Labor Positions

[Integrating Editor]

I don't know what the commenter's midwife actually said, but research clearly shows that the pelvis expands (in just about all directions) in upright positions, giving the baby more room. So while there are some legitimate reasons for laboring on your back, an expanded pelvis (or portion of the pelvis) is not one of them. Yes, lying down slows labor, so there is a slightly lower risk of tearing. But a slower labor has its own complication risks (like higher C-section rates, lowered fetal oxygen levels, and fetal heart rate irregularities, not to mention an exhausted mother), so it's not exactly a desirable goal unless there are signs of precipitous labor. Plus, other professionals have suggested that the smaller pelvic diameter created by a supine position actually increases tears. And I know way too much about this for a 19-year-old virgin who will very possibly never be in labor.

[Dragon Lady]

I have to admit, that comment is a little... jarring... to my natural birth instincts. My personal experience is that laying down is such a HORRIBLE idea. At least, my body hates it. They made me do it once with Dragon Baby, in order to get better readings on the fetal heart tones, and the second they were done my body flipped itself over to hands and knees, without any conscious effort on my part.

But personal experience aside, there are a *lot* of reasons not to birth laying on your back. One of which is that your sacrum angles up when laying on your back. So the baby has to go up and over that. Many women end up breaking, bruising, or displacing the sacrum during birth on their back. And then have tailbone pain for the rest of their life because they have no idea that the bone is actually displaced.

And other reasons. But I have too big of a headache to try to write them out now.

[Concorde]

Can I just say that all these labor-related questions lately on the Board are seriously terrifying me? All the talk about tearing, pushing, pain... I do not handle pain well at all and one of my major weaknesses is being one of those people who is freaked out by blood, pain and gore (I hate that blood freaks me out because I've always associated that type of reaction to weakness somehow and I hate that it makes me weaker). I have no idea how I'm going to be able to handle giving birth, especially if there are complications.

It doesn't help that my high school decided to scare us all into not having sex. We had to watch these gosh-awful movies in health class about labor and all the things that could go wrong. Like, pictures and video of tears and cutting and screaming women on the floor bleeding everywhere... I'm cringing trying to type this. It was awful.

But I figure it's normal to be scared? And billions of women have given birth before, so I can suck it up and do it to... I know my fear won't prevent me from having children, but it's still terrifying.

[pillowy]

Regarding the commenter's original questions, gravity does not help labor as much as coached pushing with the legs pulled back does. In this blog post (http://goo.gl/zTTC6L), an ob explains about the real contributions of gravity in labor:

We can go beyond the fact that the Lamaze recommendations are not evidenced based, and ask just what physics tells us about the relative contribution of gravity to childbirth. The uterus generates tremendous force with each contraction, and more force is applied with coached pushing, and by a woman holding her legs under the knees and pulling them back. The uterus supplies approximately 82 newtons (N) of force. Coached pushing...with legs adds 47 N and pulling the legs back adds 31 N of additional pushing force for a grand total of 160 N.

What would gravity add to the 82 N pushing force of the uterine contractions? For a 7 lb. baby, gravity would add 31 N. In other words, the benefit of gravity is far less than the benefit of coached pushing with legs pulled back. Not only is there no evidence that gravity has a beneficial effect on labor, there is no reason to think that the relatively small force of gravity would have much benefit.

From my personal experience with my two labors, lying down was where I wanted to be. I got the epidural 12 hours into my first labor (and loooved it), and so naturally was lying down for the rest of that labor. My second labor was very short (less than six hours total) and nearly painless compared to the first one (at least until the last 20 minutes, which were kind of like a biological volcano of pain), and I didn't even realize I was in labor until an hour before I had the baby. For both labors, walking didn't work during contractions - I'd walk, start a contraction, be painfully rooted to whatever spot I was in, finish the contraction, and keep walking. Moving offered no pain relief. At least in bed I could writhe comfortably. (Kind of joking. Kind of not.)

