Birth has now gone full circle here in the UK. Active birth is encouraged, with more and more birthing units changing the way the birth room is laid out. In our unit, we have several low risk rooms that don’t even have a bed in them, just places to rest and lots of support furniture like birth balls, stools, birth pool, a rope and a couch. The bed can always be moved in if needed.
It was Janet Balaskas who provided a research based manifesto PDF in 1982 (and revised in 2001) describing the benefits of an active birth and the restrictions from laying on your back or ‘semi-recumbent.’ This, together with some much needed common sense, has provided the backdrop to today’s approach to birth. The more active and unrestricted births there are, the less interventions are needed and better outcomes for mothers and babies. There are some countries that still favour birth in the lithotomy (on your back, legs in stirrups) position, which has it’s place when needed, but thankfully here we have moved on from that.
What does it mean to have an active birth?
Some women believe that once you feel the first twinge of labour you need to be active and upright the whole way through but that isn’t the case. If it’s your first baby, your labour may be slow, irregular and have a long build up before active labour. During this time being active can help – walking, using the birthing ball, going up and down stairs – to get the labour more established. But, if it’s 2am and you’re exhausted, it’s OK to go back to sleep or just rest in between contractions. There will be plenty of time for being active later.
When the labour is established, an active birth just means no restrictions. Move how you want to and don’t rely on the bed. Trust your instincts. Some women find one or two positions that are comfortable and don’t change. Others are all over the place. Do what feels right at the time. If the contractions are slowing, your Midwife may suggest different positions to try and get things moving naturally.
Positions for an active birth
A labour position is is physiologically effective when:
• there is no compression on the blood vessels
• movement is unrestricted
• the pelvis is fully mobilised
• the body works in harmony with gravity
Janet Balaskas
You can still rest your body whilst staying upright and active by using a birth ball, or pillows, like the image below.
Many women find leaning over a bed during the contraction helps. In terms of giving birth, you can give birth wherever you are comfortable. The Midwife will adapt so you don’t have to – I’ve done many a floor birth, and so many home births in confined spaces, so just go for it!
Sitting upright, whether on a chair, or a birthing stool keeps gravity working. A sofa or bed isn’t as good as we tend to slouch.
You can also get your birth partner to support you from behind. You can still use the gas and air, TENs machine and other pain relief as needed.
A good example of the all fours position below. Make sure you support the knees! I spent a long time in this position with my third, and my knees got so sore. You can also go from being on all fours to kneeling up over the bed or the birth ball.
Standing up – if you’ve got the energy, keep standing. A lot of women like to stand and ‘dance’ or shift their weight during contractions. Again, use your birth partner or any bit of furniture you can grab. Some birth centres have rails or ropes to grab hold of.
During the second stage of labour, staying upright is helpful by using gravity, and it also helps to keep the pelvis in the optimal position. The perineum also has a change to stretch properly, whereas if you’re lying down, it is restricted. Being active also keeps the oxytocin flowing, the hormone vital for birth.
The use of such upright positions produce the following additional benefits in the second stage:
More powerful contractions resulting in an effective expulsive reflex
Optimal foetal oxygenation
Minimal strain and muscular effort
An optimal angle of descent
Maximum space for descent, rotation and emergence of the presenting parts through the pelvic outlet
Optimal relaxation of the perineum
Janet Balaskas
Active positions for second stage of labour
Squatting
Squatting opens up the pelvis to the max, and is the ultimate position for birth. Practice squatting in the last trimester and you’ll find it easier when the time comes. You can use a birth stool or chair like the CUB support pictured to do a supported squat, or your partner can support you.
All fours is a great position to give birth in, it frees up the tail bone and pelvis for smooth delivery.
Side lying is one you might not think of as active, but lying on one side again allows the tail bone and pelvis to do it’s job, and the perineum to stretch. If you’re exhausted by this point, try lying on your side.
Kneeling up and standing provide that extra bit of gravity to aid the birth of your baby. A lot of women standing like to pull on something, it’s better to pull on a rope or material, rather than your partner’s neck!
Active birth with an epidural
Having an epidural doesn’t mean you need to be stuck in one position. If you have a ‘walking’ epidural, where the block isn’t quite so dense, you could stand, walk, or the very least change position. When it’s time to give birth, you can try different positions. The labour bed often comes apart and moves in different sections, so you can still achieve an upright birth even with an epidural.
All about the CUB Birth support
The CUB stands for comfortable upright birth, and it’s a combination of a traditional birth stool and the more modern birth ball. It supports sitting, kneeling, all fours and squatting. It’s inflatable, and can be easily packed into your labour bag. It has separate inflation chambers so it can’t deflate totally on you, and you can use it half inflated if you want a deeper squat, as pictured above.
Disclosure: collaborative post
1 Comment
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June 17, 2019 at 7:01 pm