This is not lying on one’s side and leaning your leg over!
The Sidelying Release (SLR) uses a “static stretch” to temporarily, slightly enlarge and soften the pelvis. Stretching the muscle spindles in the pelvic muscles lengthens the pelvic muscles for approximately 1-4 hours. The SLR can then be repeated if needed.
SLR comes to the birth world through Carol Phillips, DC, Dynamic Body Balancing Workshops.
The weight of the leg in Sidelying Release gives a stretch to muscles to elicit a stretch response and “Make room for the baby”. From Dr. Carol Phillips, DC.
Benefits of Sidelying Release include:
- More pelvic mobility
- Releasing muscle spasm (easier to sleep in pregnancy, less sharp contractions in labor)
- Ease pain in pregnancy and birth
- Make room for baby to turn into a better position
- Longer, softer pelvic floor muscles for baby to move through during birth
- Can be repeated every 4-6 hours, since the benefits are temporary
What situations is a Sidelying Release useful for:
- Starting labor when overdue (occasional result)
- Stall in active labor is overcome and labor picks up (common result)
- Annoying hip or back pain
- Sharp pain in pelvis or hips
- Baby is in a breech, oblique, posterior position (supports other necessary techniques)
- Contractions with no progress
- Asynclitic head or baby’s head is tipped or tilted
- Deep Transverse Arrest (baby remains facing a hip at 0 station, midway down the pelvis- follow with side lunge)
- Posterior baby (in labor, do through 3 contractions on each side or 3 on first side and 2 on second side)
- Contractions are more painful than expected
The SLR is a star in the universe of maternal positioning for comfort and progress. Nurses and Midwives may offer a Sidelying Release before resorting to cesarean.
However, there are rare complications. Use with the understanding that there could be an adverse reaction.
- 1 case of frantic fetal kicking, resolved by position change in mother
- 1 case of water breaking and no contractions, labor did not pick up, Pitocin was used but a cesarean was finally done
- 1 case of bleeding (unknown source – meaning not clear whether cervical dilation or placental bleeding) vaginal birth
Occasionally we see spontaneous membrane release in active labor following fetal rotation during the Sidelying Release. Typically there is a rapid return to progress. I have not known SLR to begin a labor before term.
How often do I do a Sidelying Release
- Twice a week in pregnancy for a better fetal position
- Once in early labor to reduce labor pain later and time labor takes
- Again in labor if there are strong contractions and no progress
How to do a Sidelying Release
This is a technique to do with a helper. A woman can do this alone with less precision, but a helper can make sure mother’s hips and shoulders are stacked.
The mother chooses which side she feels more comfortable in first. Do this on BOTH sides so the pelvic floor is more even.
Use on a firm surface (I use a couch as an example). Choose a surface as long as the mother. The edge of a couch, bed, a heavy table or counter will do. A hospital bed works wonderfully when raised a bit, during labor in the hospital. Some doulas and childbirth educators are experimenting with doing the Sidelying Release while the mother lays on the floor.
Please read the instructions below carefully. Doing it wrong doesn’t work.
- Begin on the side of choice. Head is level on a pillow, not tilted. The neck is straight.
- The helper stands in front of her. The helper has their leg or hip firmly against the edge to keep the mother from tipping off!
- Holding a chair or table near the edge of the couch, the mother scoots her hip right up to 2” (5 cm) from the edge of the couch. A 3rd-trimester pregnant belly extends beyond the edge.
- The helper curves both palms around the edge of the mother’s hip (front and top; ASIS). The helper must prevent the mother’s hip from leaning forward after her leg hangs.
- Slight rocking of the hip helps relax muscles. This is so slight as to put a tiny baby to sleep.
- The mother straightens her lower leg. But the helper must not pull the leg straight!! Toes are up (flexed) toward her knee.
- When the helper is steady and in place (but not before!), the mother slightly lifts her leg up and over her thigh and then lets it slowly hang down in front of her. Wait 2-3 minutes or until the leg hangs slightly lower. Do both sides so you don’t make the pelvis unstable.
- Person gets up and walks around the room in each direction or up and back in a straight line, depending on the space available.
See a partner learn to do Sidelying Release with a detailed step-by-step instruction on our Spinning Babies; Parent Class.
Check: is her back straight? Use a box along her lower back to line up the hips. Only use the box for a second to check your alignment – but don’t let go of the hip!
The top shoulder stays directly over the lower shoulder? (She can hold a chair, a table or a helper.) The top hip must stay over the lower hip! Now she is ready for the activity!