[Portia]

My Labor Positions is Workers of the World, UNITE!

[Whistler]

my favorite site for these types of questions is evidence based birth: http://evidencebasedbirth.com/what-is-t ... positions/

most of the articles are really good, although the one on IV fluids concluded that IVs weren't helpful when I felt like the evidence (that a woman throws up less with an IV) was a good argument for IV fluids.

[thatonemom]

Concorde, I think those labor videos are worse than actual labor. Unless you want to use the mirror, I don't think there's any position you can labor in and see what's going on. You just can't see past your stomach. And that never bothered me. Blood and guts and such freaks me out. Although my husband said there was hardly any blood involved at all. Babies are covered in goopy stuff when they come out, but it's not gory or anything. And they get cleaned up pretty quickly.

I'd trade a twice as long labor for a half as long pregnancy every time. Labor's really not so bad. At least, in my experience. I know other people have different experiences. But being pregnant just kind of sucks.
Otherwise I have no opinions on how people labor, other than that everyone should get competent medical advice & then do what works best for them.

[Dragon Lady]

Birth doesn't have to be "painful" (I speak from experience, and sans pain meds.) And being scared can make it worse. Yes, women have been giving birth for millions of years. But for the majority of those years, birth was considered miraculous, spiritual, and exciting. It wasn't until early Christian Europe that pronounced birth to be women's curse, thanks to Eve, that it became scary. Women were forbidden any help during labor; midwives were outlawed. Not even family could legally help a laboring woman. Wouldn't you be scared if you had to do it 100% alone?

Let's also talk about what's happening with your uterus during labor. The uterus is made up of three layers. The inside layer is muscle and its job is to hold the baby in. It stays contracted during pregnancy, specifically at the vaginal opening, in order to keep the baby safely inside the mother. The middle layer I'm not as familiar with, as it's not pertinent to this specific discussion, but I believe it holds blood vessels, etc. The outside layer is also muscle. Its job is to push the baby out. It stays relaxed during pregnancy, until it is triggered to go into labor. It acts as a reflex, and once it starts its mission to get the baby out, it takes a lot to stop it.

Now let's talk about fight or flight. When you are scared, your body goes into fight or flight. It sends adrenaline and extra blood to essential parts of the body, such as the arms, legs, heart, lungs, etc. and shuts off the function of non-essential organs in fighting or fleeing, such as... the uterus. It stops the inner muscle from opening. This was very helpful evolutionarily. Let's say you go into labor and suddenly a saber tooth tiger starts chasing you. Your body says, "Woah! She's scared, it's not safe for a baby here, KEEP THAT BABY IN THERE!" At that level of fear, the outer muscle would probably actually stop contracting and trying to push the baby out. But at lesser levels of fear, the reflex would keep it going.

So let's put it all together. You live in early-Christian Europe. You're pregnant. You go into labor. Alone. You know women who have died in labor. You have never helped at another person's labor. You have No Clue what is supposed to happen. Understandably, you're scared. Your body goes into fight or flight and starts to shut down non-essential organs. Your inner uterine muscle says, "Umm... clearly this isn't safe. I'm going to hold this baby tightly inside of me." Your outer muscle says, "Well, I'm gonna keep on going unless you present me with very strong evidence that I should stop." So you don't dilate. (The outer muscle works like kneading bread. It pushes down on the baby, and then pulls up from the vaginal opening stretching it, or rather, dilating and effacing the woman, so the baby can come out.) You end up with a really long labor (now would be labeled as Failure to Progress), and you get really tired and exhausted. You don't have the energy or the mental capacity to keep up with it. Maybe it makes you relax enough to finally let your body work together instead of fighting itself and the baby comes. Maybe you continue to fight it until the baby dies of fetal distress. Or you die of many various reasons. Which then breeds more fear for every woman who knows you.

There are histories written that can take you from that point to labor today and show why we do many of the things in hospitals. It's actually really fascinating. And horrifying. I have a love/hate relationship with early Christians. This is filed under the hate side.

