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Tuesday, October 27, 2009

So what position should I be in anyways?.....

This post comes from a question about positions during the pushing stage of labor. In one of my previous posts, I mentioned how you should not give birth laying on your back. So, if that's the case, what position can you push in? Answer: just about any position but that one:)

Here's the extended answer:)

It has been shown that being in an upright position helps to decrease the amount of pushing time, decrease the amount of tears, and decrease the amount of instrument deliveries. These positions include squatting, sitting, and on your hands and knees. There are good things and bad things about all of these. Obviously squatting would get tiresome, but if you have good help, they can help support you from behind. Hands and knees can also get tiresome, but it is one of the best positions to turning baby into the right position. You can also use a birthing stool to sit on, or if you are at the hospital, get the bed positioned to help support you sitting up. This is one of my favorite positions.

For those who have epidurals, or are just plain exhausted, the side-lying position has been shown to help. Essentially you have one leg raised while you are pushing on your side. With an epidural, you can also have the head of the bed raised to allow you to be more upright. Just make sure you are fully up and not just half way as this will decrease the space in your pelvis.

A good book to look at for positioning is Penny Simkins book, Labor Progress. She does a wonderful job of explaining different positions throughout the labor and why you would use them.

If you feel a need to be in any kind of position, I would stick with that. Many times, a woman's body can tell how they need to be to help move that baby down. Your biggest hindrance will be with medical staff that aren't used to these positions. I would make it clear from the get go that you want to push differently. Talk to your doctor about this also. Some are fine with doing whatever, and others are pretty stuck in the lying on the back mode.

I also had a question about doula's. First off, I'll say that I never had a doula, but probably could have used one. I have a wonderful supportive husband, but I feel like a doula who has been trained and been to many births, has experiences that neither I nor my husband had had at the time. Plus a doula allows the husband to take breaks when needed. A good doula will help the husband in his supportive role. I also think that there is something different about how men and women think, and having a women's support along with your husbands would make a difference.

Studies on doula's have shown that women who use doula's have shorter pushing times, less instrument deliveries, and breastfeed longer(Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 2009 Mar-Apr; Vol. 38 (2), pp. 157-73.).

I would interview them first to see if they would fit well with what you want to do and how you feel about things. If you plan on having a hospital birth, I would also try and find a doula that has worked well with the medical staff in the past. If money is an issue, try and request a nurse that has had natural birth experience. Sometimes, you can get a nurse to help with the labor support if needed.


The Journal Of The American Osteopathic Association [J Am Osteopath Assoc] 2006 Apr; Vol. 106 (4), pp. 199-202.
The Journal Of Perinatal Education: An ASPO/Lamaze Publication [J Perinat Educ] 2006 Fall; Vol. 15 (4), pp. 6-9.
Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG [J Obstet Gynecol Neonatal Nurs] 1997 Nov-Dec; Vol. 26 (6), pp. 727-34.


Anonymous said...

Thank you for writing this! I'm having a natural birth and you answered so many of my questions!

Cherylyn said...

What do you know or think about stretching your body out when you push? With my home birth I was in the tub with my head at one end (my husband sitting behind me with his arms supporting my back) and it felt SO good to stretch my body out as I pushed the baby. I'd never done that before, as I'd always been in the hospital where they had me scrunch up into a ball and hold my knees. It felt REALLY good, and apparently it worked. It seems against logic to stretch, but for some reason that's what my body wanted to do. I think of a tube, and when it gets stretched it tightens. I wonder if this tightening helps the uterine muscles push the baby out better?

Rachel said...

I have actually heard of women loving that. I think Penny Simpkin talks about how sometimes it's good to stretch your torso in labor because it perhaps allows a baby that is positioned wrong to maneuver a little bit better. There is more space in the torso, so baby can pull back up and realign himself. With your breech birth, that makes sense to me that that might be the case.

It just goes to show you that the body knows what it needs to do if you pay attention. I heard a story one time of a lady that was in the tub and felt the need to pull her leg up on the side of the tub while pushing. She had a large baby and was experiencing some shoulder dystocia(where the shoulders get stuck). Doing this helped to effectively open up her space just how she needed so she could birth that baby.

Cherylyn said...

I've read that too, but I don't remember which book it was in. I wasn't even thinking about that when I was pushing. It was later that I remembered "oh yeah, I read about that before, and it worked for me!" Originally I had wanted to be upright for pushing, but my midwife assured me I would be in the position that felt right at the time, and that's exactly what happened.

Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.