Helper: Don’t let her hip lean forward! Here’s the point of the Sidelying Release: Her top leg hangs forward into the air. Let the full weight of the top leg hang free. Avoid the mother’s thigh so the thigh can hang freely. The mother breathes deeply and slowly. As her belly relaxes, her leg relaxes more.
Q: When should I start SLR in pregnancy? A: Now. Q: But, how many weeks is best to start? A: Now. But, how long can I postpone starting and still get a good fetal position? A: Go back to the beginning of this paragraph and reread.
How to do a Sidelying Release better
If you do the SLR incorrectly, you will not get the benefits you want.
Keep the hips and shoulders stacked and in a rectangle that doesn’t twist. In other words, don’t let the person lean forward and don’t push the hip back. Keep it upright.
In pregnancy: Her leg hangs like this for about 2 1/2 minutes. It’s ok to try it longer, but it’s vital that it’s done on both sides.
A few people have reported holding each side for up to 20 minutes to flip a breech, but this length of time is not required for head down babies. Explore and see what feels best for each situation. Two 1/2 minutes on each side allows the stretch receptors to activate and most of the time, respond.
In labor: Let the leg hang like this through 3 contractions and switch sides for another 3 contractions (sometimes a rest comes after 2 contractions and the uterus stops contracting for several minutes up to an hour.)
You will see regular contractions that are more effective either immediately or after the hour rest period.
If contractions strengthen but then slow again, assess and address engagement or a locked sacrum. Then repeat SLI and see labor progress.
Do SLR on both sides so that you don’t create more of an imbalance!
After we finished the left side, she got up to use the restroom. Contractions were more regular, not so close together and VERY productive. Suddenly she “had to poop!” Her water broke, she began to push and we scrambled to get things together for the hospital….I learned that I will reserve these spectacular techniques from Spinning Babies for when we’re close to the delivery locale! – An anonymous doula
Is there any time you shouldn’t do a Sidelying Release?
The Sidelying Release is typically safe before and throughout pregnancy, even into early labor.
- Avoid if bleeding other than a normal bloody show of labor
- Avoid if the pregnant person is experiencing cramps that are not clearly related to childbirth or pooping
- Avoid if recovering from hip surgery. In a well-progressing labor, there may be no need for SLR
- Don’t both if labor is progressing fast (though if fear or panic is present, SLR may sooth these fast!)
If you do the Sidelying Release, do it on both sides and keep the hips straight. This is important!
Caution: Do not do any exercises, including any inversions or twists, or the Sidelying Release, if you are having cramps or pain of an undetermined origin (meaning not from labor or prodromal labor) before a physician can help determine that the pain is not related to the placenta.
Older people or people with tight legs may feel a pull on the outer leg. If sharp, stop and address the muscles on the outer leg with a massage stroke. If still painful, stop the SLR and address the TLC muscle before repeating SLR.
Please pay attention to a pain that persists more than a few minutes. Report abdominal pain to your provider, including shoulder pain.
Stop these or other exercises immediately if the baby begins sudden, vigorous, frantic movements during the new position. Don’t get upside down or do the Sidelying Release after such vigorous movements before assessment. Have the baby’s heartbeat assessed immediately anytime, with or without exercise in which the baby moves frantically. Don’t get upside down if you have high blood pressure or are otherwise at risk of a stroke.
Frantic fetal movement or placenta pain is an unusual occurrence in any event, and extremely unusual at Spinning Babies. I have heard of one possible instance of each situation in the last ten years. There were warnings that were not understood, so listen to your body and check out unusual symptoms with your physician before trying these exercises. Meanwhile, thousands of women are getting mild or dramatic benefits from the inversions and Sidelying Releases in total safety. Be confident but, also, assess.
Extra details about SLR for a better understanding…
What’s the problem that Sidelying Release helps?
If one side of the opening is tighter than the other, or higher than the other, the asymmetrical tension can pull the pelvis out of balance. The baby can be tipped and/or rotated into an unfavorable position.
Even if the pelvic floor is evenly tight, fetal rotation or descent (coming down) can take longer than usual. The strong pelvic floor of a dancer or horseback rider may lengthen labor considerably.
Common habits of modern life can make the pelvis tight on one side or even twists the hips (one leg shorter than the other, pain in the Sacroiliac or symphysis joints). Simple things like driving a car or crossing our legs, sports accidents or falls on either the head or the bum might affect the pelvic floor.
