This month's Brilliant Activities for Birth Educators post is all about positions that a laboring person can use during the first stage (labor) part of birth. Lamaze Healthy Birth Practice 2- Walk, Move and Change Positions during Labor demonstrates that movement is particularly helpful to promote a well-positioned baby and labor progress. During a childbirth class, it is helpful to demo and encourage families to practice lots of different positions, because no one really knows which one will be a favorite when things get rolling.  Today, regular contributor Mindy Cockeram shares an activity you can use in your classes to engage families in discovering what positions they might like to try in labor.  Find all the Brilliant Activities for Birth Educators posts in the series here. - Sharon Muza, Community Manager, Science & Sensibility.

Introduction

One of the first things I point out in childbirth class is that if you don’t know your options, you don’t have any. Therefore, if you don’t know any helpful labor positions, you probably won’t be in one during labor.  Being in a good upright, forward and open (UFO) labor position knocks an average of 82 minutes off the first stage (Lawrence  A, Lewis  L, Hofmeyr  GJ, Styles  C., 2013)  AND makes approximately 28% more room in the pelvis.  When families hear the double whammy of benefits, they are usually keen to try out the positions.  In class two (of five), we concentrate on stage one labor positions for use at home, in the parking lot, waiting for a table at a restaurant, in the hospital or wherever one finds themselves in labor.

As I have been teaching, I have given various positions memorable names like The Proposal, the Fifth Grade Slow Dance, the Dyson Ball, and the Dilation Station.  Many families will write me a birth story referencing how they ‘dangled’, ‘wagged the tail’ or ‘rocked on Bertha’ which makes me realize that the names are memorable.  I want families to prepare for labor by imagining and planning where in their home they could labor comfortably ahead of time. 

How I use UFO positions in class

Over the years, my class size has been growing and for the first time ever, I recently had13 pregnant people and their support people.  I knew I didn't want the size of the class to limit my ability to do hands-on learning activities, so I created thirteen labor positions on thirteen pieces of paper and set them up around the room planning carefully so that they are in order of likely use during labor progress.  I use two birth balls, five chairs (one without arms), a kitchen counter (a luxury in my classroom!) and a bit of wall space. 

I assign a number verbally (1-13) to each family and then ask them to “find their station.”  I let them try it for about 30 seconds and then yell ‘rotate’ up to the next station. Everyone rotates to the next station and the last family moves to the first station.  I always provide a caveat that if a pregnant person has any kind of bodily complications (like knee weakness for example), feels uncomfortable or just doesn’t want to try that position, that’s OK with me.  When possible, I ask the partners to also try out the position so they can understand how to help and also put the pregnant person at ease when practicing in a less than flattering position.

Creating Your Own Stations

It is really simple to make the stations you need and want to use.  I have used illustrations for many of the positions from an old PDF from the Royal College of Midwives ‘Campaign For Normal Birth’.  The document encouraged sharing of the positions.  You may have your own favorite resources for images.  Just remember to follow the copyright guidelines for the images you choose. 

 Here are my 13 suggested stations:

1. Kitchen Counter Position – leaning forward with elbows on the counter while gently swaying hips.
2. Backward against partner against the wall – resting the back of the laboring person's head on the support person's chest or shoulder.
3. ‘Under Arrest’ – with arms at ear level and leaning against wall gently swaying hips.
4. Kneeling against the bed – both knees on floor; basically a ‘kneeling kitchen counter’.
5. The Dangle – aka deep supported squat
6. 'Fifth Grade' Slow Dance (fig 1 above)
7. ‘Dyson Ball’ – while kneeling, put your head and arms on the birth ball and gently roll like a Dyson vacuum ball.
8. Side Lunge – aka the ‘Captain Morgan’ (pirate positions on a bottle of rum) either standing with one foot on a chair or kneeling with one foot out to the side.
9. Dining Room Chair – sit backward on the chair with a pillow between the bump and the back of the chair (figure 2 below).
10. ‘The Proposal’ – Seated on a birth ball, the partner is on one knee in front of the laboring person embracing them. 
11. ‘Dilation Station’ – sitting on the toilet (and possibly using a ‘squatty potty’).
12. ‘Wag The Tail’ – on hands and knees gently rocking their bottom side to side.
13. The Abdominal Lift – to help turn an OP baby.  I usually talk them through this one since it is used only with back labor.

Figure 2- Dining Room Chair

Modifications

This activity is easy to adapt to your own teaching space and class size – just change numbers on the stations to personalize to your environment and reduce the stations if you don’t have a birth ball or countertop.  Having said that, it is often pretty simple to use a chair and pretend (with a good visual on the paper) it’s a kitchen countertop or the side of a bed.  A few weeks ago, I was unable to use my normal room and decided to try passing the stations around instead.  It was a real disaster because the props also had to be rotated and people didn’t pass the stations around in any order!  You can also do the activity on a smaller scale where you demonstrate the position and then ask everyone to do the same in their confined space but unless you have enough armless chairs and balls, you will need to skip or improvise some of the stations. 

I am always sensitive to the pregnant person who is without a partner or with a partner that they would not feel comfortable slow dancing with or dangling from.  I walk around the room helping out or giving positive feedback.  For homework, I ask them to have a look around their home and, based on the positions they liked the most in class, start trying out the different places they may labor and use those positions. 

After some research I did on deep squats, Not All Squats Are Created Equal for Science & Sensibility, I do suggest that people who have hemorrhoids, vasa previa, placenta previa, a breech lie or have experienced lightening (when the baby descends into the upper pelvis normally around the 34-38 week mark in primips) should avoid the dangle.

Conclusion

The class seems to love this activity and I hope you do too. It also helps when you do not have a lot of supplies (ie, birth balls or armless chairs, since you can rotate families through those stations one at a time.  It gets families up and out of their seats, developing muscle memory for the positions they might want to try in labor.  Seeing an image of the position helps them understand how they should practice.  Active learning is always best and builds confidence for when labor does start.  Let me know if you have any questions or feedback on its use in your classes. Do you already try something similar?  What position for the first stage can I add to my repertoire? What am I missing?

References

Lawrence  A, Lewis  L, Hofmeyr  GJ, Styles  C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub3.

About Mindy Cockeram

Mindy Cockeram initially certified with Lamaze in 2011 and works with a large hospital chain in Southern California where she’s been teaching for seven years.  She trained initially through the UK’s National Childbirth Trust in Wimbledon, England in 2006 after winding down a career in the financial markets.  She graduated from Villanova University in 1986 with a bachelor’s degree in Communications and a minor in Business Studies.  She is the author of Cut Your Labor in Half: 19 Secrets to a Faster and Easier Labor and is currently working on a breastfeeding book.  She lives in Redlands CA with her British husband, two children and a menagerie of rescue pets.

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