Day 7: Get Up, Stand Up! Upright Positions for Labour & Birth

Sometimes I feel like we don't hear enough about the benefits of being active and laboring/birthing in upright positions. Babies have to navigate the pelvis in a series of necessary movements. When Mom is sitting in bed, a baby must do this all on his own; if she is moving around -- sqautting, walking, climbing stairs, rocking on a birth ball, changing her positions from being active, to resting, her baby has more help to get into optimal positions. This is a true partnership between Mom and Baby -- she helps her baby in the race to meet the outside world. And as Bernie points out, this makes things better for birth.

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​You have just grown a tiny person,
You are Wonder Woman,
Stand up and be proud!
 
OK, so you may or may not feel like adopting the Wonder Woman stance for your entire labour and birth, but here are 7 great benefits to being upright during labour:

 1. Do You Know the 3 Cs? Feeling Calm, Confident and in Control!  

• Mums who choose their own position during labour will rarely lie on their backs, and they report more feelings of confidence and being in control.  
• Stress hormones are lowered when adopting an upright position, allowing oxytocin and endorphins (birth hormones) to flow.  
• Women feel more a part of their birth team and less like a patient when they’re not lying in bed.

You can imagine it could be difficult to feel confident being the only person in the room on your back with no underwear on. ​

2. Shorter labours! 

• In a study by Lawrence, et al 2013, it was found women who birthed in an upright position had shorter births than those lying down, by up to 1 hour and 20 minutes.  
• The effect of gravity on the baby within the uterus helps to create more efficient surges.
• With more efficient surges, birth hormones are flowing and helping to nudge baby down as well.
• Stands to reason (excuse the pun) that gravity would help when you look at how we are designed – it’s a much smoother exit for baby!  When you’re on your back it’s like trying to push baby up a hill!

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3. Less chance of Distress to your Baby!

• Getting off your back allows maximum circulation (blood flow and oxygen) between you and your baby.
• Your baby is 54% less likely to have abnormal fetal heart rate patterns.
• It reduces the risk of aorto-caval compression.  

You know how you’ve been told not to lie on your back during pregnancy?It usually gets quite uncomfortable from somewhere in your second trimester anyway. The reason is that the main abdominal artery and vein can be compressed by the uterus and the weight of the baby, limiting blood flow. This can result in low maternal blood pressure, feeling faint, sweating and dizziness, and it may also effect baby’s heart rate. It doesn’t sound like a good idea at the best of times, never mind when you’re in labour. This does not occur when a woman is in a side lying or upright position. 

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4. More Comfortable Labour!

• Moving into comfortable positions will help you manage your sensations. Think about what you did the last time you had a cramp in your leg – you probably got up and wiggled your foot until the cramp eased...same idea.
• Women tend to move and sway during their surges. Standing, leaning on your partner, squatting, hip circles on your birthing ball and rocking on all fours can all be comfortable positions for labour.  
• Mums who use movement in labour find their labour sensations more manageable and have less need for epidural and other pain relief. 
• Birth partners can easily support mums and use comfort measures like massage and counter pressure with greater access to her back.

5. More Room for Baby! 

• Standing, squatting, kneeling, all fours and sitting facing forward in a chair all increase space in the pelvis.
• Squatting can increase the space in the pelvis by up to 30%!
• More room makes it is easier for baby to get into the perfect position for birth (back to point 2 – shorter labours!).
• Babies who start out in the OP (back to back) position have more room to turn, and surges help baby turn in the uterus when the mum is supported. Helping the baby to turn increases mum’s comfort level as well.

6. Decrease Chance of Assisted Delivery by 23%! 

• In  2012 Cochrane Review of 22 studies, including over 7,200 women, those who were in an upright position for labour were 23% less likely to have a forceps or vacuum-assisted delivery.
• An assisted delivery can be prevented by avoiding birthing on your back and common interventions such as the epidural or amniotomy  (artificial rupture of membranes).
• The benefits of avoiding assisted deliveries include less damage to the pelvic floor and a gentler birth for baby.
• An assisted delivery may be necessary if baby is in distress or if the mum is exhausted after a long labour or long pushing phase.

7. Decrease Chance of Episiotomy by 21%!

• In the same review, it was found that women who were upright in birth were 21% less likely to have an episiotomy.
•  An Episiotomy is a surgical cut to the perineum as baby crowns.
• Disadvantages to episiotomy are increased pain after birth, more likely to cause 3rd / 4th degree tears, infection and longer healing times. 
• To avoid an episiotomy, birth off the bed, no purple pushing (pushing when you want to versus because you are told to), slow controlled “pushing” phase, labour in water, practice perineal massage and pelvic floor exercises during pregnancy.

​Reasons NOT to Lie Down in Labour:

• Because there’s a bed in the room! 
• Because you’ve seen it on TV and in the movies! 
• Because “Everyone” gives birth like that! 
• Because “insert name” told you to! 
• Because your care provider expects you to!

To Sum It All Up:

• Choose whatever position you feel comfortable in: 
• Lie down if you need to rest or you’ve had the epidural
• Choose a side lying position 
• Use pillows / peanut ball to create space in your pelvis
• Get your partner & midwife to help you change sides every half hour.

More Information:
Whole, Healthy and Intact - Avoiding Perineal Trauma, by Tracy Donegan 
What is the Evidence for Pushing Positions?

References: 
​2012 Cochrane review, Gupta et al., de Jonge and Lagro-Jansenn 2004; Green and Baston 2003; Green et al. 1990. ​Lawrence et al 2013

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Bernie Burke is a GentleBirth Instructor and DONA trained Birth Doula, with a background in Holisitic therapies.  Bernie found GentleBirth during her second pregnancy and fell in love with the program, it transformed how she felt about birth.  She is passionate about all things birth and she has seen first-hand the positive change in her clients and their partners while using the program.
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Bernie believes that when women and their partners feel empowered to make decisions about their birth, no matter what path it takes, they step into parenthood feeling confident and secure.  Bernie is looking forward to assisting families as a Doula in 2016.

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Supreme love and thanks to my friend Christine for allowing me to share her amazing pictures. She deserves to be a meme <3. Stacie