Tension or torsion in the pelvic floor makes labor longer. An uneven tightness in the pelvic floor may make the baby’s head tip, causing an asynclitism (tipped head) that makes labor longer and increases the chance of cesarean or vacuum (ventouse).
What’s the solution?
The Sidelying Release can help labor progress, reduce pain, calm a tense birthing woman. Try it in the presence of a posterior, brow or asynclitic fetal presentation. Try it, also, when labor is taking longer or feels sharper than expected.
Tania and Alice’s story told through the emails of doula, Amy Peterson, shows how Sidelying prevents 3rd Cesarean. Many more babies and mothers can enjoy immediate skin-to-skin contact when cesareans are avoided with this technique!
Who benefits from a Sidelying Release?
- First-time mothers benefit from releasing spasm in the pelvic floor once or twice in late pregnancy.
- Ballet dancing, horseback riding, and daily running strengthen the pelvic floor so much that fetal descent can be slow and birth can be much longer. This technique may shorten labor for these women.
- Women who have had previous cesarean(s) for “failure to progress” or transverse arrest may benefit from a pelvic floor release in late pregnancy.
- Women who have had posterior, breech or other less than favorable fetal positions in previous births or has a baby in an unfavorable position in their current pregnancy.
- Women with a head-down baby may benefit from the Pelvic Floor Release 1-2x a week, but there isn’t harm from doing a pelvic floor more often, even daily. Women with breech, transverse, or posterior babies could do the pelvic floor release once a day.
- Women whose joints are very loose to the point of being hypermobile probably shouldn’t do this activity daily. That’s a guess.
- Women on bed rest may do this technique as part of a gentle stretching routine on their couch or on their bed with a helper.
Anyone can do this technique! It’s not just for pregnant or birthing women. If intercourse or elimination is painful due to a tight or twisted pelvic floor give this technique a try.
Occasionally, but not often, a woman does the Sidelying Release and gets tender or sore in the lower back, A Standing Sacral Release relieves the discomfort in minutes. If you don’t have help, try pelvic tilting on hands and knees or while standing. Move gently and with fluid motion, not forcefully. Sometimes, but not often, older persons find the outside of the leg tight and painful when hanging the top leg. This may be a tight ligament/muscle on the outside of the leg – massage the outer leg crosswise, near the hip, a few minutes and then retry the SLR. Anyone and any age can benefit from SLR!
Is there any time you shouldn’t do a Sidelying Release?
Contraindications for Sidelying Release may be:
- If there is a history of fast births, and this one seems to be fast, too, the Sidelying Release is probably not necessary.
- In a labor that is progressing steadily, there is likely no need but may reduce pain.
- You can ask your care provider if there is any medical reason not to do the Sidelying Release.
- Recent hip surgery and the bruising and stitches haven’t healed.
- Any bleeding except for normal bloody show just before or during labor, or any threat of placental bleeding.
- Bleeding from a placenta previa or low-lying placenta may be helped or harmed by SLR, we do not know. Be warned.
- If you are seeing a myofascial worker, a craniosacral therapist or chiropractor, please talk to them first about doing the Sidelying Release to be friendly and respectful. They may do this on one side only because of their opinion. Carol Phillips, DC, states to do this on both sides and that makes sense to me.
- If you don’t want to!
If you do the Pelvic Floor Release do it on both sides. This is immensely important!
When to do a Sidelying Release in labor
Discomfort in pregnancy from tight, tender areas (front or back), achy hips, or achy lower back may be symptoms that a Pelvic Floor Release could offer comfort. Also, if the baby hasn’t engaged by 38 weeks gestation, a Pelvic Floor Release may be helpful.
In labor, the benefits of a Sidelying Release help to overcome a stall or plateau of dilation in the presence of strong contractions. In other words, the uterus is trying, but can’t bring the baby down. Or the uterine contractions are not symmetrical.
The Sidelying Release May be helpful when:
- Labor just can’t seem to get started. Contractions start and stop, are strong then weak.
- Contractions are strong but not bringing the baby
- Contractions have slowed down after a period of hard, but non-progressing contractions as if the uterus is tired from trying to move the baby.
- When the mother feels pain beyond her ability to cope
- Labor stalls at 5, 6, 7 cm or later.
- Baby’s head is tipped or asynclitic.
- Baby’s head is stuck facing a hip and halfway down the pelvis at 0 station (Transverse Arrest. In this case, follow up with the lunge 3x on each leg and repeat each leg another 3x before trying another technique).
When can the Sidelying Release be used?
