Positioning for Prevention

What image comes to mind when you picture a birth in a hospital?

Most people see a picture of a woman on her back, with her legs raised or perhaps in stirrups. That is the perception that the technological model of birthing has transfixed into our mind's eye.

The obvious problem is that by lying on one's back or by sitting semi-reclined on one's tailbone, the space of the pelvic outlet (birth canal) may be reduced by up to 30%. By adopting a traditional hospital position that is convenient for birthing professionals, one unknowingly reduces the space the baby has to enter this world.

There is no medically sound reason to give birth on one's back, and there is every reason to give birth in a safer position that works with female anatomy and physiology, in a way that women’s bodies were designed.

It is so easy to open up the birthing canal to help ensure a safer passage for the baby, and to reduce the risk of injury to the mother's body as well.

By simply rolling over to one's side, which can be easily accomplished, even with an epidural, allows the sacrum the freedom to move back as the baby is passing through.

What is most important to remember is to get the mother off her back!

Changing positioning during the first and second stages of labor can dramatically reduce the incidence of shoulder dystocia, and thus eliminate the resulting complications
Risks of Traditional Positioning

With positions that close the birthing canal, such as lying down, there may be increased risk to the baby of:

* increased need for forcep or vacuum delivery
* broken clavicle/collarbone
* excessive bruising
* pressure on baby’s neck vertebras
* excessive head molding
* compression of umbilical cord
* stress on baby
* poor position/angle of the fetus in relation to the pelvis
* brachial plexus injury
* broken humerus
* disruption of the baby’s oxygen supply

and increased risk for the mother of:

* less effective contractions
* labor slowing and not progressing
* possible increased hypotension & pregnancy-induced hypertension
* ineffective pushing
* may lead to illusion of cephalo-pelvic disproportioin due to reduced pelvic diameters from poor positioning
* increased risk of need for Cesarean section
* strain and tearing to the mother's tissues
* episiotomy
* back pain
* fractured coccyx/tailbone

Janet Balaskas, the recognized pioneer of natural childbirth and author of “Active Birth” reiterates the danger of being in a supine position:

“In the semisitting position the mother’s weight rests on her coccyx and the pelvic capacity is reduced.” “In the semireclining position the sacrum is immobile and the pelvic outlet narrows.” “Your coccyx is designed to move out of the way as your baby’s head descends. Sitting on your coccyx during birth restricts the pelvic outlet and can also lead to dislocation of the coccyx, which can be extremely painful for months after the birth.”

The sacrococcygeal joint, the joint between the sacrum and the coccyx or tailbone, also softens in pregnancy; it is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges. Of course, this is impossible if the mother is sitting on her coccyx.
Benefits of Proper Positioning

Opening the birth canal by using positions that support a woman’s anatomy, will decrease the risk of possible trauma to the baby and mother’s body. .Moving around during labor and using birthing positions such as left side-lying, hands and knees, upright, squatting, etc. offer several benefits:

* increased comfort
* reduced pain
* an enhanced sense of control and involvement in the birth
* more effective contractions
* better progression of labor
* baby more likely to descend in an optimal position
* work with gravity instead of against it
* better blood and oxygen supply to the baby

Beyond these advantages, there are equally important effects on the baby and on the progress of labor. Changing positions during labor can change the shape and size of the pelvis, which can help the baby's head move to the optimal position during first stage labor, and helps the baby with rotation and descent during the second stage.

Swaying motions such as walking, climbing stairs, lunging, and swaying back and forth are especially helpful with this.

Movement and upright positions can help with the frequency, length, and efficiency of contractions. The effects of gravity can help the baby move down more quickly. Changing positions helps to ensure a continuous oxygen supply to the fetus.

“There is evidence to suggest that if the mother lies flat on her back then vena caval compression is increased, resulting in hypotension. This can lead to reduced placental perfusion and diminished fetal oxygenation. The efficiency of uterine contractions may also be reduced”. (Humphrey et al. 1974, Kurz et al. 1982)

Changing position can also reduce the length of labor. Mendez-Bauer and Newton (1986) state that duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in patients who alternated supine and standing with standing and sitting positions.

Another positive outcome from positioning is the reduction of the use of episiotomies and fourth degree tears. Since there will be less dystocias, doctors will not feel inclined to cut the perineum, to give more manipulation room. These have been done for many years without anatomical reason, but more so for legal record.

An ideal position would include:

* opening the pelvic outlet as widely as possible
* providing a better fetal position with a smooth path for the baby to descend through the birth canal
* using the advantages of gravity to help the baby move down
* giving the mother a sense of being safe and in control of the process
* and most importantly, decreasing the risk of injury to the baby and to the mother

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