Sphincter Law – Part 2

doula at work

Sphincters May Close Suddenly if the Owner is Frightened

The sudden contraction of the Sphincters is a fear-based reaction, as a part of the fight-or-flight response of adrenals. The Adrenaline/catecholamine level will rise in the bloodstream when frightened or angered.

If a female animal in the wild is in process of birth, the birth process will reverse if the animal is startled by a surprise encounter with a predator. Humans can do the same thing.

In her book, Ina May’s Guide to Childbirth, Ina describes a situation where during labor a woman developed a fever; soon it became apparent that there was a bladder infection. She was seven centimeters dilated, but stalled in labor. So Ina chose to transport her to a hospital.

The laboring woman was examined by a doctor that was rough…who stated she was only 4 centimeters. Her dilation retracted from 7 to 4 centimeters as an automatic response to the roughly-handled internal exam…a natural self-protection, evidence of the function of the sphincter function.

What Helps the Sphincters?

• Trust, comfort, familiarity and safety
• Laughter
• Slow and deep [abdominal] breathing
• Immersion in warm water which calms and relaxes
• Relaxation of the mouth and jaw
o Relax the throat and jaw by singing
o Release an audible low moaning sound (similar to the sounds of lovemaking)
o “horse-lips” similar to the tone that horses make when they make that sound with their lips flapping, or “raspberry” sound.
• Relaxed labor supporters

~This information was taken from Ina May’s Guide to Childbirth. Ina May is an internationally known Midwife, who has delivered babies and written books on Midwifery and natural childbirth. She works at THE FARM, in Tennessee.

Sphincter Law- Part 1

doula at work
In birth work, obstetricians use the Law of Three Ps:

• Passenger (baby)
• The Passage (the pelvic structure and vagina)
• And the Powers (strength of uterine contractions)

From these Ina Gaskin believes stems the misunderstood capacity of a woman’s body from both the pregnant woman and the doctors who work with them. From the misunderstood capacities are the causative factors leading to all the interventions and procedures that now create problems in birthing, such as: Cesarean sections, Forceps use, vacuum extractors, etc.

The blame is placed upon women, for what obstetricians see as “dysfunctional birth”. Women have birthed for eons without a hitch; doctors perceive having a baby as “a problem of physics rather than a millions-of-years-old physiological process (168)”.

The Basics of Sphincter Law

• They function best when the atmosphere is private, and familiar.
• They do not open “at will” and do not respond to commands such as “Push!”
• When in the process of opening (relaxing) they will suddenly close down if a person is upset, frightened, humiliated, or self-conscious. This is the reason why in most traditional cultures women assist women in birth.
• If the mouth and jaw are relaxed, there is a direct correlation to the ability of the sphincters opening in the cervical and vaginal area (or the anus, for that matter).

What are the Sphincters?

These are a grouping of muscles that surround the rectum, bladder, the cervix and vagina. Each has a function for the body. These muscles remain contracted to keep the openings of certain organs held shut until something needs to pass through.

How do they work?

They work in conjunction with the brain. The brain has two sections that directly influence the functions of the Sphincters. These sections are the neocortex and the brain stem (or “primal” brain).

The brain stem is the portion that is directly connected to hormonal functions, and more instinctual. The hormones it releases (related to birth) are oxytocin (the main ingredient in the drug Pitocin, used to induce labor), endorphins, and prolactin.

Whereas the neocortex stimulation works to inhibit the brain stem from hormone release. It is “stimulated” during labor by asking too many questions of a woman in labor, bright light, and failure to protect her privacy during birth.

The sphincters work with the brain stem (and its many hormonal excretions) by a relaxation response. They respond to emotions. A good example of this relaxation response is what happens when toilet functions are interrupted. Everything gets held in, and it takes a while to relax again, right?

~more on the “Sphincters” next week!

Pain in Childbirth – Part 2

father in delivery room

What contributes to PAIN in labor?

Fatigue

Muscles that are stretched, hurt. The muscles of the uterus work faster, the blood and oxygen flow is lessened. When there is tension, the uterus works even harder and fatigue sets in. The tension of the surrounding muscles has created a “brick wall”. So, relax.

Tension

The stretching of the lower uterine portion and the intense contractions of the upper uterine muscle are what is thought to be the source of the pain felt. But these muscles actually have very few pain receptors. You would not feel the pain unless the muscles were forced to work in an unnatural manner. If tense and fearful the nerve endings of the muscles and tissues around the uterus send messages to the pain receptors. There is a direct correlation of tension to pain.

