Getting Upright in Labor: InJoy and Lamaze Push Vertical Pushing
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.