The Keys to Proper Labor Positioning
There are some things in life that cannot be described in mere words. The act of giving birth is one of them. The rhythms of labor and the moment of birth are both beautiful and yet so exhausting that birth can at best be described as supernatural. Labor is “Super” because it requires an act of faith to trust and believe in your Creator in the midst of the intensity, and yet “natural” because a woman’s body is beautifully made with a knowledge of how and what to do in the midst of it all.
Trust Your Body
Trusting the body and the process of birth is by far one of the most important parts of laboring during this supernatural experience. After three natural labors, I am convinced that there is no formula for a perfect delivery. It seems that each birth story is just as unique as the child. However, one of the most important keys to a successful natural birth is proper labor positioning. Moving the body into different positions will keep you steady through the hours and minutes of birthing your baby.
Historically this would be a silly discussion as most women knew from watching other women, that birth was an active event that often occurred in an upright position. However, our culture has changed. Somewhere along our adoption of a western medical mindset birth became more about the physician attending the birth than the comfort of the mother. In order for doctors to get a better view of what was going on, women were made to lay on their backs during birth. This idea has become so prevalent that it is rarely challenged unless you are fortunate enough to give birth in a setting that promotes natural birth. Even Hollywood continues to perpetuate this idea that labor must be done flat on the back and this painful visual is frightening our young women and first-time moms right into epidurals.
Unfortunately with the advent of epidurals mothers are now opting for desensitized labors in fear of pain and are unaware of the host of disadvantages and risks that affect the health of the mother and the baby. There is an extensive list of complications involved with epidurals, but in relation to birthing positions, epidurals limit the mother’s ability to feel pain and even more so limit the body’s ability to adjust to the sensations of labor. This leaves the mother flat on their back in an unnatural birthing position that can slow the progression of labor and also risk unnecessary damage to the pelvic floor.
Believe it or not, pain can be a helpful communicator. Often times the positions that are the most painful during labor are the ones that need to be avoided! And interestingly the positions that feel the most relieving should be the ones that the mother uses and asks for assistance from her birth team to maintain. This is where the trust begins. It is imperative to listen to the body and respond to the cues it gives you. These cues will help you work together with the baby for a smooth labor process.
Gravity is Your Friend
There are good reasons that your body does not want to be laying on its back in the midst of labor, with gravity being the first and foremost. Gravity is your friend, and while laying down during labor can be beneficial for resting and pacing yourself, most women will find that keeping upright will assist the downward descent of the baby.
How The Pelvis Works
Laying on your back is also contrary to the way the pelvis is designed to open during birth.
The pelvis is in the shape of a ring made up primarily of four bones: the sacrum and coccyx (tail bone) in the back and the two coxal (hip) bones on the sides that join to form the pubic area in the front. The joints that connect these bones soften during pregnancy and by the third trimester they are very mobile in preparation for the day of birth. In an ideal environment, all pelvic joints would widen together during birth, opening the pelvic outlet as equally as possible to allow the baby to descend through the birth canal.
If we look at labor from an anatomical perspective, you will see that laying on the back restricts the ability of the sacrum and coccyx to lift away from the pelvis, limiting the opening of the pelvis and ultimately creating a narrowed pelvic outlet. For birth to be successful, the other joints (especially the pubic area anteriorly) must then make up for the lack of space and may endure a stretching that is beyond what was intended for those areas. This explains the difficulty and intense pain that women may go through when laying flat on their backs as it often creates more pressure on the pubic symphysis and dis-uniform stretching on the perineal area, making chances of tearing and pain even greater.
In Ina May’s Guide to Childbirth, she lists the benefits of upright positions in labor as:
- Better use of gravity
- Maximum circulation between mother and baby (no compression caused by the baby’s weight on the mother’s major blood vessels)
- Better alignment of the baby to pass through the pelvis
- Stronger rushes
- Increased pelvic diameters when squatting or kneeling
5 Upright Positions for Labor
There are numerous upright positions that can be helpful during labor. Here are just a few of the most common that I have personally tried during my labors:
While there is benefit from resting and pacing your body in labor, standing and walking is by far one of the most helpful tools in helping a baby with the downward decent. This is usually easier in the early stages of labor, although I do know a few women who have given birth while standing up! Ina May’s Guide to Childbirth shows drawings from the nineteenth century of women using ropes or bracing themselves up with tree limbs or their birth partners into a standing position so that the lower body could relax and open while the upper body kept her steady. I found that leaning on a wall, a counter, or taking a nice 1980’s slow dance with my hubby helped me focus during early labor contractions.
As labor progresses there are times during a contraction that you may feel best in a sitting position. A sitting position assists in opening the lower portion of the pelvis and with the extra support of sitting, the legs can take a little rest. The options for siting are often on a birth ball, on the edge of a bed or sofa, on your birth partner's lap, on a birth stool or YES on a toilet. The toilet has been my favorite of all as it is a great place to relax and let go of anything that might need to come out before the arrival of the baby.
In all my labors the kneeling position has by far been the most comfortable position during the difficult moments of contractions. Kneeling creates a wide opening of the lower pelvis. It allows the sacrum, located on the back of the pelvis to lift up and away (which cannot happen when you are laying on your back). My preferences were often to kneel on a soft blanket while I placed my elbows to support my upper body on something sturdy like the edge of a bed, sofa, or a chair. During my most recent labor, I spent most of my time in a kneeling position with my upper body draped over a birthing ball (exercise ball) which allowed me to sway side to side during the contractions.
4. All Fours
Placing your hands (or elbows) and knees all on the floor is another form of kneeling although this allows the upper body to get lower to the floor. In some ways, it mimics the “squat” like position, but it can be a more sustainable position that is less exhausting for the mother. It can also be a place of rest and opportunity for your birth partner to give you some encouraging and soothing massage.
You may notice the progression presented here from standing to sitting and kneeling and ultimately on all fours. This can be a typical representation of the flow that mothers choose to position themselves during labor leading up to birth. As the unique moment of birth arrives, the mother may then feel the urge to prop herself up and use a squatting position. This is the most dynamic position to widen the pelvic outlet and take full advantage of gravity. I was blessed to experience this in my last labor as a very efficient and timely way to deliver a baby. Squatting may be done unassisted or with the assistance of a birthing partner, doorframe or anything sturdy that can support the weight of the body while it drops into a deep squat.
It is clear that labor and delivery are not passive events but rather a very physical endeavor that requires mother and baby to work in unison to bring the baby from womb to world. In the wave of our cultural norms, we have lost sight of the importance of the mother’s role during labor and have chosen to circumvent God’s design with abnormal positioning that often leads to unnecessary interventions. Choosing a natural birth that allows freedom of movement will maximize a mother’s ability to do her part. I always encourage mothers to prepare for this day by practicing these positions with their spouse, doula or birth partner and incorporating a regular physical exercise routine that creates both the flexibility and strength to maintain these positions during birth. You never know which position will be your favorite, so it helps to know the benefits of your options ahead of time and familiarize yourself with them in preparation for your beautiful birth experience.
Learn more in our blog and video: How Exercise Helps You Have a Healthy Delivery.