Active Birth

I have been watching Call the Midwife recently. This is a lovely BBC series set in the East End of London in the 1950s following a group of community midwives in the area (it’s based on the memoirs of one of the midwives Jennifer Worth).

The one thing that strikes me in every episode - and indeed in all the fictionalised births I watch on TV -  is how the women are mostly shown lying on the bed as they labour and give birth. Even Bones, a TV series about a highly intelligent forensic anthropologist who is known for questioning the status quo constantly during the show, ends up lying down while giving birth. I was very disappointed as I had high hopes that her birth would be different to what we normally see on TV shows. I am often heard screaming - ‘get up off the bed’ at the TV (yep I know they can’t hear me but still it makes me feel better!!!)

What is the problem? Well for anyone who is hoping to have a natural birth, lying on your back is probably one of the worst positions to be in during labour. Being upright and moving around can help make labour so much more manageable. It also decreases the need for an epidural or other pain relieving measures and reduces the need for a forceps or vacuum assisted birth. However, most first time Mums (and Dads) who come to my workshops are usually not aware of this. They have learned about labour from TV and so don’t realise that lying on a bed is not an optimal position for giving birth - thankfully they are in my workshop so we talk about why it's not so great and what other positions can be used instead.

Janet Balaklas was the first to coin the term ‘Active Birth’. She noticed a huge difference in both the progression of her labour and her experience of it during her second birth when she got up and moved around, practising positions she had learned during her pregnancy. In her book ‘Active Birth’ she writes how during this birth ‘...it dawned on me, for the first time, that it is necessary for a woman to move and to be in harmony with gravity in order to help her body to open up in labour.’ (Balaskas, New Active Birth, 1991, p.vii)

I am not sure how I would have managed my labour on both my first or second, if I’d had to be in the same position the whole time. At one stage I remember trying to sit on the birth ball and watch Desperate Housewives, but just couldn’t focus on it and had to get up and move around. The birth ball was my saviour. Rocking back and forth over the ball was one of my favourite moves during both my labours.  It helped me to  feel  like my surges were fluid; ebbing and flowing through me as my labour progressed and it also soothed me. Even on my first when I got into the birth pool, I used the handles to rock myself from side to side. The urge to move rhythmically was very strong and I followed my bodies lead throughout.

 

When you are instinctively moving around during labour and adopting an upright position of some sort you are benefitting from - among other things

  • The pull of gravity. This can help shorten labour considerably since you are working with the urge of the baby to move down the birth canal.
  • Stronger and more efficent contractions - as the babies head is bearing down on the cervix
  • The ability of the pelvis to move and expand during labour due to increased flexibility in the pelvic joints. This increased flexibility is due to the extra amount of hormone Relaxin your body produces during pregnancy. This hormone softens the ligaments in the pelvis and allows them more flexibility. This in turn allows the pelvic outlet to expand by as much as 30 percent. You are also taking advantage of the fact that the tailbone can also move backwards during childbirth.
  • You are less likely to have an instrumental delivery (with forceps or vacuum) or have an episiotomy during the second stage of labour

It is important to listen to your body and follow it's lead. If left to do this, it has been noted that most women adopt similar positions during labour, and these are mostly upright.  However, not all women will want to be active in birth. Some will want to lie down. In a recent conversation with a former GentleBirth client she related that she did not want to move around during labour, as she felt very comfortable on the bed. She had a really positive birth experience, but had no interest or need to be off the bed. The main issue is whether or not you are aware at how much being upright helps so you can choose to use this tool to enhance your labour experience if you feel you need it and that you feel confident enough to follow your bodies lead. Your partner can be a great support and help with this. They can check in with you to see if you are comfortable in the position you are in, they can support you in some of the positions you choose - and enhance them by for example massaging your back as you bend over the birth ball or lean against the bed. The can also remind you to get off the bed and get active if you don't remember yourself. 

If you have to be monitored and you were hoping for an active birth, it doesn't mean game over. You can still adopt positions on the bed that allow you to be upright, or use the birth ball to rock and sway on the bed itself while also still having the monitor on.

For more information on active birth and positions during labour here are some useful posts:

http://www.bellybelly.com.au/birth/active-birth#.UVXS1o75hDw

http://www.abc.net.au/science/articles/2009/04/22/2549707.htm

Finally this fantastic link from the Royal College of Midwives gives lots of ideas regarding positions and shows how you can incorporate upright positions if you have to be continuously monitored. Bookmark it and get your partner to have a look at how they  can help facilitate your active birth. 

http://www.rcmnormalbirth.org.uk/practice/positions-in-labour-and-birth

Did you find being active during birth helpful? What positions or movements did you use?