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Birth preferences: positions for labour and birth

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When we think about births we have seen on TV or in films, it usually looks something like this:

Birth preferences: labour and birth positions - AlphaBirth

Image courtesy of www.popsugar.com

The bed is usually the centre of all the action! The reality is, unless you’ve had an epidural, the bed is the last place you should be. Often, it’s the presence of it in the room in the first place that makes people – women, partners, healthcare providers – gravitate towards it. It’s there, so why wouldn’t you use it, right?

The bed in your delivery suite can be a great tool to support you, but not by lying on it! A 2013 Cochrane Review found that the first stage of labour, when your cervix is dilating from 0-10cm, may be approximately one hour and twenty minutes shorter for women who are upright or are walking around. It also found that when women who were upright and mobile during labour were compared to women who laboured lying down in a bed, their risk of Caesarean birth was reduced, they were less like to use epidural as a method of pain relief and their babies had a lesser chance of being admitted to the neonatal unit.

Another Cochrane Review, this one published in 2012, recommended that women should be encouraged to give birth in comfortable positions, which are usually upright. It found that women who give birth on their backs were more likely to have an instrumental delivery (using forceps or vacuum), more likely to require an episiotomy but had less blood loss.

So the evidence shows that for both labouring and giving birth, being upright and mobile is preferable for improved outcomes for both mothers and babies.

Now that we’ve looked at the science, what about the instinctual? When labour begins naturally and women are progressing well at their own pace and without intervention, they usually find that their body adopts the position they find most comfortable all by itself. Some women find that they really like being on all fours, or sitting on their birth ball. Others like to walk around or use the bed to lean forward on if they are kneeling, for example. Many women love being in water, either in a birth pool, a deep bath or a shower. If you are feeling comfortable and safe, with all that lovely oxytocin flowing in your body, you will find that you will instinctually move into positions that work best for you. This applies not only when you are labouring but also when you are delivering your baby. You might find the very last place you want to be is on your back.

Take a look a this infographic that you may have seen on social media to see why:

birth preferences: labour and birth positions - AlphaBirth

So what are the best positions to use? Only you will know yourself when labour begins. You might like the idea of a few positions and then discover on the day that you’d actually prefer something completely different! The National Childbirth Trust (NCT) in the UK have produced these excellent posters to give you some ideas to try.

It’s a good idea to include a sentence in your birth preferences along the lines:

I prefer to labour and birth in any position that I find comfortable

This will help your midwife on the day know the type of birth that you have prepared for and she will be able to support you as you try different positions during your labour and birth.

More support and comfort measures for both you and your birth partner to use during labour are covered in depth at my GentleBirth weekend workshops. Take a look at dates coming up for rest of 2014 and reserve your place now.

Other posts in my birth preferences series:

Do I need birth preferences?

Birth preferences: what about vaginal exams?

© Sylda Dwyer, AlphaBirth 2014.  Unauthorised use and/or duplication of this material without express and written permission from the owner is strictly prohibited.

Birth preferences: what about vaginal exams?

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Last week we looked at the importance of birth preferences and how they can help to organise your thoughts about labour and birth, and to identify what’s important to you. While having written birth preferences to share with your support team on the day is really important, they will only be useful to you if you have carefully considered each item, understand why you have put it there in the first place, and if it is important to you that your caregivers are aware of this preference. Copying someone else’s birth plan – from a friend or the Internet – might seem like a great idea when there’s a ready-made one for you to use,  but your birth preferences should be unique to you by reflecting your personal informed choices.

Over the next few weeks, we’ll cover a selection of preferences you might like to consider and include, and today I thought we’d start with a closer look at preferences around vaginal examinations.

Vaginal Examinations

Vaginal examinations or internal examinations are performed during labour to establish how your labour is progressing. You might also hear people refer to them as a VEs or “internals”. Your midwife or doctor will be able to inform you if your cervix is dilating and how many centimetres dilated it is. Your cervix is considered fully dilated at 10cm and it is at this stage that your baby starts making its way down the birth canal.

When you initally arrive at the hospital, your midwife will ask to perform an admissions vaginal examination to help decide your care pathway from that point onwards. If your cervix is less than 3cm dilated, your midwife might suggest that you go home and return when your labour has further progressed. Alternatively she might suggest that you are admitted to a pre-labour ward. If you are in established labour (3cm or more dilated), she will most likely send you directly to a delivery suite where you will remain until after your baby arrives.

Once you have been admitted to either the pre-labour ward or to a delivery suite, it’s worth evaluating the merits of further vaginal examinations. Some maternity units have a policy that they like to perform vaginal examinations at two hour intervals after that first admissions VE. Often this is offered as part of a care package called the Active Management of Labour however best international practice recommends that VEs should only be carried out either at four hourly intervals, where there is a concern about progress, or when the labouring woman requests them. The NICE Guidelines from the UK are a good place to start when researching information on evidence-based care.

There are a number of reasons for keeping VEs to a minimum. Reducing the risk of infection is one, particularly if your waters have already released. Any internal examination introduces something foreign to the area – be it a caregiver’s gloved hand or a medical tool/instrument – so minimising this also reduces the chances of an infection.

A second reason is that the bag of waters around your baby may accidentally release. We will revisit artificial rupture of membranes (ARM) – or breaking your waters – in a few weeks time but this might be something you’d prefer to avoid, and not having a VE is the only way to prevent this happening.

Another important reason is your own comfort. It is usually necessary to lie down when a VE is performed and this can be quite difficult and uncomfortable when your labour is quite far along. If you have been active during your labour or if you have been using your GentleBirth techniques, an unnecessary examination may break your concentration or upset the focus you were enjoying to manage your labour. Experienced midwives can usually tell from the behaviour and movement of the labouring woman herself how far along her labour is.

So what kind of preferences would you include on your birth plan when it comes to vaginal exams? Some women like to include a line that says:

“I would like to have a vaginal examination on admission and then at four hourly intervals, in line with best international practice”

Or drop the last part altogether and just say:

“I would like to have a vaginal examination on admission and then at four hourly intervals”

Others like to say:

“I would like to have a vaginal examination on admission and then only at my request after that, unless there is a concern for my baby”

Or:

“I would like to keep vaginal examinations to a minimum and only at my request”

Some women are happy to be guided by their healthcare provider on VEs, in which case you might not include any preference.

Whatever your personal preference is, be clear in your mind as to why that is your choice. Remember too that vaginal examinations can only be performed with your permission so you are more than within your rights to refuse an examination at any stage if you’re not comfortable with it. Take the time during your pregnancy to read the evidence around the benefits and risks of vaginal exams to help inform your decision, like the NICE guidelines mentioned above. This Cochrane Review is also helpful.

Next week, we’ll look at preferences around positions in labour and how they are relevant to you.

© Sylda Dwyer, AlphaBirth 2014.  Unauthorised use and/or duplication of this material without express and written permission from the owner is strictly prohibited.

Do I need birth preferences?

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During your pregnancy you’ll hear a lot of discussion about “birth plans” or “birth preferences”. You’re probably wondering if this is something you should think about yourself.

The answer to this is a resounding YES! Here’s why… Read more →