Tired muscles

The biochemistry of the muscle is imbalance when tired. It creates tension that sends out more electrical activity. The physiological changes will lower the point at which the muscle will hurt.

The outlet is too small, or baby too big

These actually do not need to be an issue. Usually the position of the baby or laboring mother, are the causative factor of pain. The pain messages are signaling that something isn’t right. What will help is a change of position of the mother.

Get out of the horizontal position, to a vertical one, and things will change. The baby is assisted (most of the time) to re-position him/or herself in the womb to facilitate birth without as much pain. As stated in a different hand-out, just doing this type of change in position opens the outlet by 20%.

Fear

Information is out there on all the things that “can go wrong”. We are not taught that birthing is a natural process; we women are pummeled with media and other females telling horror stories about birth.

There is a shroud over the whole process of birth, making it seem to be a great mystery. What is needed is correct information.

Your uterus is a magnificent muscle which is affected by the neuro-hormonal pathway that connects the brain, the circulatory system and the uterus. Fear causes an alteration of the pathway creating a reduction of blood and oxygen to the brain. This results in the tightening of the cervical opening of the womb.

Fear unbalances the hormones of the body. Being fearful causes the release of labor inhibiting hormones. These are the stress hormones of the adrenal glands that when in stress, we release hormones that are the fight-or-flight mechanisms. Animals also have them, and the hormones are released to stop labor allowing them to find a safe place for birthing. These then block the labor enhancing hormones . This lengthens the labor and increases the pain felt.

A well-informed, correct education about birthing will assist you. Make sure your labor supporters also have been educated so that their fear is not surrounding you when you are in labor.

Occasionally, the sensation of pain will continue, even after all the relaxation techniques are implemented. This may be due to a tightened psoas muscle or mal-aligned hip. Both can cause tension in the body, and / or problems with the baby being delivered easily. These two issues can be checked, and remedied.

The Natural Pain relieving Narcotic: Endorphins

“Circulating throughout the body are natural hormones that relax you when stressed and relieve pain when you hurt (138)”

What is sad is that most women do not know about these hormones, or that they can activate them when needed. In the 1970s studies were being done for drug addiction and the presence of these hormones in the receptor sites of the brain (for morphine-like substances). What was found was that the nerve cells that are attached to receptor sites, had chemical pain relievers that acted to dull the sensation of pain in the cells. Here is how they can work for you:

As you probably know, Endorphins are raised during exercise and well, labor is strenuous exercise!

  • When the abdomen contracts in labor, the Endorphin level is raised.
    o This is especially true in the second stage of labor.
    o They are the highest after labor, and two weeks beyond.
    Endorphins are highest during vaginal birth, not so much when labor was started but delivery was cesarean.
  • Endorphins are higher in newborns that had signs of fetal distress during their delivery.
    o Baby also receives Endorphins during birth.
  • The release of Endorphins also will stimulate the production of prolactin, the hormone that relaxes and creates the “mothering” sensation.
    o Prolactin regulates milk production, which boosts the interaction with baby and mother.
    o These hormones are what researchers think are the cause of the “birth high”.
  • Mothers who had surgical birth have lowered hormone levels, which would account for the delay in milk supply after cesarean birth.
  • Endorphin production is directly tied to a person’s emotional state.
    o So if stress and anxiety are not resolved the body increases the stress hormones, Catecholamines, which counteract the relaxation produced by Endorphins.
    o Like commercial narcotics, Endorphins may behave differently woman to woman, which is why some women may feel more pain than others.
  • Injectable narcotics give you a bit of blast of pain relief, whereas Endorphins give you a steady dose throughout labor.

Women in labor are very aware of the natural hormone effects and describe the experience as a “natural high”.

Pain in Childbirth – Part 1

father in delivery room
Biological Purpose of Pain

The human body responds to pain with either the response to flee, or the response to stand and fight. Some responses are automatic, such as the immediate withdrawal of the hand when burned accidently. External pains can be avoided.

But, what is known as visceral (ves-er-al) pain cannot be escaped. These are ones from the internal organs, and the uterus is an internal organ. This is in the case of normal and natural function, not a diseased state.

Extreme hunger or excessive thirst are due to physiological imbalance. These can be painful, but satiated by eating and drinking.

How Pain is Felt

On the body surface and on the outside of various organs are nerve endings. These were heightened during man’s primitive days, as sensors when man was attacked by creatures with tooth and claw. Certain exterior areas are very sensitive such as the neck, under the arms, abdomen, and chest.

