I cannot emphasize how important it is to be as mobile as possible in labor and during the pushing stage. There are such an abundance of different positions to assume in labor, even with an epidural. Maternal position changes will help the baby move into optimal position for the birth process.
Many times, I have women who are laboring with 'back labor'. Back labor is when there is (obviously) pain in the lower back with contractions, and often times, also in between the contractions. This can be quite painful, in addition to the pain felt across the uterus and in the front low pelvic area. It can simply feel unrelenting. (Can you tell that I've been there, done that, bought the t-shirt?) The root cause of the back pain is usually a posterior lying baby, or even an asynclitic lying baby (cock-eyed, off to the side).
I often wonder, why so many posterior babies? Simply put - we're a reclining society. We sit back in our recliners, couches, office chairs, dining room chairs, rocking chairs and more. Our babies get into these funky positions from us lying back.
This is why it is so very important to get up and move in labor. No lying back on the hospital bed if you possibly can! Lying in the bed just lets the baby stay in a sub-optimal position for birth, leading to back labor, long labors, 'failure to progress' and yes, even some c-sections. I cannot tell you just how many c-sections I have witnessed for 'failure to progress' and the baby is in a posterior or asynclitic lie.
Up. Move. Lean forward. Lie on your far left or right side. Squat. Walk. Dance. Hands and knees. Modified lunges. Sway from side to side.
Even with an epidural -- yes, you can do many different position changes! Left lateral, right lateral, squatting with support, squatting with no support (light epidurals, when you can bear your weight on your legs), knee chest, sitting straight up with the foot of the bed lowered.
I am a huge fan of position changes. If one position doesn't work, or doesn't feel right -- MOVE! Change it!
Good bye persistent lithotomy or supine position.
Hello position changes!!
(I need a t-shirt to wear at work that says "L&D Nurses Do It In Every Position")
16 comments:
Do you find that squatting positions lead to more perineal tearing? I'm 25 weeks with my second and looking to avoid the 4th degree I had with my first (vacuum assisted OP)
I tell patients to remember gravity is our friend...get up and walk!
I also like old fashioned rocking chairs.
Those who just lay in bed I privately think of as slugs.
I am the position change Nazzi at work! It drives me insane to take over on a patient and find out that she has been laying/sitting in bed ALL day! When I know that I am getting a labor admit, I don't turn the sheets down & leave it raised. I pull the rocker up next to the fetal monitor....hint hint....u don't need to get in the bed!
For me, the best position of all was half lying on the bed, head/shoulders/chest on the mattress, stomach and legs off. I used that with all three kids, though the second two were born in the tub. And mooooooooooooaning low and deep. Keep the sounds low and your body is more relaxed. Easy peasy.
FWIW @type (little): unfortunately I tore with all three, but two also came out both shoulders at once, so it would have been hard to avoid. First was because the resident *hauled* DD1 out without waiting for her to turn; DS I just pushed that hard and that fast; DD2 I had some skid marks and my midwife had a horrifically sore shoulder from keeping me from repeating DS' delivery. SO having someone help you avoid precipitous delivery of the shoulders is a Good Idea.
Great informative post! I'll be sharing some of this info on my blog :)
Type (little) a: You had several risks for increased lacerations -- OP position baby and the vacuum extraction. Both of those things require a larger pelvic outlet and will stretch/tear the vaginal/perineal tissues more to accommodate the larger space required. Squatting should not increase your chance for tearing, but actually opens your pelvis up just a smidge more to allow the baby to rotate into an optimal position for birth.
Been there done that...and baby was still born op with asynclitic to the right. I had that last time...but baby did turn. We tried position changes but it just didn't happen and the midwife even tried to turn the head. Baby kept popping back. I tend to be a walker in labor, and found that back labor hurts a little less that way. I get more deserate and tend to be very agitated when baby is OP verses not. The midwife even noted my anxiety and desire to control things (fix the anxiety). Wonder if it's just knowing something is not right? Don't know.
