You’ve seen it all…women on TV birthing in various positions that you never even thought of. They walk, they rock, they get on all fours – is there something they know that we don’t?
WORDS MELISSA ESPECKERMAN
The time has come. Your contractions have started and they’re just minutes apart. Your bundle of joy will be here in no time. It’s time to get into position but just what exactly is the best position for you?
Once you’ve checked into the delivery ward, you will most likely be shown the bed which you will be in for the next several hours. And chances are you’ll be lying down for most of that time. “The most common childbirth position today is the supine or semi-sitting position. This is a relaxing position for the mother that makes monitoring of the baby and labour process the easiest. It is also the chosen position if the mother chooses epidural analgesia as a form of pain relief,” says Dr Anthony Siow, obstetrician and gynaecologist at Parkway Gynaecology Screening & Treatment Centre, Gleneagles Hospital.
Samantha Liew, mum to Noel, who’s now 18 months shares, “From the moment I walked into my delivery suite till I was wheeled back to my ward, I was on the bed. Apart from the couple of times, I had to go to the loo, I was otherwise on the bed hooked up to the foetal monitor. And because I had an epidural, it was even harder to change my position or even to move.” For this working mum, her labour lasted a total of 18 hours! She didn’t get a chance to walk or do anything else to help labour along. And she was not the only one.
Cynthia Menon who was in labour with her second child also spent most of her labour on her back. “For the first day, I was in bed most of the time. If I wanted to walk, I had to ask for assistance. But it was nothing like you saw on television. I did not get on all fours and there was no birthing ball to help my labour progress.” And for this assistant manager, when the time came for her to push, out came the stirrups for her legs, leaving her with not much choice of birthing in any other position.
With many shows and books depicting women birthing in all types of various positions, from squatting to standing, is lying down really the best way to go about it? Deborah Fox, EMMa care co-ordinator at NUH Women’s Centre says, “Although traditionally most women give birth on the bed in a lithotomy position, it is not necessarily always the best position for a smooth delivery. Women with healthy full term babies can actually choose a variety of positions to birth their baby including standing, squatting, hands and knees/all fours, lying on their side or sitting on a birth stool.”
And these positions aren’t anything new. In fact, throughout history women in many different cultures have given birth in various positions such as the upright or gravity-neutral positions like side-lying and hands-and-knees. “Over the centuries, inter-professional struggles between surgeons and midwives, as well as the use of forceps for delivery in the 17th century, have changed childbirth position from the upright position to the supine or semi-sitting position. In the last decade, there has been more debate regarding which childbirth position is best for mother, baby and birth attendant because more women now want to actively decide and choose the way their childbirth is conducted and the kind of birth experience they want,” says Dr Siow.
From walking to rocking, there is a whole list of positions that can ease the discomfort many women experience during labour. But that’s not all, these positions have also been known to help the baby move down into the birth canal – with the help of gravity of course!
In The Whole Pregnancy Handbook, authors Dr Joel Evans and Robin Aronson write, “The positions you labour in and your breathing can ease the discomfort of labour as it intensifies. Many labour positions involve using gravity. For example, you can stand and sway with your partner/labour coach (slow dance) through contractions; sit on or drape over a birth ball while leaning into your partner/labour coach; lunge through contractions; or simply sit on the toilet.”
Simply put, lying in bed, especially if you’re on your back and not moving can slow down your labour so it might help to try some of these techniques to get labour moving. Who knows? Your labour might just be shorter because you moved around.
Anna McGrail and Daphne Metland state in the book Expecting that being upright, staying mobile and changing positions in labour can help your contractions to work more effectively. So get walking. In early labour, walking is one way to get yourself more comfortable and also speed things up. And the best part is, you can walk anywhere. Whether it’s around your home or the hospital halls, go slow and let gravity do its job.
If you’re finding it difficult to relax during labour, you might want to try the side lying position. Arrange your pillows to support your head, arms and legs and get comfortable. This position is also good for your baby as it doesn’t compress the major veins in your body, which can compress the umbilical cord blocking blood flow to your baby.
It pays to know that by simply changing your position, it could ease the intensity of your contractions. “Rocking, either on a chair or swaying back and forth, allows the pelvis to move and encourages the baby to descent,” explains Dr Tan Wei Ching, senior consultant, Department of Obstetrics & Gynaecology at Singapore General Hospital. You might want to try rocking with the intensity of the contraction. So the more painful the contraction, the more you should be rocking.
What is really an exercise ball, birthing balls can effectively move labour along. Sit astride the ball while rocking your pelvis from one side to another or lean on it during labour. Dr Tan says, “Sitting can ease the pain of contractions and allow gravity to assist in bringing the baby down into the birth canal. This position can be adopted even with an epidural or a fetal monitor strapped on.”
Getting on your hands and knees during labour can bring you much relief when you’re experiencing back labour and it also opens up the pelvis while gravity assists in the delivery process. The book The New Art and Science of Pregnancy and Childbirth by Dr Tan Thiam Chye, Dr Tan Kim Teng, Dr Tan Heng Hao and Dr John Tee states, “The “all fours” position, which is kneeling in bed and leaning forward with support, may help to relieve the back pain when the baby is in an occiput posterior (face up) position (OP) and may also facilitate rotation of the baby’s head from OP to occiput anterior (face down) position.”
Because squatting increases the opening of your pelvic outlet, it is a great position to deliver in. “Squatting, a position adopted only late in labour or during delivery itself, also employs Newton's finest while opening up the pelvis to provide more room for the baby to descend,” says Dr Tan.
While this position can result in a faster pushing stage and can be used in conjunction with monitoring equipment, it does however have its disadvantages. Squatting blocks the practitioner's view and hinders the use of instruments such as forceps, stirrups and vacuum extractors. The New Art and Science of Pregnancy and Childbirth also states that the use of a birthing chair or stool is recommended for giving birth in a squatting position. But it doesn’t come without any drawbacks. With a birthing chair, there may be the chance of excessive tearing of the perineum. While the tear is not a serious problem, it might lead to more discomfort and a longer healing time.
So what exactly is the best position for you? Talk to your doctor about your options and it might be a good idea to try each position to see which one you feel most comfortable with. But keep in mind that once the contractions start and labour begins, things might feel a whole lot different so go with what you’re most comfortable with.