Saturday, August 01, 2009

The Evidence Says: Upright Positions Enhance Labor!

Women in industrialized countries are lead to believe that laboring is such difficult work that they should stay in bed and rest. Also, since their center of gravity is off and certain contraction may take them off guard, the chance of falling is present. Staying in or near the labor bed also makes coping with an IV and electronic fetal monitoring (EFM) easier. With regards to the EFM, tracings from the monitor are of better quality when the laboring woman is not only in the bed, but also somewhat still. Finally, vaginal exams are easier for the careprovider to perform and the vaginal more visible when the laboring woman is laying on her back.

However, a Cochrane Database Review (April 15, 2009) studied the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labor on length of labor, type of delivery and other important outcomes for mothers and babies. The review includes 21 studies with a total of 3706 women.

There is now evidence that walking and upright positions in the first stage of labor reduce the length of labor and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labor.

Labor is a physical and emotional event for the laboring woman. For the infant, however, there are many positional changes that assist the baby in the passage through the birth canal. Because of the resistance met by the baby, positional changes are specific, deliberate and precise as they allow the smallest diameter of the baby to pass through a corresponding diameter of the woman's pelvic structure. Neither care providers nor the laboring woman is directly responsible for these position changes. The baby is the one responsible for these position changes ~ the cardinal movements.

Changing upright positions every 20-30 minutes not only assists the baby in completing the cardinal movements, but also gives the mother a mission ~ something other to focus on besides the discomfort from the regularly occurring contractions. Changing positions can be coupled with using the restroom to empty the bladder. A full bladder has been known to partially or completely block the birth canal ~ adding to pain and pressure, impeding the birth and lengthening labor.

Upright positions or gravity positive positions are best for laboring women and their babies! Upright positions assist with the cardinal movements and, thus, can decrease the length of labor and the amount of discomfort the mother feels. These positions can also hasten the cervical dilating and effacing by keeping pressure on the cervix, much like pressing down on modeling clay. This also has a decreasing effect on the length of labor!

Positions for labor include walking, standing, sitting, rocking, leaning forward, slow dancing, lunging, sitting on a birth ball, being on all fours, and sitting the toilet. Alternating position changes with rest is an optimal way to facilitate labor and have positive outcomes!

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