BUT what about cultures, even today, that don't fall under that particular umbrella of history? What of women in Africa who are working in the field, go into labor, walk into the trees, come back out a few hours later with a baby? What of crazy women (like me) in America that claim you *can* have a "pain-free" labor? (Note: I say pain free, but I don't mean it'll be nice and relaxed like you're watching a movie, being fed grapes and fanned. It's still a lot of hard work. Dragon Baby's birth was painful. (I was also terrified of a c-section.) Niffler Baby's birth had no pain. But there was a lot of pressure. Intense pressure, there at the end. But not pain. I've been on both ends. I know the difference between pain and pressure now. A lot of it is simply mentality.)

The key is controlling your own stress and fear levels. Most labor methods, Lamaze, Hypnobirthing, Hypnobabies, etc., focus on teaching you how to relax, how to trust your body, how to let go of your conscious control to let your body work on natural instinct. Or in other words, how to avoid entering fight or flight. They teach you to let your body work with itself instead of fighting itself.

Concorde, you ask, "Is it normal to be scared?" And the answer is... it depends. Are you an average American? Is your only information coming from Hollywood and people with horrible birth experiences? Then yes, it's completely normal. But if you live outside of America or gather information from outside of fear mongering and drama-driven television, then no, not it's not normal.

My advice to you is to educate yourself. I'd highly recommend Ina May's Guide to Childbirth. It's fascinating and teaches you a lot about the female body and what it does during labor.

Now, let me be clear: I am not advocating only natural, out-of-hospital births. I'm advocating education. Education can change your perspective and lower your fear-levels, no matter where you give birth. No matter if you have an epidural or not. And even if you're planning on an epidural, most women have hours of labor before they even go to the hospital or have progressed enough for an epidural. Wouldn't it be nice to increase your body's efficiency and lessen your pain during that time?

[Dragon Lady]

Sorry. You've tapped into one of my biggest passions. I'll try to restrain myself.

[Portia]

In those chapters I read about hysterical and denial pregnancies, those who tend to be anxious and externalize their stress by nature have much more difficult and painful pregnancies and births. It makes a lot of sense, and confirms my viewpoint that my paralyzing fear would be a self-fulfilling prophecy. Pass the laudanum to the hysteric!

[Concorde]

Hah, I'm more just scared of stitches down below and shots... The actual pushing a baby out doesn't scare me too much, but the clean up does. I don't want people cutting into me for a C-section if I ever needed one.

Stitches are probably one of my worst fears. D:

[Portia]

What about the twenty-five years after? Pregnancy is NOTHING compared to how very much I don't want an infant.

[Dragon Lady]

In good news, they won't be infants for 25 years.

[Whistler]

What of women in Africa who are working in the field, go into labor, walk into the trees, come back out a few hours later with a baby?

I've read a lot about "primitive" labor practices and a lone labor is not the most common. Usually "primitive" women in labor have other people helping them through it, and in some traditional practices, labor is supposed to be painful, as in the Yucatan tradition (they also have a tradition of pushing too early). In some Native American practices, the woman is attended by her mother and aunts, and if something goes wrong a shaman would assist (and women didn't always live through it).

We can learn a lot from the labor and delivery practices of other cultures, but they don't always get everything right.

[Portia]

Yes, but if you don't bond with your infant, that doesn't seem promising. And I find babies to be so, so, so annoying and repulsive.

[Dragon Lady]

What of women in Africa who are working in the field, go into labor, walk into the trees, come back out a few hours later with a baby?

I've read a lot about "primitive" labor practices and a lone labor is not the most common. Usually "primitive" women in labor have other people helping them through it, and in some traditional practices, labor is supposed to be painful, as in the Yucatan tradition (they also have a tradition of pushing too early). In some Native American practices, the woman is attended by her mother and aunts, and if something goes wrong a shaman would assist (and women didn't always live through it).

