Get off your back!

I'm going to give you a hot tip: the position you labour and birth in, can have a huge impact on your labour, birth and overall experience! Unfortunately, most of the time when you walk into a birthing room, the first thing you'll see is the bed, in the middle of the room, which you are automatically drawn to. Then the nurse/midwife/obstetrician asks you to lay back on the bed for them to do some routine assessments. Then things get hectic and before you know it, you're tied to the bed and it's impacting on your labour (even if you don't know it).

Well, this post is going to tell you why you should get off your back, and how!

Here are some quick stats on birth positions and their effects on labour and birth:

  • In a study of over 100,000 mums (yes, that's a lot!), the position resulting in the lowest rates of severe perineal tearing was standing. The position associated with the highest rates of severe tearing was lithotomy (on your back, legs in stirrups) [1]

  • For first-time mums, birthing on their side protected them from severe perineal tears; for subsequent births, using a birth stool/lithotomy position were both associated with increased rates of severe tears [1]

  • Babies of mums who had epidurals and laboured flat on their backs have high acid levels in the cord blood at birth [2], and the World Health Organisation also recognises that upright positions in labour are associated with less abnormal fetal heart rate patterns [2]

  • Waterbirth has many advantages in labour and birth - one of which is the buoyancy of your body in the water - it's much easier to move and change positions, compared to when you feel tired and heavy at the end of your pregnancy! A recent study of waterbirth in Sweden showed the benefits of waterbirth were reduced tearing, a much shorter labour (by over an hour!) and less intervention [3]

  • Walking and upright positions in the first stage over labour reduce the overall length of labour, the risk of caesarean section and need for epidurals [4] - this was a systematic review (the highest level of evidence available) of over 5000 women

  • The duration of the second stage of labour (pushing the baby out!) is reduced in women who birth in upright positions compared to on their backs. Instrumental births and episiotomies are also less likely [5]

  • Movement is a good coping strategy for contractions [6], and being open to movement and position changes mean you will find a position where you are able to handle with contractions more easily 

Now that we've covered that, let's talk different positions and how they look in birth. It's really important that you share these with your birth team so they can suggest these positions when you reach a brick wall in labour, and help you to get into these positions. Please enjoy these beautiful images from Adelaide Birth Photographer.

A beautiful image of a mum using a birth stool (covered with towel). This position is great at opening the pelvis and helping bub to descend down. Partner is applying pressure/massage to the lower back which can be great pain relief for some women.

This is a great image - it illustrates that you can have all the intervention but still achieve an active, normal birth. Here, mum has an IV drip, and fetal monitors are strapped to her belly. She is standing up being supported by the bed (this is great for allowing rest in between contractions). Midwife is assisting dad to deliver his own baby - what a fantastic moment for all!

Another way you can use the bed, but not be lying flat on your back. This way, you can relax into the bed and rest in between contractions. Partner is providing great, close support (and probably sips of water from the bottle right near him). Midwife is on the other side, all medical equipment in close reach if need be, but mum is still upright.This is a great position to keep in mind if you do have an epidural - use the bed to support you on your side or knees - don't just stay on your back.

Another fantastic image showing various levels of intervention but a mum using water during labour. Mum has an IV and fetal monitors strapped to her abdomen. She's on her knees, and you can see the towels on the edge of the bath - shes able to lean in and rest on them, so is probably changing position frequently (always good!). Many places will tell you it's "against policy" to labour in water with an IV/fetal monitoring etc, etc, etc but it can be done, as the above image shows!

Again using the bed, but not for lying down. Mum is on hands and knees (probably my favourite position as a midwife!) and she has wonderful support to her side and in front! I just love how curious the little girl is, not shy at all about trying to look!

Ok, so we've covered the benefits, and we've covered the how! Now it's just up to you! I recommend talking with your midwife/OB about your preference to be active and upright in labour, so they can support you. Be wary of anyone that directs you to hop on the bed, but doesn't encourage you to get off it (it is very, very easy for us midwives and OBs to monitor you when you're on your back...but a bit more work to facilitate position changes and monitoring as well...). Stay at home as long as you can in early labour, and visualise how you might use different positions at home in early labour - do you have a fit ball you can bounce on? Can you kneel in your shower? Use your bed or a beanbag to support you on all fours, while you still get some rest? (Another little hint - sitting backwards on the toilet is a great position for opening the pelvis and progressing labour - you can pop a pillow on the top of the toilet to rest into!)

I hope this has been a helpful read. Remember to share with any mamas-to-be, and drop any questions below or contact me! And for those of you that have had babies - I'd love for you to comment below what positions you found great for labour, and what position you gave birth in, to see the variety!

Want more?! Read related topics below!

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1. Elvander, C.; Ahlberg, M.; Thies-Lagergren, L.; Cnattingius, S.; & Stephansson, O. (2015). Birth position and obstetric anal sphincter injury: a population-based study of 113,000 spontaneous births. BMC Pregnancy and Childbirth 15(252)

2. Walker KF, Kibuka M, Thornton JG, Jones NW (2018).Maternal position in the second stage of labour for women with epidural anaesthesia.Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD008070.DOI: 10.1002/14651858.CD008070.pub4.

3. Ulfsdottir, H.; Saltvedt, S.; & Georgsson, S. (2018). Waterbirth in Sweden - a comparative study. Acta Obstetricia & Gynecologica Scandanavica 97(3): 341 - 348 

4. Lawrence A, Lewis L, Hofmeyr G, Styles C. (2013). Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub4

5. Gupta JK, Sood A, Hofmeyr G, Vogel JP.  (2017). Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2017, Issue 5. Art. No.: CD002006. DOI: 10.1002/14651858.CD002006.pub4

6. Ondeck M. (2014). Healthy birth practice #2: walk, move around, and change positions throughout labor. The Journal of perinatal education, 23(4), 188–193. doi:10.1891/1058-1243.23.4.188

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