Why Choosing Free Range Labor May Make Birth Easier

[A Lamaze news release]Close your eyes and imagine a woman in labor. If you picture the scene as it occurs regularly in movies, on television and in hospitals everywhere, you probably see her lying in a hospital bed, hooked up to an IV and wearing belts around her belly to continuously monitor the baby's heartbeat and the contractions. Her range is limited to a few square feet. What's wrong with this picture? A lot, according to research. The best way to keep your baby moving down and out is to keep your own body in motion. said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International. Being confined to bed, tethered to monitors and IVs, interferes with the body's ability to move the baby through the pelvic bones and down the birth canal. Many hospitals have routine protocols like continuous fetal monitoring that limit movement and the use of epidurals commonly requires confinement in bed. Researchers have examined published studies that compared policies that encouraged movement during labor with policies that restricted movement. The conclusions show that the policies which encourage women to walk, move around, or change positions during labor may help women experience:

• less severe pain
• less need for pain medications, such as epidurals and narcotics
• shorter labors
• less continuous monitoring
• fewer cesarean surgeries
• lower likelihood for an episiotomy and use of vacuum extraction or forceps

Why does movement during labor have these effects? Staying upright during labor means that gravity can aid the body's natural efforts, which let the pelvic bones open as much as possible. Women who are laying on their backs confined in bed lose this advantage, which increases the likelihood that the baby will be unable to navigate through the pelvic bones. It's frustrating to see women routinely put on their backs and confined to bed and then be told that they 'failed to progress' or that the baby 'didn't fit' through their pelvis when a simple move into an upright position could easily resolve both situations, said Marylou Carrico Tietz, LCCE, FACCE, a Lamaze childbirth educator from Bethesda, Md. and president of the Washington, D.C. chapter of Lamaze International. Women need to be encouraged to listen to their bodies in labor and question routine hospital policies that may slow their progress. Lamaze educators find that many women also report that movement during labor is an effective pain management tool, reducing pressure on the lower back, increasing space within the pelvis and allowing for an easier descent. Tietz continued, "The mother's movement throughout labor can help ease the baby through tight spots in their journey to being born. The easier it is on the baby, the easier it tends to be for the mother as well."The best ways to avoid unnecessary confinement to bed include:

• Choose a care provider who supports mobile moms If they express support, put their answer to the test and ask what percentage of their patients end up staying up and mobile during labor.
• Know the facts on fetal monitoring In low-risk mothers, research shows that occasional checks of the baby's heart rate are just as safe as constant monitoring.
• Know the facts about epidurals The benefits are well known, but also consider the possible drawbacks. Switching positions can help get babies un-stuck but an epidural will render you mostly immobile.
• Choose the right support A doula or labor support person who will help you stay moving and can negotiate with your care provider or nurses, as needed. They can also help you manage each and every contraction.
• Use a birthing ball when you need a rest Remember that you may need to bring your own, since many hospitals still don't support women laboring in upright positions.
• Stay upright during the pushing phase too Many care providers will let mothers walk or sit up during the dilation phase, but will put them on their back or bottoms during the pushing phase. These positions shrink the pelvis and make it harder to push the baby out.
• Don't be afraid to insist It is difficult to go against hospital routine, but remember that many hospital routines are in place for the comfort and convenience of staff, not the health and safety of you and your baby. The easier the birth is for you and your baby, the better the chances of a safe and healthy outcome for both of you.

Avoiding unnecessary medical intervention is part of Lamaze's Six Healthy Birth Practices. Based on recommendations by the World Health Organization and backed by extensive research that supports a woman's natural ability to give birth, these practices are:

• Let labor begin on its own
• Walk, move around and change positions throughout labor
• Bring a loved one, friend or doula for continuous support
• Avoid interventions that are not medically necessary
• Avoid giving birth on your back and follow your body's urges to push
• Keep mother and baby together; it's best for mother, baby and breastfeeding

To learn more about the Lamaze Six Healthy Birth Practices, please enroll in a Lamaze childbirth education class and visit www.lamaze.org/healthybirthpractices.

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