K.D. BraininFounder & Director

The benefits of being upright during labour

Blog: 2.10.2016

Originally published  by Janet Balaskas – author and founder of the Active Birth Movement

If a woman wants to be active and move around freely during her labour, she cannot do so easily and securely on a standard delivery bed.

Her movements and also her psychological attitude are bound to be restricted and inhibited by the confines of the bed.

On the floor, she can move freely and naturally.

She’ll feel more stable and secure, and have the freedom to explore the movements and positions that are most comfortable for her during labour and birth – a sure way to instinctively do what’s best for her and her baby!

Active-Birth-Stool

The benefits of being mobile and upright in labour have been well known for more than two decades, yet are only rarely put into practise.

This is often because of the lack of the simple expedient such as a clean, hygienic and comfortable space the mother can use for kneeling, standing or squatting.

With the provision of a suitable floor mat and a few supportive comfort aids,the mother’s movements are not dictated or restricted by the furniture.

This actively encourages her to be mobile and upright – thus harnessing the help of gravity to promote good strong contractions, ensuring an optimal blood supply to the placenta and allowing the pelvic diameters to increase, making more space for the baby to descend.

It is essential to provide the right protection for the mother, her partner and midwife during an active birth.

Long periods in the kneeling position can damage the knees or result in injury unless the floor surface is sufficiently soft – while firm enough to offer adequate support from the ground. (For example a mattress on the floor is usually too soft and too thick so that it becomes more difficult to change positions or to keep the surface clear).

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If the mother is in a birthing pool she may need to leave the pool for the birth, but not want to or be able to get onto a bed. She’ll need an alternative that can be quickly put in place beside the pool.

The Active Birth Mat is lightweight, water proof, easy-to-clean and disinfect, and just the perfect size at 1.5m x 1m. The thickness of the mat is ideal for firm support, while the density of the material used protects the knees without being too soft.

Freedom of movement lies at the heart of physiological birth. To us this is now not news. But most of the mothers we work with need the active encouragement of midwives.

By providing a supportive and inviting environment for active birth more women will discover how upright positions are most comfortable and also more beneficial.

Janet Balaskas – Founder of the Active Birth Movement and author of the revolutionary book “New Active Birth” recently won the Presidents Award at the Lamaze Conference 2001 in Minneapolis for her early work in pioneering Active Birth in the late 1970’s. In her keynote lecture Janet stressed that:

Active Birth is backed up by common sense, logic, clinical experience, history, anthropology and science.

It is safe, cost effective and life enhancing. There are few areas of birthing practise, where there is such clear evidence available.

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Yet bed birth with the mother semi recumbent, is still the norm in most maternity units, despite the increase in innovative practise that is also happening everywhere.

7 randomised controlled trails undertaken to evaluate ambulation in labour all agree that there are no negative effects. Despite the fact that most of the research has been undertaken in a medicalised setting, authors like Mendez Bauer in 1975 (8) , Flynn et al in 1978 (3) and Read et al in 1981(7) found that contractions were more effective, labours shorter, there were fewer inductions, fewer operative deliveries and less fetal distress.

Janet went on to remind the audience that in fact such research findings were already available as early the 1930’s and have been and are still largely ignored:

In addition, the positive effects of gravity reduce the risk of aorto-caval compression (and therefore improve fetal acid based outcomes) and this has been written about by Bonica in 1967(1), Humphrey in 1975(6).

There is radiological evidence from the 1950’s and 1960’s of the increase in pelvic diameters in kneeling and squatting positions written about by Borell and Fernstrom 1957(2) and Russell 1969(9).

The most recently published by Gould in 2000(4), proposes that movement is a central characteristic of normal labour and that women, when given the choice, will change position an average of 7-8 times in the course of labour.

A systematic review by Gupta and Nikodem, of 18 randomised controlled trials was also published in 2000(5). This examined upright positions in the second stage and confirmed that second stage was shorter in the upright group, there were fewer assisted births, less pain, and fewer abnormal heart tones, and fewer episiotomies.

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If one needs scientific evidence to justify active birth it’s certainly there!

With the right attitude and enthusiasm it is not difficult to provide a facilitating environment for an Active Birth.

The meaning of the phrase Active Birth is far more than a matter of physical position.

The physical change from lying down to being upright – means a change from passive to active – from dependent to independent- from being controlled to being in control – from being powerless to being empowered.

Being physically free and mobile transforms the mother from a passive patient to an active birth giver.

The sense of pride and satisfaction women feel as a result is what makes the work of the midwife so uniquely rewarding.

References:

Bonica J (1967) Principles and practice of Obstetric Analgesia and Anaesthesia. FA Davis Co, Philadelphia. Borell U, Fernstrom I (1957) The pelvimetric method for the assessment of pelvic mouldability’. Acta Radiologica 47: 565 –9 Flynn A, Hollins K, Lynch P (1978) Ambulation in labour. Br Med J 2(6157):591-5 Gould D (2000) Normal labour: A concept analysis. J Adv nursing 31 (2): 418-27 Gupta JK, Nikodem VC. Women’s position during the second stage of Labour (Cochrane Review). In: The Cochrane Library Issue 1, 2000. Oxford Update Software. Humphrey M, Hounslow D, Morgan S, Wood C et al (1975) The influence of maternal posture at birth on the fetus. J obstet Gynaecol Br Commonwealth 80: 1075-80 Read J, Miller F, Paul R (1981) Randomised trial of ambulation versus oxytocin for labour enhancement: a preliminary report. Am J Obstet Gynaecol 159:669-72 Mendez-Bauer C, Arroyo J, Garcia Ramos Cet al (1975) effects of standing position on spontaneous uterine contractility and other aspects of labour.J Perinat med,5: 89-100 Russel J (1969) Moulding of the pelvic outlet. J Obstet Gynaecol Br Connonw 76: 817-20
 

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