Easing Labor Pain: The Complete Guide to a More Comfortable and Rewarding Birth exerpts from the book by Adrienne B. Lieberman

Walking through Labor
Given freedom of choice, few women in any part of the world lie down during labor. The supine (flat on the back) position reportedly originated in the French court of Louis XIV. A voyeur who relished watching his mistress giving birth, the king's quirky preferences soon dictated fashion for the country. The supine position found almost universal favor in United States hospitals from the 1940s on because a woman's lying flat enabled her obstetrician to perform interventions such as forceps delivery, anesthesia, and episiotomy more easily.

But lying down has no medical benefits for most mothers. In fact, it carries several proven risks. When you lie on your back for long periods of time, the weight of the uterus compresses the descending aorta and inferior vena cava, blood vessels that supply or drain the lower part of your body. This interference with your circulation reduces your blood pressure, compromising blood flow to your baby and causing his heart rate to drop. When you stay upright (or at least off your back), placental circulation improves and fetal heart rate abnormalities may be alleviated.

A host of medical studies have demonstrated conclusively that upright positions shorten and ease labor.

A host of medical studies have demonstrated conclusively that upright positions shorten and ease labor. One famous Latin American study comparing reclining to vertical positions showed that labors for women who stayed upright were 36 percent shorter for first-time mothers and 25 percent shorter for mothers who had previously given birth. A British study comparing mothers who walked during labor to mothers who stayed in bed demonstrated that walking not only shortened labor but also reduced pain and the need for medication.

How does walking help your labor along? For one thing, your contractions become stronger, more regular, and more frequent when you stand up. Gravity helps your baby make his way through your pelvis. Furthermore, the upright position improves both the angle of your baby's body to your spine and the application of his head to your cervix. Because your uterus naturally tilts forward in your abdomen during contractions, it meets the least resistance when you are standing, leaning slightly forward. Finally, even though contractions get stronger when you're upright, many women feel more comfortable, more in charge, and better able to relax in this position. A typical mother put it this way: "When I lay down, it slowed my labor down in the early stage. When I was in active labor, I found lying down much more painful than when I was walking."

To promote your labor, keep walking as long as you can. One couple took a scenic stroll along the lakefront near their home before checking into the hospital when the woman's contractions were three minutes apart. Another mother remembers "walking and walking and walking around the apartment. During a contraction I would just hold onto something for support--a chair or my husband. Because you'll probably need to rest while you're having contractions, learn to lean on your partner in a manner that won't make him sore the next day. Janet Balaskas, the author of Active Birth, suggests this as the best way for your partner to carry your weight properly: As you drape yourself around your partner, he should keep his shoulders down, bend his knees, and lean back slightly while tightening his buttocks. It's especially important for your partner not to bend forward with raised shoulders, because this will give him a backache.

Changing Positions during Labor
Most women can't spend their entire labor walking around. Especially in a long labor, you may need to alternate walking with resting. Brief periods of sitting, kneeling, or side-lying can help you rest by temporarily reducing the strength of your contractions. Simply changing positions regularly will probably help you to be comfortable longer than any one "best" position you could find. One study found that obstetrical patients assumed an average of 7.5 different positions in labor.

Joyce Roberts, Ph.D., Professor of Maternal-Child Nursing at the University of Illinois at Chicago, has spent years researching positions for labor and delivery. Roberts points out, "A woman's contractions are most efficient if she alternately sits and stands during labor." It's also necessary, she says, to adopt positions that are comfortable and appropriate for your particular labor.

For example, you may need to be in bed because of bleeding, fetal distress, or premature rupture of membranes with your baby's head in a high position. If you have received an epidural, you have to stay in bed. If you are instructed to lie on your back, make sure your head is elevated with pillows and that you have a pillow or rolled-up blanket under one hip to tilt your uterus off your backbone. According to Roberts, alternating every half hour between lying on your back and lying on your side can help prevent the adverse effects reclining has on your blood pressure, your baby's heart rate, and your labor's progress. Side-lying makes contractions less frequent than when you are standing, but they are also more efficient. Best of all, side-lying is good for your blood pressure. In fact, because it enhances circulation to your uterus, this position is often employed when a baby appears to be in distress.

