Research shows that moving freely in labor improves a woman’s sense of control, decreases her need for pain medication, and may reduce the length of her labor. Sometimes it is hard to move in labor due to routine procedures or lack of support and space. A recent US study found that 71 percent of laboring women did not walk at all during active labor. Instead, women often labor in bed propped up with pillows. Women who have labored this way say next time they want to be more upright. This list
provides evidence-based tips for women who want to stay free to move in labor.

1. Choose a care provider and your birth place carefully to make sure you will be encouraged and supported to move and change positions. Find a care provider who will support you in choosing the positions that work best for you. When choosing a birth setting, look for birth balls, rocking chairs, squatting bars, and tubs.
2. No matter where you give birth, stay home until you are in active labor, when contractions are five minutes apart and last about one minute. If your cervix is not dilated more than 4 centimeters
   when you arrive at your birth setting, consider going home or for a walk until your cervix
   dilates more. It’s often easier to move and respond to your labor at home. You can rock, slow
   dance, walk, or sit on your birth ball. Listen to your body and rest when needed.
3. Once at the birth setting, request that your care provider not use any routine intervention that may make it harder to move around. This will mean that continuous monitoring of the baby’s heart rate (“continuous EFM”) and intravenous lines (IV’s), are only used when needed for medical reasons. If there is a medical reason for these, tell your care provider that you want to maintain as much freedom of movement as possible. There may be ways to minimize the effect of these interventions on your ability to move freely.
4. Arrange to have continuous support in labor from a professional labor assistant (a doula) or a close friend or family member who makes you feel safe and confi dent. Ask them to remind you to try different positions or activities in labor.
5. Plan to give birth without pain medications. All pain medications make it hard to stand or walk in labor. It is usually impossible when an epidural is used. You may hear about a “walking epidural” but this usually just allows you to move your legs in bed or walk short distances. Pain medications often lead to the need for other interventions, such as IVs and continuous electronic
   fetal monitoring, which restrict movement. Choose to birth at a place that provides easy access to a tub. Using water in labor decreases the need for pain medication. If you want an epidural in labor as a pain coping technique, wait until labor has progressed and you have already used lots of movement to help the baby rotate and move down in the pelvis.
6. Attend a childbirth class that focuses on active labor, giving you and your partner plenty of movement and position options. Keep a list of the positions that you like best and bring it with you as a reminder in labor. Practice positions and movements before your labor begins, so you and your partner feel comfortable and confi dent using them.

Quick checklist for place of birth

• Safe place to walk
• CD player for dancing music
• A tub
• Birth ball
• Rocking chair
• Squatting bar
• Telemetry
• Policy for intermittent auscultation
• Policy for respecting women’s choices for labor support

References:

Introductory paragraph
Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. (2002). Listening to mothers: report of the first national U.S. survey of women’s childbearing experiences. New York: Maternity Center Association.

Tip #2
Jackson, D. J., Lang, J. M., Ecker, J., Swartz, W. H., & Heeren, T. (2003). Impact of collaborative management and early admission in labor on method of delivery. JOGNN Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(2), 147-157.

Tip #3
Thacker, S. B., Stroup, D., & Chang, M. (2004). Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database of Systematic Reviews.

Enkin, M., Keirse, M. J., Renfrew, M., & Neilson, J. (2000). A guide to effective care in pregnancy and childbirth (3rd ed.). Oxford: Oxford University Press.

Tip #4
Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2003). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews.

Tip #5
Mayberry, L. J., Clemmens, D., & De, A. (2002). Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. American Journal of Obstetrics & Gynecology, 186(5 Suppl.).

Cluett, E. R., Nikodem, V. C., McCandlish, R. E., Burns, E. E., Lewis, L., Webster, J., et al. (2004). Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews.