think they are expected to stay in bed. Labor partners do well to educate themselves along with the pregnant woman about different labor and birthing positions to help "guide" the laboring woman. The labor partner would do well to offer suggestions and tips especially when the mother seems discouraged, frightened or uncomfortable. 

Leaving you now with a video of healthy birth practice #2 out of 6 from Lamaze International

For more information on Lamaze's other 5 healthy birth practices visit Amy Romano's blog : Science & Sensibility

All images courtesy of: Google Images