As long as your labor is progressing normally, however, you may want to try any or all of the following positions in preference to lying flat, which tends to lengthen your labor and add to its risk and discomfort:

• STAND, leaning against your partner, a high counter, or a bed.
• KNEEL on all fours or with your arms and head against some pillows on an upraised bed. You could also try this on the floor, leaning on a cushion placed on the seat of a chair.
  
  
• HALF-KNEEL, HALF-SQUAT, with one knee up and one knee down, in bed or on the floor. This is easier than squatting, described below. If it feels good to you, rock back and forth toward your raised knee during the contractions. Change legs as needed.
• SIT UPRIGHT in bed or straddle a chair, leaning on a pillow on the back of the chair. A review of labor positions by the International Childbirth Education Association concluded that labor contractions were least efficient in sitting and supine positions. But sitting may still afford you a needed rest.
• SQUAT on the floor or on the bed. When you squat, your pelvic outlet opens to its widest diameter and your contractions will be strong and effective.

Before you go into labor, you should practice squatting to build up your endurance. With your feet one and a half to two feet apart and your heels flat on the floor, descend gradually, without bouncing, and hold the squat for 15 to 20 seconds. Work up to holding this position for a minute at a time. If you have trouble keeping your feet flat, widen your stance a bit, or try putting a rolled blanket under your heels, or wearing low heels, or sitting on a short stack of books. Rise up slowly and repeat several times. If you need help balancing, lean against your partner or grasp a chair or bed. It's not a problem if your knees "crack," but don't do this exercise if you feel pain in your knees or pubic joint.

During labor you can vary the squatting position by squatting on the floor, leaning on a chair or on the labor bed. Or ask your partner to sit down on the bed or chair; facing away from him, try dangling into a squat, resting your elbows on his knees.

You could also squat in bed, supported under your arms on one side by your partner and on the other by a nurse. Or try squatting on the side of the bed with your arms draped around your partner's neck. Your partner could even sit behind you in bed, toboggan-style, supporting you under the arms as you squat. You could sit-squat on the low footstool in the labor room. Put a pillow and sterile pad on it, and just sit down with your knees higher than your hips. Or perch on a short pile of books, a large cushion, or a beanbag chair.

One mother who moved around a lot during her labor remembers, "standing, holding on to the bureau, and literally dancing through the contractions. At times I would go from sitting to standing to all fours. My husband danced along next to me, wiping my face with a cloth, following me when I started walking, letting me hold on to him. During transition, I climbed on the bed and got onto all fours, then walked around again when the contraction was over."

You're probably wondering how you can do all this when standard hospital routines -- fetal monitoring and IVs, for example -- appear to command your complete immobility. It may not be easy.

You'll need to negotiate with your doctor well in advance of going into labor and come to a meeting of minds about the conduct of your birth. We've got a tool that makes planning your birth easy! Use our Birth Plan Maker to formulate a guide that will help your doctor, labor coach and everyone involved with your birth.

You'll need to negotiate with your doctor well in advance of going into labor and come to a meeting of minds about the conduct of your birth. Many physicians insist on continuous electronic fetal monitoring and IVs in high-risk labors. But women may be monitored by remote control or on an intermittent basis, preserving their ability to move around. If an IV is medically necessary, it can be attached to a mobile pole, if your doctor agrees (see chapter 17).

If you learn that your hospital's or doctor's custom is to confine all women to bed for the duration of labor, you may want to express your own wishes and come to a compromise. It may be a good idea to have any agreement you reach entered into your chart, especially if your doctor might not be at the hospital while you are in labor.

You could plan simply to arrive at the hospital at a point late enough in labor that you are willing to get into bed. Or you may decide to switch to a birthing environment that respects your need to be comfortably active during labor.

Back to Part One here.

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