The internal organs also have receptors, but only register with pain mechanisms when the external area is severely injured. The interesting thing is “the intestines and uterus can be burnt, cauterized, handled and moved without any sensation of discomfort to the patient,…(34)”. But if either has been torn or stretched the receptors respond with pain. The question we have to ask is why only during birth is the sensation of pain felt…a normal function.

The nerves send the information to the part of the brain called the thalamus. Here the intensity of the pain is interpreted. Then they are sent to the outer cortex of the brain to be balanced and qualified. The response to the messages from the Thalamus would be dependent upon the magnitude of the message by the Thalamus. The strongest response is fear, which brings about the most motor responses.

The thing to emphasize here is that this response is recognized in the normal and uncomplicated labor. The degree of neuro-response mechanism is determined by the state of the particular woman who has the pain. One may get a sense of total agony, and feel she is in great discomfort. While another woman may sense that it is not intense agonizing pain. It depends on the mental state of the person.

For the woman in birth the first time, the pain sensation will cause tension. This tension sets the stage for a flight reaction, that causes the uterine muscles that are circumventing the lower portion of the uterus to tighten. The longitudinal muscles are then constricted.
It is the longitudinal muscles that work to assist the fetus to be expelled at birth. The circulatory muscular portion of the uterus causes the longitudinal muscles to struggle in the effort to dilate the cervix. They work in opposition rendering the lower portion of the uterus and outlet resistant to dilation. The two opposite reactions in the muscular structure is then interpreted by the brain as pain.

Therefore, the fear OF pain produces ACTUAL pain.

We are so conditioned to believe that childbirth must be painful. Even Hollywood’s depiction is of childbirth as a painful ordeal, showing women screaming in agony.
It does not have to be this way…

Pain in any other part of the body at any other time is an indicator or “alarm” that something is not right. In labor it is also…an indicator that you need to RELAX.

Pain in labor releases a hormone that inhibits labor.

The Vocabulary of Pain

 

father in delivery room

The following information was written in order to understand pain in childbirth. This is a preliminary to understanding what your body senses when in labor.

Pain Threshold

The definition is “the point in which an individual first perceives the presence of pain”. This could be when ice or heat no longer is affective for blocking and / or reducing pain.
Each person has their own threshold. It is thought that threshold remains the same throughout ones life. But, Childbirth educators have found that the threshold is quite flexible. It is found that when comfort measures are used that effectively reduce pain or make it easier to bear, and the woman is distracted from her comfort measures, then the comfort measures no longer are useful. It will take a stronger stimulus to then break through the pain. Nothing had changed in the strength of the pain itself, “rather, her distraction reduced her pain threshold so that less pain was necessary in order for her to notice it (162)”.

Intensity
Intensity is defined as “the quantitative measure of how strong or severe the pain is (Ibid.)”. The usual measurement is a scale of 0 to 10. O being no pain, and 10 meaning that the pain is out of control.

Character
Character is a qualitative measure, using verbal or pictorial descriptors and analogies. Pain character may be described as burning, aching, tearing, or sharp like a knife. Character is the most important aspect to consider when managing pain.

Duration
Concerning when pain is first noted, and how long it lasts, and whether it is a steady pain or sporatic. It is particularly significant in that smaller diameter nerve fibers may, after repetitive signals become more responsive to pain signals. Many management strategies that are not pharmaceutical focus on the larger nerve fibers, which respond well.

Location
It is where the pain is perceived in the body. Depending on the location, the distress level may rise and start to interfere with eating, breathing, sleep, concentration, or the ability to otherwise function normally. If she is unable to concentrate due to location or any other aspect of the pain, she will be less able to use the pain management strategies she has learned.

Sensation Threshold
It is the point where the stimulus was first perceived. When reached, it is when the client first is aware of itching, cold, pressure, pain, or any other sensation. Of these, pain is the most important in that it could signify potential or actual tearing. Other sensations that may later become concerning may eventually grow strong enough to be perceived as pain.

Pain Tolerance
Defined as the greatest severity of painful stimulation an individual is able or is willing to tolerate. “Encouraged Tolerance” is the highest level of pain a person will tolerate when encouraged to try to tolerate more”. It serves a purpose, but not for women in labor as it may lower the tolerance to pain. It actually would translate to suffering rather than just pain.

Categories of Pain

Cutaneous
Occurs at the dermal level, and is sharp, localized, and generally tonic. An example would be the prick of the needle when given an injection.

Visceral
Occurring at the organ level, could be sharp or dull. There is less localization and could either be tonic or episodic. Examples: uterine contractions, severe constipation, and intestinal gas.

Somatic
It occurs at the soft tissue level. It is dull, aching, not localized and usually tonic.

Nerve Compression
The pain results from pressure on one or more nerves. It may be localized, or be referred pain to one or more regions of the body.

How to “Trust the Process” in Childbirth

Trust the Process

Trusting is a big word. We oftentimes say we trust others, but do not even trust our own selves. The nurturance of our babies and bonding that would be necessary in utero, assists in developing a trust between baby and mother. But before working on the baby-mother bond learn to trust your own instincts.

Science has determined that the mother-baby bond is essential after a child is born. But what about the significance of bonding while the baby is growing inside the uterus? This is the essential missing information not communicated to women in our modern times.

Due to the obsession of the over-technological world we live in, we forget to listen within. We tend to not realize important knowledge lies inside our psyches. We avoid listening to our bodies. The cues are there, we just do not stop to listen.

The pregnant body is communicating what it needs all the time, and, believe it or not, the unborn baby is, too. All we have to do as mothers is learn to listen, give ourselves permission to trust the connection, and take the time to respond (Peters & Wilson, 22).

For survival, the baby must begin to adapt to its environment while in the womb in order to survive. There are special molecules that act as messengers, to allow the mother to communicate to her baby in utero. Components such as hormones and neuro-peptides cross the placental wall, sending information to the fetus.

Emotional intelligence is taught to the fetus via this mechanism. So he or she learns the whole range of emotions via the mother. Her responses teach the fetus. She sets the tone, so-to-speak for coping within the world.

Creating the bond with the fetus is a spiritual act that transcends the normal functions of mothering. How one adjusts to life, begins during the prenatal period.

Researchers and clinicians have found that prenatal and birth experiences of the mother, effect the birthing patterns she has with her own babies. These would include cultural patterns imbedded in the lives of the family. We can prevent “life-constricting patterns (McCarty, 9)” that are developed while in utero by addressing these issues and healing our own birth traumas.

This scientific approach closely parallels the work of John Upledger in his ground-breaking work with Cranio-Sacral and Somato-Emotional Release therapies. His theory is that the body stores memories at the cellular level.

Have you ever massaged someone, or been massaged, and a small soft-tissue lump is discovered that almost feels like it “crackles”? That is a “energy cyst”. When released it creates an emotional response, and the muscular tension abates. It is thought this “cyst” holds the memory of the injury. In Unpledger’s book, he states that traumatic injury can be fully healed by the release of these “cysts”.

I have come to look upon this phenomenon as ‘tissue memory’. By this I mean that the cells and tissues of the body may actually possess their own memory capabilities. These tissue memories are not necessarily reliant upon the brain for their existence [[Upledger, 64].

I would consider this muscular and tissue intelligence. If Upledger’s theory is true [and is likely, due to hundreds of patients having experienced his work] then it is an important aspect to consider for the mother and the mother-baby bond.

There are four essential KEYS to developing the mother-baby bond, and learning to be aware of and trust your own instincts.

Being: an awareness of thoughts and feelings
Observing: a state of mindfulness
Nourishing: involves all the things women do to tend to their emotional and physical needs.
Deciding: to make an active participation in creating your own reality. A conscious agreement
to make decisions based on deep inner-listening.

Steps to making the conscious agreement are:

1. Separating ourselves from all external influences (even for a few moments in the day)

2. Get quiet and pause. A few deep breaths in order to connect to your “source”

3. Listen. What is your gut saying to you? How does your body feel? How is your body reacting? How does your baby react to what you are feeling, physically or emotionally?

4. Then decide and commit. This is when you honor your feeling and that of your baby. Make a decision that will be in harmony with the messages your intuition says.

Through this practice, then you will develop a trusting respect for your own intuitive thought process, allowing it to guide you. You have several months of your pregnancy to find your awareness of self and of your baby.

When the day comes for labor to begin you take this newly-developed self-awareness, the bond you created between you and baby, and the education you have gained about safe birthing practices to trust fully the process of labor! “Listen” to your own self, and what your baby is telling you.

Relax into labor, BE with it. OBSERVE what is transpiring within your own body, and NOURISHING your emotional / physical needs while you are in labor. Then DECIDE. Decide to trust your instincts, trust your body (which is wonderfully made!), and to trust your bond you’ve made with your baby…

COMMIT to Trusting the Process.

