Make Sure Movement is Part of Your Labor

When you picture your upcoming birth, what do you see? Specifically, how do you see yourself moving through contractions? The key word here being moving. 

Research shows, time and again, that moving around freely in labor provides pain relief, decreases the need for pain medication, may make labor/birth easier/faster, and improves your sense of control in labor as well as overall satisfaction with your birth experience.

And yet, we continue to see -- and be -- people lying still in a bed during labor and birth. Why the disconnect? Often it's due to hospitals' routine procedures that make it difficult to move and/or the lack of support needed to move around. It's also a cultural phenomenon -- the desire for a pain-free birth combined with a widespread lack of continuous, knowledgeable support throughout labor and birth (like that from a doula).

Many people who have labored mostly still and lying down say they want to be more upright and incorporate movement next time. Informed with the best evidence and support, you can make sure your first birth (and beyond) includes active movement. The best way to learn how to do this is by taking a quality childbirth education class. The following tips will help you get started.  

Tips to Make Movement a Core Part of Your Labor & Birth

1. Choose a care provider and your place of birth that supports and encourages moving around and changing positions in labor. Find a care provider who will support you in finding the positions that work best for you. When choosing a birth setting, look for birth balls, rocking chairs, squatting bars, and tubs -- a variety of options that support active labor and birth.
2. No matter where you give birth, stay at home as long as possible (home is where you'll have the most freedom and comfort to move around!). Ideally, you stay home until you are in active labor or 6cm dilation. If you're not yet considered in active labor when you arrive at your birth setting, you may consider going back home or another place nearby. Take a walk or find a way to stay active to encourage dilation. Listen to your body and rest when needed.
3. Once checked into your place of birth, you may decline unnecessary interventions that make it harder to maintain freedom of movement. Things like continuous monitoring of the baby's heart rate (continuous EFM) and intravenous lines (IVs) are interventions that make movement difficult and when used without true medical reason, can bring more risks than benefits. If you do end up needing an intervention that restricts movement, enlist the help of your partner/support team, doula, labor nurse to stay as mobile as possible. 
4. Arrange to have continuous support during labor from a doula (professional labor assistant) or a close friend or family member who learns about healthy labor and birth, and who makes you feel safe and confident. Your support person can remind and help you to try different positions or movements in labor.
5. Consider the impact of pain medications on your ability to freely move during labor. All pain medications make it hard to stand or walk in labor. An epidural makes standing almost impossible. You may have heard about a "walking epidural," but this usually just allows you the ability to move your legs in bed. Additionally, pain medications often lead to the need for other interventions, such as IVs and continuous electronic fetal monitoring, which also restrict movement. One of the ways to reduce your need for pain medication is to choose to birth at a place that provides easy access to a tub. Laboring in water provides great pain relief. If you choose an epidural in labor as a pain coping technique, wait until labor has progressed beyond 6cm and you have already used lots of movement to help the baby rotate and move down in the pelvis. Encourage your support team to learn about ways to support a person with an epidural.
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/support person feel comfortable and confident.

How can you know if your chosen place of birth encourages movement during labor? Here's a handy checklist: 

• Safe/ample places to walk
• Offers, allows, and encourages the use of tub 
• Offers birth balls
• Has rocking chairs
• Option of a squat bar for pushing 
• Use of telemetry (portable device used for fetal heart monitoring)
• Maintains a policy for intermittent auscultation (intermittent heart rate monitoring)
• Upholds policy for respecting a laboring person's choices in labor, including the use of a doula 

For more information on the importance of maintaining movement during labor, check out the Lamaze Healthy Birth Practice video all about walking, moving, and changing positions during labor.