- Before labor
- During labor contractions, staying in position between 3 on each side,
- When baby is above the brim
- When baby is down into the midpelvis, near 0 station at the ischial spines of the pelvis. Sidelying Release is dramatic when baby is already engaged and on the pelvic floor.
- Before Forward-leaning Inversion, which is specific for a non-progressing labor at 9-10 cm dilation.
If baby is high in the pelvis or above the pelvis, a Sidelying Release may still help. But more specific to a non-engaged baby is the Abdominal Lift and Tuck through ten contractions, but not in between.
If Abdominal Lift and Tuck doesn’t work, or if a heavy epidural is in use, do brim-opening Walcher’s position through, and between, three contractions. These allow the baby into the pelvic brim when the baby is -3 or higher (-2 is worth a try with Walcher’s) and contractions are not able to bring the baby into the pelvis (engage the baby).
If baby is already (well) engaged, Sidelying Release will likely help when baby is at or near “0” station.
What should one be feeling when doing the Sidelying (or Pelvic Floor) Release?
Some feel a subtle stretch of some muscles, others feel nothing. Pain means either too hard a surface or some part of the person is not lined up properly. Adjust position. This technique stretches any of several muscles or muscle groups:
- The pelvic floor
- The piriformis and other Deep 6
- Iliotibial Band
- Round ligament (may even hurt during SLR in rare cases, and when it does, I suggest Webster’s Maneuver with a Chiropractor before repeating this technique or using a gentle pregnancy belt while doing Sidelying Release. Let me know if those help.)
Not all women feel something stretch, but most people feel more relaxed afterward.
Where does one get a Sidelying Release?
A myofascial therapist can help guide you through a Sidelying Release if you do wish for professional help.
With a little trial and error, you can probably figure out how to do one by yourself and with a friend. At home or in the hospital, more and more nurses and midwives are trying — and loving — this technique! See it with instructions on Spinning Babies; Parent Class.
A woman can do this alone, but a helper is very useful.
Doing the Sidelying Release by yourself without a helper:
If done alone, she braces herself with her arm, holding a heavy table, for instance. She has to consciously keep her hips stacked one above the other.
- Lay on your side close to the edge of the couch. Have a coffee table in front of you.
- Lay your head on your lower arm. Hold the table with your other hand.
- Make sure your hip is right on the edge of the couch! Right on the edge so that you feel that tipping forward would make you fall off. Don’t tip forward!
- Straighten your lower leg. Keep your top shoulder over your lower shoulder as best you can while you hold the table (move the table first to make this easier). Keep your top hip over your other hip, this is important.
- Let your top leg hang forward into the air. Let the full weight of your top leg hang. Keep your lower leg straight. Breath deeply and slowly. Let your belly relax.
- Let your leg hang like this for 2 1/2 minutes in late pregnancy. Let your leg hang like this through 3 contractions if you are doing this in labor.
- Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.
You can also check out how to do a Diaphragmatic Release from an article in Midwifery Today. This is a complementary technique.
Gail’s first experience with the Pelvic Floor/Sidelying Release
I was taught the Side-lying Release by Carol Phillips, DC at a long birth. This first-time mother got to 4-5 cm on her 3rd day of on and off again labor. Carol arrived and showed me how to do this release. The mom went right into transition and her second stage was so smooth that the baby was crowning before anyone in the room realized she was even in the pushing stage! Her baby was in an anterior position and was not asynclitic. She simply had a really tight pelvic floor. Not everyone gets that great of pain relief from this technique, but it almost always enhances labor progress in a happy and noticeable way when done to help a stall (contractions without progress).
Dr. Carol Phillips has a video of her class learning to do the Sidelying Release on her youtube channel. Be sure to watch the entire thing as Dr. Carol corrects mistakes of the students who are doing it. Watch it here.
What is the Pelvic Floor?
Within the bony pelvis is a supportive “floor” of muscles and connective tissue.
Resting, the “floor” is lifted, supporting the womb and other abdominal organs. Two openings (holes) in the pelvic floor allow the anus in the back opening, and the urethra and vagina to fit through the front one (women only!). The baby presses through the pelvic floor during childbirth. These muscles turn baby if needed or if possible when needed.
The pelvic floor opening is a front-to-back opening through which the baby turns, like a button going through a buttonhole. Up-curved sides of the opening are strong and springy and direct the head to turn.
Hypothesis: Longer, more flexible, and balanced pelvic floor muscles open around the head with more ease than short, tight or twisted muscles.