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Sunday
Jul122009

Getting Upright in Labor: InJoy and Lamaze Push Vertical Pushing

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Last week, Mothers Advocate, a service of InJoy Birth and Parenting Education made a collection of videos and print-friendly materials available to the public. The information is adapted from material developed by Lamaze International and covers six steps to a healthier birth. The three and a half minute video, Get Upright and Follow Urges to Push, shows footage of women laboring upright in a hospital setting.

Footage of upright birth in a hospital setting is typically not readily available to pregnant women, making it difficult to envision what it will be like to labor upright in hospital. Position changes are seldom encouraged and leaving the bed is even discouraged, as detailed in this doula’s account of a laboring client’s interactions with a man she calls “the classic old school doc” on the Better Birth blog:

The old doctor straightened up and adjusted his glasses. “No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn’t even want to know what. But they are catastrophic. Sometimes babies die. I’m just trying to keep your baby safe. And didn’t you understand, the best position for this baby to come out in is when you lay back? Do you understand?”

Fortunately for laboring women, that old school doc couldn’t be more wrong.

Rixa from Stand and Deliver posted Upright birth in hospitals in March 2008, in which she wrote about her observation that there seem to be two major factors important for giving birth upright in a hospital setting: a strong commitment by the staff to active, upright labor as well as first-hand experience facilitating it, especially for moms who are restricted by epidurals, IVs or continuous fetal montioring.

The Royal College of Midwives (UK) discusses upright labor on their Campaign for Normal Birth web site:

From a physiological point of view, lying on one’s back to give birth has many disadvantages and few advantages. This supine, ‘confined’ position, which has been common for the last two hundred years or so, came about for social and historical reasons which are no longer relevant. We continue to use it only from habit and familiarity.

Throughout the ages, and across human cultures, women have preferred to give birth with their bodies vertical. Historical manuscripts often show women giving birth in a standing or squatting position with their legs spread. There is now substantial evidence to suggest that these positions increase the outlet of the pelvis.

Their claims of disadvantages to supine birth are confirmed by the 2009 Cochrane evidence review, Mothers’ position during the first stage of labour, which looked at 21 studies and examined 3,706 births. By avoiding lying in bed during early labor, women can shorten the first stage of labor by about an hour. Additionally, women who avoided the bed during the early stages were also 17 percent less likely to have an epidural.

In this first screenshot from the Get Upright and Follow Urges to Push video, a woman strains while a man, either her doctor or partner, coaches her to push as hard as possible while he counts to ten.

 

The following screenshots show two women laboring upright; one leaning over the top of the bed and the other using a squatting bar. 

 

 

Click here to watch Get Upright and Follow Urges to Push.

The videos and materials are intended to be shared with as many people as possible, according to the web site. The logo is also available in many sizes to use for online promotion.

 

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Reader Comments (5)

Your post on "Pit to Distress" made me cry. But these videos have me cheering!!! What a succinct and well-done series. It should be "required" viewing for all pregnant women!

July 12, 2009 | Unregistered CommenterJennifer DeVries

I know. Finally something uplifting here, huh?

I wish there had been something like this before my first pregnancy. I think these are outstanding.

July 12, 2009 | Registered CommenterJill

What a great, easily accessible resource! I'm passing it along immediately. Thank you for sharing this!

July 13, 2009 | Unregistered CommenterDou-la-la

My wife labored upright for her last two labors, and delivered the last one standing up. I don't think that baby (at 11+ pounds) would've come out otherwise...it would've been an emergency section if she had been put on her back. As it was she came out with no tearing. She's getting her birth story together to put on my blog.

Come to think of it, my second child came out with an arm up, which slowed labor down immensely. That probably would've been a section, too, and after an even longer labor, if not for being able to labor upright.

When I was a student in the hospital, they showed us squatting bars but said it's usually too difficult and inconvenient to use it. They'd probably be surprised at the head of the bed thing. I'm glad to see these videos, because women don't know they exist and they probably aren't offered by hospital staff too often. I tend to think squatting is conducive to tearing, so I almost worry that an increase in squatting would lead to an increase in tearing, but tearing rates are already so bad in hospitals it would probably actually go down.

One of my nursing school instructors stated that the only labor position worse than supine was standing on one's head, but then said most of us would never see anything else.

July 15, 2009 | Unregistered Commenterman-nurse

I'm anxiously awaiting your wife's story! I also had an 11 lb., 5 oz. baby standing. I squatted and the midwife finally had me stand and put one leg up on the side of the tub and it was instant... it felt as if she spun right out. I really wish more women knew they could move around.

July 15, 2009 | Registered CommenterJill
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