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Archive for March, 2012

Birthing Positions

Traditional medical practice dictates having a laboring woman laying on a table during delivery. In fact, most people tend to think of birth as happening in this position. However, this is not for the mother’s benefit in the least. Instead, it is for the benefit of the doctor, so he or she can easily see without having to crouch or get on hands and knees. Can you imagine a typical doctor in the “good ol boy’s” club at your local hospital kneeling beneath a a woman to catch the baby while the mother sits on a birth stool, squats, or stands?

No, I can’t envision that either.

Despite ease for the doctor, this position is less than beneficial for the mother or baby. In fact, it is quite easily the worst position she could be in. Lying back closes the pelvic opening, making it more difficult for the baby’s head to get through. It also ensures that the mother has to work against gravity, trying to get the baby up and out. This is not a recipe for success, and along with the labor pain medication many women are given, it frequently creates serious trouble for the baby. You may have heard of terms such as “fetal distress” and “failure to progress” to describe the reason for an emergency c-section. These are listed side effects of labor drugs, but they are also caused in part by the difficulty of getting a baby through that closed space.

Convenience for the person who is not in labor doesn’t seem like a very good reason, does it?

So, if back-lying is not ideal for birth, what are the best positions? Really, a mother given freedom of movement throughout labor will generally be able to intuitively find the best position for her, and for that particular labor. However, here are what are generally the best positions for birth:

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Squatting

Squatting is virtually unpracticed in most Westernized countries. However, it is by far the best way to give birth. In a squat the pelvis opens up fully, and gravity helps draw the baby down. For women who live in countries where squatting is culturally normal, this is also an easy position to hold for the length of time necessary for birth. For someone unused to squatting, an assisted squat while holding onto a bar, partner, or rope is possible.

A squat is a great exercise to practice during pregnancy in preparation for birth. To do so easily, especially with a large baby belly, open a bedroom door. Place a foot close to the edge on each side and hold onto the doorknobs while you lower yourself into a squat. You can sit there a while before standing. Repeat as many times as desired. Even if you decide not to use the position during labor, it is a great prenatal exercise.

Sitting

For women who prefer not to squat, sitting with knees spread wide apart is very similar in benefit. Using a birth stool or toilet (the latter is usually not recommended because you don’t want the baby to drop into cold germ-water!), just sit upright or slightly lean back or forward as desired. This is easier because we’re used to sitting like this on the toilet, and it also opens up the pelvis and uses gravity to our benefit.

Sitting up is my personal birth position of choice. The first two births I was not allowed to sit up, even though I had an overwhelming urge to. I still get frustrated just thinking about the individuals who hindered me. My third birth I was able to sit on a birth stool, and it was the best labor I’ve had. No screaming, no yelling, no frustration. Very little pain. My body was exactly where it needed to be.

Standing

Standing also uses gravity to help bring the baby down. To do this the mother stands, leaning and holding onto her partner or a chair for support. She can either face her partner, or be supported under her arms while she faces away. This also works while kneeling on a bed, facing her support. These first three positions are very beneficial because they are types of vertical birth.

Kneeling

Finally, kneeling is chosen by some women during labor. A woman can kneel on the floor and hold onto the bed or chair while pushing.

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Really, there is no “wrong” position for birth, as long as a woman is able to choose her own position. If she is listening to her body and given the freedom to do so, then she will naturally shift and adjust to what is best for her unique birth. For labor-support, follow her lead. If she seems unsure, ask if a certain position listed above sounds good. If she tries it and hates it, no harm done, but she just may discover the perfect place for birth.

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I sat on the toilet in our bathroom, holding onto my husband and drowning in sheer misery. This labor was too hard. I felt like I was about to die from pressure and pain. Or scream in frustration.

It wasn’t this difficult last time, was it? I’m sure it wasn’t. Nothing could be as horrible as what I was going through at that moment. Nothing.

I looked up countless times to tell my husband that we were having no more kids. No more! I’d say. I am finished doing this! But the words never made it past my lips. Instead I thought it to myself, drowning in pain and an overwhelming feeling of helplessness. This was one experience I couldn’t escape. The baby was coming, whether I wanted her to or not.

Sometimes, staying pregnant seems like the easy way out.

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Transition. As any mother who’s given birth sans intervention knows, this is arguably the most difficult part of labor. After hours of work – of contractions and no sleep – it strikes. Suddenly, you feel helpless. Contractions double up and barely pause between surges. Each can last two minutes, with barely 30 seconds of rest between. It’s impossible to get comfortable and becomes difficult to handle the intense pressure of the baby descending. Women get nauseous and have hot or cold flashes. They may start spitting, burping, or vomiting.

The worst part is the hormonal upheaval. A capable woman who was handling labor well will suddenly feel like she can’t do it. She may want the baby out right now, just to no longer experience labor. These feelings are due to a surge of adrenalin released into the brain that triggers our “fight or flight” response. Temporary fear, panic, nausea, and shaking are normal during transition.

But transition is actually a very good sign. This is what our bodies do immediately before pushing the baby out. The emotions and sensations tell us that our bodies are nearly ready for birth. It is during this short period of time that the cervix finishes dilating and the baby’s head begins pushing down into the vagina.

Although transition is difficult, it is also only lasts a relatively short period of time. Usually between 5 and 20 contractions occur. A woman’s partner or birth assistant can help her get through this difficult time by encouraging her, and reminding her to breathe deeply through each contraction. Some women find physical touch extremely comforting, some prefer not to be touched at all. No matter which type, no woman should be left alone during transition.

For anyone supporting a laboring woman, it is very good to know the signs of transition. Due to the “fight or flight” response, women may ask to go home if they are laboring in the hospital. This is also the time when many women will ask for an epidural or other labor drugs. We want something – anything – to stop labor pangs. Even if a woman has decided that she really wants to give birth naturally, she may ask for drugs or an epidural. I have to be careful here, but asking for a painkiller does not necessarily mean that she actually desires one. Some women ask in response to their sudden intense desire to escape labor, but would not want the drugs any other time. Now, if she keeps asking, then of course give her the painkillers, but also know that all the signs of fear and panic and a feeling of helplessness and an “I can’t do this anymore” mindset means that the baby is coming soon. A drug or sedative is not going to help for long, and will be a hindrance during pushing. Encouragement and support are extremely helpful at this time, and gentle reminders that she gets to meet her baby soon.

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I wanted a c-section. Or to just go to the hospital for some serious drugs. Time lost meaning as I sank deeper into labor-land. Then the contractions paused briefly. I sat, relishing the break. Suddenly my body instinctively bore down in a push. I reached my hand down and felt hair on top of a tiny baby head! 

A surge of renewed energy snapped through me as I made myself ready to meet my baby.

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