Labour Pain: Movement and Upright Positions

Written by Asheya

When you picture giving birth, what position do you picture? Lying flat on the back or semi-sitting is the most common way the media portrays birth. These two positions are actually the least effective and most painful!

After the question, ‘what is the purpose of pain in labour?’ has been asked and considered, even if we don’t know all the answers, we can move on to discussing appropriate ways to cope with pain in labour.

One of the purposes of pain in labour is to get women to move, and not-so-coincidentally movement and upright positions are effective methods of coping with labour pain. Movement also helps with labour progression.

The Lamaze Healthy Birth Practice #2 is Walk, Move Around, and Change Positions Throughout Labor.

When I was in labour with each of my children I found the positions that felt the best at different points of the labour. With my first baby I found I really enjoyed sitting on the birthing ball, swaying my hips slightly. Later I got into a hot shower, and held onto the back of a chair while I swayed my hips standing up. My doctor instructed me to lie on my side when I had the urge to push, because she didn’t think I was dilated enough (see my previous post for why this was unnecessary). Lying down and trying not to push was one of the most agonizing experiences I have ever had. When I started actually pushing I squatted to begin with, and then at the request of the doctor I went into a semi-sitting position. It was when I was semi-sitting that pushing slowed.

With my second baby I found that standing up leaning on something and swaying my hips was very effective for the first part of labour, and for my third baby I enjoyed the birthing ball again for the first part of labour. With both my second and my third babies I got into a large birthing tub (really just a five foot wide blow up kiddie pool!) during transition, and the warm water was a relief. I will write more about water as an effective tool for pain management in a later post. While I was in the tub I squatted and knelt leaning on the tub, and continued to move my hips.
During my labour with my second baby I was feeling tired just as I was entering transition, so I thought I would try lying down during a contraction. I just wanted labour to stop for a little while so I could have a rest! I lay down on the bed, and that contraction was awful! The worst pain of the entire labour. I decided not to lie down anymore.

Lying flat on the back as a birthing position has only happened in the last century, after doctors started giving women drugs for pain relief in childbirth. These drugs, both historically and today, often make it impossible for women to move around. In the past, women were often unconscious because of the drugs they received. This of course made it difficult to move around! Doctors and nurses took over the actual delivery of the baby, with the woman flat on her back and unconscious.

Today, epidurals most often make it difficult for the woman to move from the waist down. There is the possibility of a ‘walking epidural’, which allows the woman to move, but she may still require assistance. Not all anesthetists are aware of walking epidurals and not all hospital environments are supportive of them, however, so most hospitals in Canada do not routinely provide them. Epidurals as a method of coping with labour pain will be discussed more fully in another post.

Historically, before the administration of drugs for pain relief in labour, women laboured and birthed in various upright positions. Not only does movement help with pain management, it also helps with the progression of labour.
Standing upright, sitting on a birthing ball, or swaying on hands and knees, as a few examples, all make use of gravity to help efface and dilate the cervix and engage the baby’s head. These positions also make it easier for the mother to breathe, and do not put pressure on major uterine arteries, which helps the baby to get enough oxygen and have a stable heartrate. Movement assists the baby in optimal positioning, so that the baby’s face is towards the mother’s back, making labour easier on both the mother and baby.

Upright positions and movement also help to open the pelvic floor, making more room for the baby. And when it comes time for pushing, flat on the back or semi-sitting means that the mother has to push the baby uphill, because of the shape of the pelvis. Any upright, squatting, or kneeling position makes use of gravity to pull the baby down as the mother is pushing, as well as making the most space for the baby.

Movement and upright positions may contribute to shorter labours, less use of pain medications, and fewer c-sections. With all these benefits, it seems obvious that birthing environments should be encouraging movement in labour. Many hospitals in Canada do encourage movement and upright positions, especially in the first stage of labour. However, the main piece of furniture in most hospital labour rooms is still the bed, which in and of itself sends a message to the labouring woman. And unfortunately many doctors in Canada still feel most comfortable when the mother delivers the baby in a semi-sitting position.
What can you do? Listen to your body. It can be hard to block out the messages, some subtle and others not so subtle, that encourage you to labour and birth in positions that are not optimal for you and your baby. Try to find the positions that work for you. It will probably be different even in each labour you experience, as each baby and each birth is different.

A woman in labour is quite vulnerable, and being in labour is difficult enough without having to fight your care provider for what you want! Ask your care provider ahead of time what labour and delivery positions they encourage and what they prefer. If they don’t seem very open to upright positions and movement, try to find another care provider.

One of the best things you can do to facilitate healthy birth practices is to hire a doula. This is actually Lamaze Healthy Birth Practice # 3, and it deserves a whole post of its own (if not two or three!).

Accustom your body to the different positions by practicing them before you are in labour. Stand and lean on the back of a chair while swaying your hips. Sit on a birthing ball and practice relaxing, closing your eyes, and breathing deeply in and slowly out. Kneel on all fours and sway your hips. Practice squatting. Put a rolled up towel under your heels to make squatting easier if your muscles aren’t used to it.Practicing positions and visualizing yourself moving during labour, as well as watching videos of women moving and in different positions in labour, will help prepare your mind and your body, so that when your birthing day comes, you and your baby can find the positions and the movements that are optimal for you.

Lamaze International
Midwife And Doula