14 Feb Movement and positions in labour

Movement is about understanding how the bones of the pelvis move to create space for the baby as the baby descends and rotates through the pelvis.

Think logically – use gravity during labour. Gravity pulls down so get into an upright position to use gravity to pull this baby down during labour. Your baby has to negotiate moving through the tight constraints of the pelvis and negotiating tight twists and turns. So it is important to move regularly during labour and change position so to help this baby jiggle its way successfully and quickly through the pelvis.

The pelvis has three main spaces within it,

1. the inlet is the top area of the pelvis where the baby enters in
2. the mid pelvis, which is midway through the pelvis is also known as the cavity
3. the outlet, which is at the bottom of the pelvis where the baby comes out.

These three areas of the pelvis require different movements in order to help create space depending on where the baby is. The station refers to where the baby is in the pelvis.

The foetal position refers to how the baby is presenting through the pelvis. Is the back of the baby’s head along the right side of the mom’s body? Is it along the left side of the mom’s body? Is it towards the back? Is it towards the front?

Depending on how the baby may be positioned and depending on where the baby is within those three areas of the pelvis, you have the opportunity to use specific positions to create space in order to help facilitate the baby’s rotation and to help facilitate space change where the baby is within those three areas of the pelvis. When we open the top of the pelvis, the bottom, the outlet, actually gets smaller. When we open the outlet of the pelvis, the top gets smaller. We have to think what positions in labour will open the space where the baby needs it at that moment. You want to help open the top part of the pelvis at one point of labour and open the bottom part of the pelvis at another point in labour, depending on where the baby is. In physiologic birth what you’re doing when you’re moving is helping the baby to descend and rotate. First and foremost, movement is more important than any specific position.

If you forget the specific things to do at which point in labour, just remember to move. Move and change position.

Let’s say, the baby is at the inlet of the pelvis, the top of the pelvis… Then, what we want to focus on is having wide knees so that would be external thigh rotation, and incorporating some pelvic tilts or some rounded back positions to help pull the top of the sacrum out of the way, and remembering to change position often.

The 5 4 3 rule during labour

5 – every 5 contractions change position

4 – use the 4 basic positions –

Standing

Seated

All fours

Reclining

3 – the 3 ways we can change space within these positions –

Thigh rotation – (knees together / knees apart)

Pelvic tilts – anterior and posterior tilts (rounding or arching the lower back)

Asymmetry – both halves of the body doing something different to create asymmetry eg lunge, one leg on a chair.

A big part of the partner’s role is to help with facilitating the movement changes. The partner can chat with mom right after a contraction and be  “Okay, after the next contraction, let’s change positions?” Plan it out one contraction ahead.

A popular comfortable position often is an all-fours position. With an all-fours position – incorporate movement into that position. Rock your hips side to side, do some kind of circles with your hips, lean forward, lean back, do some pelvic tilts, so that not only do you wind up in a position that is helping to open up space towards the middle and the bottom of the pelvis, possibly at the top, depending on how the thighs are, but also we are actually moving within that position too, and then it’s kind of wiggling the baby down and out.

If the mom is experiencing this constant rectal pressure with an overwhelming urge to bear down, then we’re going to start thinking about opening the outlet with positions, like bringing the knees closer together. Positions like knees closer together, arching the lower back, so that we’re actually creating that space at the outlet of the pelvis.

Remember – move, change position, move, change position!