Anyway, my theory for ME on why my last two have been op is that I've had so many babies (this was #7) and I didn't fix my stomach muscles after birth. They are seperated, I even have an umbilical hernia. I believe my muscles don't hold baby where they should and with the room baby can move around. Also, I had placentas anterior these last two times (hopefully not again in the future). I wonder if that changes how the baby lies? When my placenta was on top of the uterus, my baby was born in a normal position and quickly with an easy labor.
Blessings!
Dawn
I was not permitted to get out of a prone position due to elevated blood pressure (140/90). I could do left lateral and right lateral, but that was it. Baby was posterior, and I was C-sectioned for failure to progress after pushing unsuccessfully for four hours.
I haven't been able to find anything one way or the other on whether HBP really requires so much restriction on movement. What's the normal practice where you work?
Hours and hours & hours of painful labor, forced to be flat on my back, got me to 2 cm, finally relented & got the epidural.
With my son, I stayed at home as long as possible and was only on my back for maybe 15 minutes of my 25 hours labor. Easy peasy. Well, maybe not easy peasy but it was actually enjoyable (weird? maybe?) and incredibly empowering.
This makes me sad. I had planned on a natural (unmedicated) birth, but it all went to hell when my water broke at 3 am and I had NO contractions at all. I was GBS+, and the drumbeat of "you need to get to the hospital for antibiotics" began. I held out for 8 hours, but even then I was only having contractions maybe every 10 minutes.
So I ended up in the hospital, where I did not want to be until I was in more active labor. Took over an hour to get the IV set up, then the L&D nurse forgot me and left me on the monitor for almost an hour. Too much bed-time for them to do monitoring, combined with intense contractions from no water cushion, and the psychological defeat of not progressing beyond 4cm after 2 hours, and I surrendered to the epi.
Of course, I knew nothing about laboring with an epidural because I'd be so adamant I wouldn't have one, so I didn't know that I could change positions. I was on my back for the entire labor and pushing. I kept begging to change positions during pushing, but was told I couldn't do it with the epi. I was also told that the CNM who was on call instead of my regular CNM "had a bad back" and that's why she needed me on my back in the stirrups.
So I ended up with several "micro episiotomies" to deliver a 7lb2oz baby. It still infuriates and shames me.
I appreciate that you post this information, but it's the care providers who need to be educated. Even I knew that I should be changing positions, but with an epidural I needed help to reposition myself, and no one would help me.
AMH - I hurt for you! I can totally empathize with how difficult things were for you, and frustrating to not be listened to by your care providers.
Yes, we do need to educate care providers more on this! Nurse, midwives, and physicians.
That pink handout? Was like a life-preserver preserver in my 2nd labor. That very one.
I absolutely credit my mobility in labor for my 2 successful VBACs and place the blame for my primary c-section squarely on the fact that I was restricted to bed because my water had (ahem, WAS) broken. If only, if only, if only I knew then what I know now!!!
YOU CAN CHANGE POSITIONS WITH AN EPI!!! Just last week a fellow L&D Nurse and I had a young mom with an epidural pushing in every position known to man, yes, even standing! She squatted, used the towel pull on the bar, left side, right side, hands and knees, dangling from her boyfriend's shoulders. If you can't feel your legs enough to move, ask the nurse to turn down your epidural! YAY!
Drat. There is no "friggin' awesome!" label to choose from on your blog. :P
I'm bookmarking this and sharing it with everyone I can. :D
@Type (little) a
squatting does not increase vaginal tearing. What increases tearing is pushing too fast and lack of lubrication.
I can highly recommend using Hypnobirthing aka the Mongan Method. It teaches you to "breathe your baby down", rather than the "purple pushing" practiced by so many ignorant nurses and midwives and doctors.
Also laboring or birthing in water significantly reduces vaginal tearing. If you can't have a waterbirth, deliver some place where you can at least be in the tub for labor.
Of course, I agree! At my hospital we don't do a whole lot of intermittent monitoring. Most women are stuck in bed with epidurals, but those beds are miracle workers IF the nurse is present and uses them effectively. I flip my patients from side to side, "chicken wing" them, flip them on hands and knees (yes even with an epidural), and sit them up. I tell them that I am trying as much as I can to simulate what would happen IF they were laboring as God not doctors intended (unmedicated and mobile). Yes, I actually do say that!
Love your stuff!
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