REFERENCES:

McCarty, Wendy Anne. Ph.D. , R.N. The Call to Reawaken and Deepen Our Communication with Babies: What Babies Are Teaching Us. International Doula. Summer 2004, Vol 12.

Tracey Wilson Peters, CCCE, C.L.D., and Laurel Wilson, IBCLC, CCCE. The Mission Piece: Consciousness and the MotherBaby Bond. Pathways to Family Wellness. Issue 31, Fall 2011

Upledger, John E., D.O., O.M.M. Your Inner Physician and You. 2nd Ed. North Atlantic Books. 1997

Midwife Model of Care VS Hospital Model – Part 1

doula at work

The Midwifery Model of Care

This ancient form of birthing care approaches the idea of birth as more holistic way of care-giving, recognizing the female power of creation. It also acknowledges the holistic view with a seamless unity of mind, body, and spirit; that mother and baby are inseparable units, birth is a normal healthy process.

Visits are much longer. The Midwife is attentive to the pregnant woman, answering her questions. Care-giving, education, counseling are all a part of the Midwife Model of care.

Nutrition is emphasized as the means for a healthy pregnancy, good birth, and strong thriving babies. Companionship during labor is considered important to minimize the use of technology to intervene in the process of birth.

The Midwifery Model has not time-constraint on the process of birth. Labor has its on rhythm, “…it can start and then stop, speed up or slow down and still be normal (Gaskin, 184)”. Midwives give continuous assistance throughout the duration of labor and delivery, and postpartum support after the baby is born. Women can move freely and eat freely throughout the process of labor.

Medical Hospital Model of Care

A product of the industrial revolution, and male derived, its basis is technology and medicine. It is assumed that the body is machine-like, full of short-comings or defects (some has stated child-birth as “pathological”). Pregnancy and labor are viewed as an illness, and that to prevent harm to the mother and baby, must be treated with drugs and/or medical equipment. Also, birth MUST take place within 24 hours.

Mind and body are separate entities. Women are consigned to the bed in a supine position, hooked up to electronic fetal monitors, intravenous tubes, and blood-pressure machines. Eating and drinking, after a certain point in the labor process, are not allowed. Analgesia is administered to ease labor pains since the Medical Model of Care deems pain as unacceptable.

Office visits during pregnancy are short, and questions are discouraged. The mother must take the back seat in her concerns during pregnancy, and passive role during labor. Women are treated homogeneously, with individuality considered unimportant.

Water Birth – Part 2

THE USE OF WATER FOR LABOR

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

Some suggestions for labor:

• The temperature should be body temperature
or slightly lower.
• Be equipped with an efficient pump, heater, and
a thermostat.
• A thermometer and large plastic strainer to
clear the water.
• At least 2 feet deep, to cover the abdomen when
she is doing squats or is kneeling. In order to
encourage the “freestyle movement” it should
be a pool that is at least 5 ½ feet wide.
• Optimum time: during active labor (5-8
centimeters in dilation).
• When having back labor, get into the water. The water relaxes and acts as a counter-pressure.
• If you have previously had an active labor and then stalls once in the water, get out of the pool
and move: squat, kneel. Walk, sway hips.
• Or if the labor is stalled, get into the pool, sometimes it’s just the relaxation you need to get
things started again.

It is safe to use the pool once your membranes have ruptured. Birthing centers with experience using the pool have not had any increase in infections reported.

Don’t expect all pain sensation to cease. It will decrease the pain, but does not make it completely go away. Often it’s how you move in the water, not just the pool of water.

An advantage of using the water pool for labor in the hospital is that you can really feel a sense of privacy, allowing space to sink into your own intuitive self for labor. Anxiety and blood pressure both are lowered when in the water. The stressors of hospital atmosphere is diminished, lowering the catecholamine (stress hormones) and “the secretion of endorphins” which are the relaxants that you body naturally produces, and the hormones that produce pain relief.

WATER FOR BIRTHING

Water birth is perfectly safe.

Sears & Sears state “The school of water-birthing that practices slow emergence (baby is left under the water, SIC) can be dangerous (156).” They use the example of water mammals that birth in the water, and how these mammals assist the newly born immediately to the surface.

An additional need when doing a water birth, is some salt. Adding salt allows for the pool water to have the same salinity as the amniotic fluid of the womb. The amount necessary is a generous tablespoon of salt. Before filling the pool be sure it is cleaned with mild disinfectant, and rinsed, “unless disposable liners are provided to contain the water (Balaskas, 208)”.

If your membranes break while in the water, there is no need to change the water. The amniotic fluids and “bloody show” are both sterile.

