How to encourage a woman to remain active in labour
Midwives magazine: Issue 2 :: 2012
There are significant benefits to remaining active during labour. The University of Chester’s Professor Mary Steen describes these benefits and the ‘dry land’ positions women can adopt to maximise the opportunity of achieving them.
Historically, women have been active during birth for centuries and frequently adopted squatting, kneeling or sitting positions. During the 17th century, it became fashionable for women in many European countries to labour horizontally and this coincided with a trend towards medical supervision in childbirth. Pain relief methods introduced during the 19th and 20th century contributed to reduced mobility and drowsiness of women in labour (Steen, 2012). This led to an expectation and acceptance that during childbirth women lay passively in bed (RCM, 2008).
There is substantial evidence of benefits for women who remain active during their labours, such as the reduced need for medical interventions and the likelihood of shorter labours (Lawrence, 2009). Midwives, therefore, need to encourage women to adopt different postures and positions while they are in labour.
During pregnancy, opportunities to discuss and demonstrate how to remain active and adopt different positions in labour will help the woman and her partner to prepare. Good preparation will assist women to become confident in their ability to be active during labour. It is hoped that explaining how pressure from the baby’s head on her cervix and pelvic floor will stimulate the release of oxytocin and good contractions, so labour will progress as nature intended, will encourage a woman to remain active (Russell, 2008). Using props such as a chair, bean bag or birth ball can help her to remain active during labour and women should be advised of the benefits of these (Steen, 2007; Steen, 2012). The impact of water immersion in labour should also be highlighted as an effective birthing option.
Ideally women should be encouraged to adopt upright positions during the first stage of labour, as there are significant advantages to this. These include gravity, reduced risk of aorto-caval compression, better alignment of the fetus, more efficient contractions and increased pelvic outlet (Frye, 2004). Different positions can assist women to progress. Leaning forward is particularly helpful for women who have a baby in an occipitoposterior (OP) position. Many find sitting astride a chair and even sitting on the toilet helps. Some women find relief from pelvic rocking and others find walking around, walking on the spot or just standing helpful.
Upright positions should also be encouraged in the second stage. These include sitting (more than 45 degrees from the horizontal), squatting or kneeling, being on hands and knees. Different positions can assist women to progress and cope. Squatting or being in a ‘knees and leaning forward’ position have the advantage of increasing the pelvic outlet. However, many women are not able to squat comfortably and find the ‘knees and leaning forward’ position more comfortable. Some women opt for the squatting position and get their partners to support and hold them up. Just like in the first stage of labour, upright positions are gravity assisted and some women will prefer to adopt a high sitting position, be semi-recumbent, kneel or squat on a birthing cushion in order to assist them to give birth.
Remaining active and using a range of different positions in labour has been shown to be beneficial to women.
Frye A. (2004) Positions and activities for labour: supporting the woman during labour and birth: In: Holistic midwifery: a comprehensive textbook for midwives in homebirth practice (volume two). Labrys Press Publisher: Oregon: 419-24.
Jokinen M, Munro J. (Eds.). (2008) Evidence-based guidelines for midwifery-led care in labour. The Learning, Research and Practice Development Department, RCM: London.
Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. (2009) Maternal positions and mobility during the first stage of labour. Cochrane Database Syst Rev 2: CD003934.
Russell K. (2008) Watching and waiting: the facilitation of birth at home: In: Edwins J. (Ed.). Community midwifery practice. Blackwell Publishing: Oxford: 25-45.
Steen M. (2012) Homebirth pain management options: In: Supporting women to give birth at home: a practical guide for midwives. Routledge: Oxon: 208-10.
Steen M. (2007) Wellbeing and beyond. Midwives 10(3): 116-9.