September 7, 2010

Moving During Labor

It absolutely breaks my heart to know that many women are not given the chance to get out of bed during labor. Last January, I attended Lisa’s birth as her labor support doula. I stopped by the hospital while she was in early labor, and then headed home until she needed me. At sometime between 2 and 3am, she called and said things had been slow to progress. She was on pitocin (the synthetic form of oxytocin) and was having a hard time with the contractions. I asked her if she was moving around to deal with the intensity of the contractions, and she explained that the nurses didn’t want her out of bed. I asked “Why, was the baby’s heart rate decelerating when she got up?” She said no. I encouraged her to get out of bed and I assured her that I would be there soon.

It turns out that Lisa had not been out of bed since I had left around 6pm the night before! She was medicated only by pitocin, so her legs were not compromised by an epidural. Once Lisa was able to move (the nurse would only allow her to move on the bed) we got her onto all fours. She rocked and swayed, which alleviated pressure from her back and hips. She was immediately more comfortable and capable of dealing with the contractions. By simply getting off the back, which puts pressure on nerve endings, a laboring mother may experience less pain.

This scenario is becoming too common. There is no doubt that movement during labor is not only more comfortable for the mother, but also promotes maximum effectiveness of the uterus, and helps the baby shift into the optimal birthing position. Research shows that restricting movement during labor is NOT in the woman’s best interest. In 2003, a study in Nursing Research states, “A laboring woman’s lower back pain is worse when she is lying down.” Another study from The New England Journal of Medicine found that women who walked during labor did not have shorter labors; however, the women in the study were so satisfied with the walking that 99% of them stated that they would like to walk again during future labors. (Facts from “Care Practice Papers” from the Lamaze Institute for Normal Birth) WHO (the World Health Organization) also encourages freedom of movement and discourages the supine position during labor.

Although I am stressing the importance of moving during labor, there are valid reasons why some mothers are restricted to the bed: If the mother has severe pregnancy induced hypertension, if certain positions creates decelerations in the baby’s heart rate, or if the mother takes an epidural. Even with the popular “walking epidural” you are likely NOT getting out of bed.

The downsides to restricted movement are:

*The contractions are often perceived as more difficult when lying down.

* Gravity is our friend! When the uterus contracts, it is pulling the cervix open at the same time as pushing the baby’s head against the cervix. You can think of the cervix/baby relationship like a turtle neck sweater. As the baby’s head pushes against the cervix, it opens like a head emerging from a turtle neck. Why not use the natural force of gravity to add more pressure to the cervix, helping it stretch open?

Also in terms of using gravity to help labor progress, it is important not get get stuck in one position. The baby is still able to shift and move inside. The position of the baby can determine how labor moves. Remember that the heaviest parts of the baby are the back and the occiput (the back of the head). If the mother is on one side or her back for a prolonged period of time, the baby is likely to shift in that direction. As mentioned above, it is the baby’s head that pushes the cervix open. If the baby is either posterior (towards the mother’s back) or transverse (towards mother’s side) there will likely be less direct pressure being applied to the cervix with the optimal part of the baby’s head. In this instance, gravity may not be working with the mother, but against her. A recent study showed “Restricting women’s movement may result in worse birth outcomes and may decrease women’s satisfaction with their birth experiences”

*Pelvic bones do move! The pelvis is not a solid, fused structure. The two pelvic halves (the innominate bones aka- the hip bones) and the sacrum make up the bony structure of the pelvis. Mobility does exist here, and especially during labor when the body is brimming with relaxin- the hormone that soften tendons and ligaments. This movement provides opportunities for the baby to shift and move into the optimal birthing position.

As an example of what pelvic movements can do, one of my doula clients, Angela, named her labor movement “The Baby Hula.” She stood with gently bent knees and swayed her hips around as she breathed and moaned, helping her body open as it needed to. For Angela, her “Baby Hula” helped put her in a zone that allowed her to shift internally, and listen to what her body and baby needed. I have bared witness to many mothers who found their own instinctual maternal dance.

*FAILURE TO PROGRESS!!! The result of inadequate contractions and slow progress often leads to artificial labor augmentation, such as the implementation of pitocin, or the rupturing of membranes in an attempt to move labor along more quickly. Sometimes, the pitocin is successful in creating strong enough contractions that the uterus continues to push the baby downward, and dilates the cervix to 10 cm. That is where the saying “Pit her to 10!” or “Pit to distress” comes from. Should the mother reach 10cm, then she will have the opportunity to push. However, if the baby is still in a bit of an odd position, pushing it out the birth canal can still be challenging. Usually when pitocin is introduced into labor, the epidural is needed. So now we have a mother who has been restricted of movement and who is numb from waist down, which will only add to her challenge of getting the baby out.

If the cervix does not dilate to 10cm then the labor is declared a “Failure to progress” and the mother will undergo a cesarean birth. Which is currently how 1/3 of American babies are being born and 44% of these cesareans are a result of labor induction.

I can not promise that if you move throughout your labor you are GUARANTEED an ideal labor. However, research does show that freedom of movement has been more satisfying for women, and may lower the need for pain medication and resulted in fewer cesarean surgeries. Why not give it a try: close your eyes, crank up the music and let your body HULA your baby out!



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