- Category: Research and references Research and references
- Created on Saturday, 31 July 2010 22:03 31 July 2010
These are some of the studies on what women can do in labor to effect labor progress and outcome. More are needed. Please send the names and links of studies which you find important. Together we can make this a better article.
From João P Souza and his research team in Brazil.
This review and randomization analysis found walking and being upright to be safe. Two of the studies looked at really long labors and perhaps that is why, overall, the report doesn't show moving around shortened labor compared with laying around. Interventions in labor were common, so this isn't a study to show anything about natural labor per se.
2nd Stage or Pushing Stage
MidwifeInfo.com website has this to say about a study on vertical positions in the 2nd Stage:
Fewer abnormal fetal heart rate patterns 1 trial - OR 0.31, 95% CI 0.11 - 0.91).
(Citation: Gupta JK , Nikodem VC. Woman's position during second stage. Cochrane Library)
Nancy from MidwifeInfo says, "I find this evidence too compelling to be ignored by those of us involved in the care of laboring women. There have been varied hypotheses about the reasons for the advantages of non-recumbent positions, such as stronger and more effective uterine contractions (Caldeyro-Barcia 1960), and improved alignment of the fetus for passage through the pelvis (Gold 1950); and also lessened risk of aorto-caval compression and improved acid-base outcomes in the newborn (Ang 1969, Humphrey 1974, Scott 1963). Until recently in the history of childbearing, women would try to avoid the dorsal position and would change position during labor when and as she wished (Engelmann 1882). Different upright positions were achieved using posts, hammocks, furniture, ropes or knotted pieces of cloth, kneeling, crouching or squatting using bricks, stones, a pile of sand, or a birth stool (Englemann 1881). Today, most women deliver in a dorsal, semi-recumbent or lithotomy position. We all know that it is easier for the midwife to monitor the baby and see what is happening if the woman is in a dorsal or semi-recumbent position (yes, the ubiquitous semi-Fowler's position), and we know that this is the position modern Western women expect to assume to birth their babies (or, all too often, to be delivered of them). After all, the TV screen in the labor room is positioned so that the view is best from the semi-recumbent position in the bed, so women just naturally get into bed and slide down into that position. Then they stay there.
Nancy continues, "I would like to propose that we, as midwives, using the best available evidence, make a non-recumbent position the default position for second stage of labor, and use a recumbent position only for specific situations. Why don't we do this now? I would hazard that the reasons have more to do with habit, hospital protocols, fatigue or overwork (I am frequently too tired or too busy to try something different, even if it occurs to me that it might help) than with a conviction that the semi-Fowler's position is better. Even with an epidural, most women can sit in a chair, on a commode, or on a birthing ball next to the bed; or they can stand next to the bed and lean over it, with support from another person. Remembering the significant advantages of an upright position, I would like to challenge all of us to use this evidence to encourage our patients to sit, squat, kneel, or stand to push their babies out."
Thank you, Nancy. I'm sure the readers of SpinningBabies.com agree! Visit MidwifeInfo.com
Researcher Gupta also had this report published:
Woman's position during second stage of labour.
Which is better, being upright or lying down to push out a baby? This review of the Cochrane articles "suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies."
I wonder about increased blood loss. I think we should look at how much comes with the placental gush and then how much over the postpartum period before we decide. Sometimes when women lose more at birth they lose less in the days and weeks following birth. Watching blood loss within the next hour or two and making a comparison of blood loss would show us if this initial increased blood loss is significant.
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.