"Childbirth, as most midwives will be quick to tell you, is not something you can do lying down - yet this is exactly how many women give birth. Moving about during labour is as ancient as birth itself. It's only in the last couple of hundred years that women have been giving birth lying on their backs.
The first record of a woman lying down to gve birth was in the 17th century, when the mistress of the French King, Louis XIV, lay down so he could watch the birth from behind a curtain. Then came the invention of the forceps in the middle of the 17th century, and before long, giving birth in bed (rather than upright in the traditional birth chair) became the norm. Today, we are trying to reverse this trend.
An uphill battle:
Your position during labour and birth can make a dramatic difference to the way you cope, the pain relief you need, how easily you give birth, and whether or not you will tear. Changing positions and keeping off your back helps maintain a good oxygen supply to the baby, as well as altering the shape and size of the pelvis, which helps the baby move through the birth canal. In an upright or forward-leaning position, the angles and internal dimensions of the pelvis change dramatically, helping the baby manoeuvre its way down the birth canal.
When you lie or sit on your bottom, your sacrum (lower back) is pressed up towards the baby's head. This causes pain when the baby moves past the sacrum. Worse, it narrows the outlet of the pelvis. Even if the head gets through, the reduced diameter can make the baby's shoulders harder to delivery. This is known as shoulder dystocia and is a serious obstetric emergency.
The other disadvantage of giving birth lying on your back is that you are essentially putting the baby 'uphill'. Your perineum is more likely to tear, particularly when stirrups are used, and many women find it harder to deal with their contractions because they are unable to rock their hips, use warm water or massage for pain relief.
Dealing with early labour:
In early labour you may feel restless and want to move around. Walking is the most common thing women do during labour. Keeping active helps make the birth faster and less painful, but try not to overtire yourself before labour gets underway.
If labour starts in the night, especially if it's your first baby, try to lie down (on your side) and get some rest. Encourage your partner to sleep - you will need him to support you later. If you are too uncomfortable to lie down, try having a shower or a bath.
Leaning over the back of a chair, or the kitchen bench, and rocking your hips back and forth can be quite comforting, in fact, some women spend their entire labour doing this. If your legs start to feel tired, get onto your hands and knees or kneel over a beanbag or exercise ball. Whatever position you choose, it's a good idea to alter it every so often so taht, for example, your knees don't nd up too sore from being in a hands-and-knees position. As the labour progresses you will probably tend to want to move less.
Making a stand:
Standing or leaning forward is a popular position, especially if you use your partner for support. Advantages include:
Support plus the benefit of gravity
Contractions are easier and more efficient helping to shorten labour
Standing of leaning forward lets your ock to help with contractions, and eases backache
It also allows easy access for massage
Some women put their arms around their partner's neck and have them rub their back. Swaying to music can also help,. You can also try putting one foot on a seat and bending your knee during contractions to widen one side of your pelvis. This can help the baby move into a better position. Standing can make the second stage faster, so it's best to breathe, not push, to minimise tearing.
Hands and knees position
Many women find the all-fours position or kneeling forward onto a chair or bed comfortable, especially if their legs are tired from standing. Leaning over relieves back pain, as it takes the weight of the baby's head and away from the spine (ideal if your baby is in a posterior position(. You can also rock your hips, which helps the baby manouevre through the birth canal. Massages and hot packs are easier to use, and it is kinder to your perineum as it stops the baby's head from pushing so deeply into it. This position also helps direct the baby put of the vagina.
Sitting pretty:
Sitting astirde a chair, toilet seat, exercise ball or birth stool helps to open the pelvis and maximise the effect of gravity, and allows you to rest your legs. If you put a pillow over the pack ofthe chair you can protect your belly and have something soft to rest on. Women often gravitate to the toilet seat in second stage. It helps the,m open up the pelvis and relax the pelvic floor without fearing an 'accident'.
Squatting down:
Squatting allows the pelvis to open to its maximum and you benefit from the effect of gravity. If progress is slow, this position can help move the baby down the birth canal. Some women find it tiring though, so it's worthwhile practising beforehand nd getting your partner to support you. A birthing stool can help if your too tired to squat on your own.
A bit on the side:
Side ling allows you to rest between contractions. It's a great position if you have an epidural limiting your mobility, or if you want to slow down a rapid birth. It keeps the pressure of your back, and allows your pelvis to open and seems to make the uterus contract ore efficiently. I encourage women wh have had a perineal tear to use this position"