During birth in the water, the relaxation of the sphincter muscles may cause some fecal matter to be excreted. This is when that suggested plastic strainer comes in handy. There is no “evidence to show that it contaminates the water sufficiently to contribute any risk of infection (Balaskas, 212)”
You can kneel on all fours, squat, or be in a semi-sitting position to birth. Your partner can be in the pool with you or sitting just outside the pool.

Once the baby is born, the attendant (doctor or midwife) check to be sure the cord is not around the baby’s neck, and unravel the cord if it is. The baby may float to the surface on its own, or you may gently guide the baby to the surface.

Breathing will not occur until the baby emerges to the air, the coolness of the air causing the reaction to breathe. Occasionally the baby may need suctioning to clear the air passages. The cord has not been cut yet, so there are dual sources of oxygen. “In the rare circumstance that the baby doesn’t breathe, it is wise to take baby gently out of the pool into a cooler atmosphere. This will trigger the breathing reflex (Balaskas, 214)”. If necessary oxygen can be administered.

The baby can be held in the water, at breast level. It is best to sit or kneel in a vertical position. The rooting reflex will be strong, so turn the baby to face you, yours and baby’s bellies facing, to make breastfeeding easier.

You can stay safely in the water until the placenta is expelled, which generally takes place 10 -20 minutes later. Pay attention to the cord, if the pulse decreases it means the placenta is about to be expelled. The baby can be handed to the partner, and you can stand up slowly and leave the pool. If the expulsion occurs sooner and you feel the placenta released from the body, you can still stand up slowly once you have realized it, the cord can be cut before leaving the pool.

The persons you have present to assist the birth can cover you and baby as you leave the pool. It would be important at this time to have the temperature raised in the room. If you had not expelled the placenta before leaving the pool, you can stand or squat at this juncture to deliver the placenta. Then sit upright and enjoy your baby with comfortable warm coverings.

At this point, the midwife or doctor will check both you and the baby. After their examination, you can go to your bed and “…relax with your baby tucked warmly beside you (Balaskas, 215),…”.

 

REFERENCES

Balaskas,Janet. Active Birth: the new approach to giving birth naturally, Rev. (1992) The Harvard Common Press
Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Positions for Labor-Part 2

POSITIONS FOR LABOR – PART 2

Variations of the Squat

The Supported Squat

birthing• Your partner sits or squats behind you, toboggan-like style with back against the wall or bed, or using a chair for support
• Or your partner can be in front, doing a squat, and hold your hands for balance.
Standing Supported Squat
• As you relax down into the squat, take the weight off your feet and melt into the arms and against the body of your partner.
• In this position your body will tell your mind to relax
• You then surrender your mind and body to your labor
Dangle Support Squat
• Your partner supports from behind, or two people supporting you (one on each side) helping in supporting you in the squat position.

Kneeling

image004This position is a natural extension of the squat position when the labor is too intense.

• Kneel on the floor with a pillow
• Lean against a chair
• Or get on all fours
o especially good for back labor
o to try and turn a posterior positioned baby
o or if your labor is accelerating and seems unmanageable.

Kneel-Squat Position

• Kneel with one knee while squatting with the other leg.
• Alternate between legs, or you can do a rocking and swaying motion.
Knee-Chest Position
• Your knees are on the floor, while your head and arms are on a pillow
o Slows overly intense contractions
o Counteracts an urge to push when your cervix is not fully ripened.

Sitting

CHAIR STRADDLE• Sit straddled over a low stool, toilet seat, chair or birthing bed angled like a seat
• The best of these is the sit-squat over a low stool, for the same reasons as the plain old squat position

 

Side-Lying

SIDE-LYING• Does NOT use GRAVITY in the same manner as the SQUAT.
• Best on the left side, to prevent the uterus from compressing major blood vessels that run along the right side of the backbone
• It provides a way to labor without pressure of the uterus on the back, and allows for some sleep in a long labor.
• Use pillows for your head, and pillows under the knee of the right leg, and support pillows behind your back.
o It allows you to quickly roll into the kneel or up into a squat
o Once the contraction is done you can roll back into your nest of pillows.

 

*Images from The Birth Book, Sears & Sears (1994) and internet birthing images/stock photos*

REFERENCES:

Balaskas, Janet. Active Birth: the new approach to giving birth naturally, rev. (1992) Harvard Common Press.

Dick-Read, Grantly. Childbirth Without Fear: principles and practice of natural childbirth, 2nd ed. (2013) Pinter & Marition.

Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.