Last month, Lamaze published a press release entitled, Why Choosing 'Free Range' Labor May Make Birth Easier. As we continue re-visiting the Six Healthy Birth Practices on Science and Sensibility, today I invite you to think about Healthy Birth Practice #2: Walk, move around and change positions throughout labor. To read the research behind this recommendation, follow the above link, and check out the list of references at the bottom of the page: the written evidence is abundant, and speaks for itself.Today, however, I'd like to offer a different sort of evidence: the words of a woman who has recently undergone two different birthing experiences.

One year ago, my best friend and Physician Assistant colleague Liz, gave birth to her second child. Less than two years prior, she and her husband welcomed their first child into the world. Liz's birth experiences occurred in two different states with two different providers. Her first pregnancy and birth were anything but normal - as she explains in her reference to a 'highly medically managed' pregnancy, which continued into birth. Her second birth was quite different and yet, she created the opportunity for herself to employ 'free range labor' during both labor and birth experiences.

During both of Liz's pregnancies, I was honored to help this couple prepare for the births of their children through knowledge sharing, informal childbirth ed. discussions during a visit to them leading up to their first birth experience and telephone labor support during Liz's second labor. (I will never forget secreting away into the quiet guestroom of our house during the late-night hours while the rest of my family slept, verbally supporting Liz via telephone, as she worked through the transitional contractions that hit during their drive to the hospital.)

Liz graciously accepted my request to an interview in which she and I discussed and compared her two birth experiences, with a focus on the topic of movement during labor. Here are her insights:

Kimmelin:
Can you describe the differences between your two labor and birth experiences?

Liz:
In many ways the two labor experiences were the same and in many ways different. With both pregnancies, I carried the babies until 39 weeks gestation. With both, I labored down from 4 cm-8 cm in one hour. With both I remained active and moving - until 8 cm with the first, and until birth with the second. With both, I had my husband present for support. With both, the physician did not arrive in time for the birth of my child.

With the first, I had a highly 'medically' managed pregnancy, and I believe that alone contributed to my fear of having a natural childbirth. I had an IV, monitor, and my water was broken by nursing staff at 4 cm. I was not, however, in active labor pain. As above, I labored quickly, but found it difficult to maneuver in a hospital room with IV attached. I opted for an epidural at 8cm.

The second delivery was easier as I was home when labor started and was able to move through my own familiar surroundings, my own clothes, my own bed, etc. When I did arrive at the hospital I was fully dilated. I found recovery to be enormously easier with the second delivery.

Kimmelin:
What factors do you think influenced the difference in your two babies' births?

Liz:
For the first birth, the biggest factor which made labor difficult for me was being hooked to an IV. I am GBS positive, and was admitted to the hospital at 4 cm dilated without painful contractions, to have IV antibiotic prophylaxis and have my water broken (basically augmenting labor!). When I finally went into labor I found it difficult to move with IV and monitor attached.

For the second birth, I went into labor on my own; no induction or augmentation. The biggest factor which made labor easier for me was the ability to move within my home and surroundings before going to the hospital.

I will add for both deliveries I was fortunate to have tremendous support from nursing staff to help facilitate my need to move during labor.

Last but not least, my husband and I were better prepared emotionally in meditation, reading, and undying support from a dear friend who is a childbirth educator to have a NATURAL delivery the second time around. Even though I had this same support during my first pregnancy, EXPERIENCE of already having a vaginal delivery helped to ease the fear the second time.

Kimmelin:
Considering the speed and intensity of your second baby's birth, what labor-coping techniques helped you through your labor? Why do you feel these things helped?

Liz: MOVING! Hindsight reminds me my contractions were erratic with intensity and timing, so I had no idea when the next would start or end. Unfortunately, I didn't have the chance to 'think' about which strategy I would use for the next contraction. However, my body naturally WANTED to move through each contraction: I found myself getting on all fours; I had my husband push very hard on my sacrum as I bent forward on the counter; [I benefited from] receiving a giant bear hug from anyone willing while I stood; all of these techniques just came naturally to me to find comfort, as my body just KNEW what to do.

Kimmelin:
Within Lamaze's Six Healthy Care Practices comes the advice to 'walk, move around and change positions throughout labor.' Did you find yourself doing these things during one or both of your labors and, if so, what was your experience with movement during labor?

Liz:
During both labor experiences, I did feel that changing positions not only helped my body physically, but mentally challenged me to focus on what position I would try during the next contraction. As the pain grew stronger, my body took over and I found myself naturally moving into the most comfortable position for that contraction without thinking about it.

Kimmelin:
Looking back on the births of your children, do you feel your physical behavior during labor and birth influenced your emotional experience? If so, in what way(s)?

Liz:
Yes, I was able to move more during my second labor and birth and I feel as though this reduced my stress and anxiety level, as opposed to the first labor and delivery where I wasn't able to move as much. Looking back I now realize having to lay still, hooked to IV and monitor, had caused more anxiety for me and my husband.

Kimmelin:
What thoughts and/or advice (if any) would you offer health care providers and/or the partners of laboring women in terms of providing assistance for walking/moving/changing positions in labor?

Liz:
To anyone in the presence of a laboring woman, they need to know that ANY position she can get comfortable in is acceptable. (I still remember the look of shock on my sister's face when I was on all fours on the hospital bed). This goes for health care providers as well. If the laboring woman cannot lay supine during a contraction for the monitor to be strapped on, please TRUST in her body the baby is OK for those few minutes and wait for the contraction to pass.

Specifically to health care providers - respect the wishes of the mother's/partner's birth plan and do everything in your power to facilitate a safe and comfortable environment for the laboring woman. Petition for a birthing bar, balance balls, bath tubs in your maternity ward and practice medicine going 'back to the basics' of allowing free movement during labor. After all, having a baby is the most powerful and natural act the human body can endure. Pain serves a purpose and doesn't always need to be treated.

Elizabeth Posoli-Futch is a Physician Assistant practicing urgent care medicine at a community hospital in the Northern suburbs of Philadelphia. My deepest thanks go out to Liz and her family for sharing these insights surrounding the births of their beautiful daughters. Happy first birthday, baby M!

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