We can learn a lot from the labor and delivery practices of other cultures, but they don't always get everything right.

True. Very true. My point, however, was not that all primitive cultures do it right, but rather that those kinds of labors *can* happen. Modern-day Americans just don't believe it, thanks to over-hyped media and fear mongering.

[thatonemom]

Ok, apparently I have more opinions than I thought. I'm sure you guys aren't using the word "right" in the sense of "this is the one, best, correct way to birthe a baby." But I feel like pointing out (for the sake of anyone else reading) that labor is an individual experience and there are a lot of good ways to get the job done.

I don't think it's necessarily wise to hold up the labor experiences of women in primitive cultures to modern American women's. There are differences in genetics, diet, lifestyle, etc. Just because some women's bodies work in certain ways doesn't mean that everyone else's "naturally" behave that way. It can create unrealistic expectations, especially for first time moms. Having your first baby is like running a marathon when you've never even run before.

So I'm all for educating yourself on some of the norms of labor. But also making sure you have a doctor/midwife/medical professional you trust, and a whole lot of flexibility with yourself and your baby. There is honestly no way to predict how any given person will labor until it happens.

[Dragon Lady]

Ok, apparently I have more opinions than I thought. I'm sure you guys aren't using the word "right" in the sense of "this is the one, best, correct way to birthe a baby." But I feel like pointing out (for the sake of anyone else reading) that labor is an individual experience and there are a lot of good ways to get the job done.

I don't think it's necessarily wise to hold up the labor experiences of women in primitive cultures to modern American women's. There are differences in genetics, diet, lifestyle, etc. Just because some women's bodies work in certain ways doesn't mean that everyone else's "naturally" behave that way. It can create unrealistic expectations, especially for first time moms. Having your first baby is like running a marathon when you've never even run before.

So I'm all for educating yourself on some of the norms of labor. But also making sure you have a doctor/midwife/medical professional you trust, and a whole lot of flexibility with yourself and your baby. There is honestly no way to predict how any given person will labor until it happens.

Agreed.

In my defense, I stuck myself right next to my example of primitive culture. I didn't realize that that point would be the part pulled out to analyze or I would have left it out. I was simply trying to point out that the fearful, screaming, yelling, painful, horrible, heart-wrenching view of labor that is so commonly portrayed and believed in our culture... is not the only way. (Also, it's not common. Most women who fear that have an epidural long before they get to that "crazy psycho woman" that Hollywood portrays.)

Also, I specifically pointed out that I have no problem with other options, such as hospital births with epidurals.

My points were a) fear contributes to painful births and b) every woman, no matter their birth choices, should be educated about what their body will do.

[Portia]

Considering how many of us deal with mental illness, can we not throw around words like "psycho" and "crazy"?

Someone who is outside the norm in emotional volatility ("crazy") is not necessarily experiencing psychosis. Someone who is experiencing psychosis ("psycho") will not necessarily be emotionally distraught. Neither term is particularly kind, and both are fairly minimizing of what are very unpleasant experiences.

This idea that there's a "right" way to react to something as salient as birthing a child, in my opinion, produces a repressive culture that can lead to bottled-up emotions are that can manifest themselves in unhealthy ways.

[Dragon Lady]

Considering how many of us deal with mental illness, can we not throw around words like "psycho" and "crazy"?

Someone who is outside the norm in emotional volatility ("crazy") is not necessarily experiencing psychosis. Someone who is experiencing psychosis ("psycho") will not necessarily be emotionally distraught. Neither term is particularly kind, and both are fairly minimizing of what are very unpleasant experiences.

This idea that there's a "right" way to react to something as salient as birthing a child, in my opinion, produces a repressive culture that can lead to bottled-up emotions are that can manifest themselves in unhealthy ways.

Fair point. I apologize.

But to be fair, I do think people think that people like me, who choose to home birth, are legitimately experiencing psychosis.

I'm also curious, in a conversation like this, what word would you use to get across the point I was trying to make?