Pushing Positions

Lamaze International has identified six practices that assist a woman to have a healthy birth. I have already commented on the first four.  Here is the fifth practice:  Avoid giving birth on your back, and follow your body’s urge to push.

I have had the privilege of seeing this practice flow naturally during home birth. Women were free to change positions and were able to respond instinctively to their labor.  From active labor through pushing, some women were in tune with what worked best for labor progress.  Others needed guidance and suggestions from the doula, nurse, midwife or doctor.

I remember a couple of women that preferred to remain upright (standing, walking, swaying their hips) throughout most of their labor. They paused to lean against a counter, rested on a birthing ball and kneeled by the bed.  When they had a strong urge to push they assumed a supported sitting position.  Both women delivered large babies (11# and 10# 4oz.) with minimal trauma to their tissue. The mom giving birth to the 11# baby pushed for 6 minutes!

Several women chose to give birth in a hands/knees position.  This position relieved the pressure on their lower back and allowed the baby’s head to shift a little as it aligned for birth.  My first impression was that this position made the birth attendant work a little harder; she had to maneuver to support the crowning baby.

Through my experiences with home birth I became more aware of the physics of birth.  Babies rotate and adjust their alignment as they move down the birth canal–the mom’s pelvic movement and position change assist this process. When women were supported and given freedom of movement, they were more likely to respond instinctively to their labor.  I saw the benefits of a variety of pushing positions: sitting (curled around the uterus), kneeling, hands/knees, squatting and side-lying.  Each labor pattern and birth was unique and unfolded with its own revelation.

Lessons learned in home birth can apply to the hospital but require focused effort.  When a woman’s labor is induced or when she has an epidural the instinctive behavior is lost–medication interferes with her self-knowledge.  The laboring woman will need to request position changes and refuse to labor on her back. The nurse will need to carefully observe labor, assist position changes, and manage the monitors, intravenous lines and pumps.  When it comes time to push it is important to wait for the urge to push–or labor down with the epidural.  The nurse will need to assist an upright or side-lying position.

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