Class 7: Labor Positions

Labor Positions

• Labor positions that can be assumed:
  • Sitting
  • Hands and knees
  • Birth ball
  • Squatting
  • Side-lying
  • Upright
  • Lunging
  • Stairs
  • Reclining
  • Birth Stool
  • Birthing Bar
  • Kneeling

Sitting Position

• Good for resting
• Can still be used with a fetal monitoring machine
• Sitting on a toilet relaxes the perineum, which can help reduce tearing
• A hard toilet seat can become uncomfortable
• May not be an option if the client has had high blood pressure during pregnancy

Hands and Knees

• Takes pressure off the spine, easing back pain
• May help boost baby's oxygen level
• Client's arms may get tired

Birth Ball

• Can help move baby into a favorable birthing position
• Relieves back pressure
• Birthing ball labor positions can help encourage dilation and move baby deeper into the pelvis
• Can be difficult for client to keep balance
• Some birthing ball labor positions are difficult to do alone

Squatting

• Helps open the pelvis
• Gives baby room to maneuver as they head toward the birth canal
• May become tiring

Side-Lying

• Helps get oxygen to the baby
• Can be used if one has high blood pressure
• Makes it easier to relax during contractions
• May be difficult to assess fetal heartbeat

Upright

• Relieves backaches
• Can make contractions less painful
• Encourages baby to move deeper into the birth canal
• Not typically recommended for women with high blood pressure
• A telemetry unit is needed to continuously monitor the fetal heart rate

Lunging

• Helps baby rotate or descend
• Opens the pelvis, giving baby more room
• Requires a partner to help keep one's balance

Stairs

• Opens pelvis, allowing baby to drop farther and push on the cervix
• Helps baby rotate and get into a better birthing position
• Can be tiring, especially if one has been in labor for a while

Reclining

• Can release tension and relax the muscles
• May be a good alternative if a woman is tired but doesn't want to lie down completely
• Can work against gravity

Birth Stool

• Can help baby move farther down
• Relieves stress on the back
• Can increase dilation of the cervix
• Women may experience increased blood loss

Birthing Bar

• Expands the pelvis
• Uses gravity to push baby down
• May not be available at all hospitals

Kneeling

• Relieves pain of contractions
• Eases back pressure
• May be difficult for continuous fetal monitoring

The Miles Circuit

• Circuit includes three steps:
  • Open Knee-Chest Position
  • Exaggerated Side-Lying
  • Movement

Step 1: Open Knee-Chest Position

• To be performed for 30 minutes
• Allows for baby to scoot out of the pelvis and wiggle back into a new position

Step 2: Exaggerated Side-Lying

• To be performed for 30 minutes
• An opportunity for a deep, restorative stretch that opens the pelvis in an asymmetrical fashion

Step 3: Movement

• To be performed for 30 minutes
• Gives baby the opportunity to use gravity to descend further in the pelvis

Comfort Measures

• Rebozo involves:
  • Sifting the belly or hips
  • Pulling the pelvis back
  • Supported squatting
  • Advanced rebozo techniques
• Different types of massage include:
  • Vibrating massage
  • Massage gun
  • Manual massage (by hand)
  • Rolling massage (rolling pin or rolling ball)
• Counter pressure includes:
  • Sacral press, good when the baby is still up high
  • Double hip squeeze, good for when the baby has descended some
  • Tennis ball press on hands and knees or against the wall
• TENS (Transcutaneous Electrical Nerve Stimulation) Unit - A machine that sends an electric current through the muscles, typically used on the back
  • Based on The Gate Control Theory of Pain, a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself
• Compress may include:
  • Hot pack/cloth
  • Electric heating pad
  • Cold pack/cloth
  • Ice
  • Most effective when used intermittently
• Hydrotherapy may include:
  • Showering or pouring water;
  • Soaking in a small bathtub(home) or a large bathtub (home/hospital); or
  • Using a birthing pool (home/birth center) -Acupressure involves the use of specific pressure points on the body to induce labor:
  • BL60
  • SP6
  • BL32
  • LI4

Other Comfort Measures

• Low-Intervention Clinical:
  • Nitrous oxide (laughing gas)
  • Sterile water injections
• Mental/Emotional techniques:
  • Distraction
  • Position affirmations
  • Music/sound
  • Aromatherapy
  • Hypnosis (Hypnobabies/hypnobirthing)

Things to do

• Research the Spinning Babies method, an advanced method to promote optimal positioning for baby
• Research Hypnobabies, an advanced comfort measure which utilizes guided imagery and hypnosis

An overview of labor positions including sitting, hands and knees, birth ball, squatting, side-lying, upright, lunging, stairs, reclining, birth stool, birthing bar and kneeling. Some positions are good for resting or easing back pain, while others can help move the baby into a favorable birthing position. Each position has pros and cons for the client to consider.