How to use Movement to Improve Birth Outcomes

Why is movement during labor important in improving birth outcomes?

I don't know about you, but growing up, I thought that labor and birth was something women did while laying on their backs in bed. This was what the media depicted labor and birth to look like. But the body actually requires movement for a vaginal birth to occur.

Even when laboring with an epidural, which means laboring in bed, there is still a lot of movement and position changes going on to support the progression of labor.

In this post, you will learn how movement:

1. helps to shorten the length of labor

2. lowers the risk of medical interventions and

3. acts as a form of pain management

How movement can help shorten labor

When we think of labor progression, we often think of cervical dilation - the opening of the doorway of the uterus. But another important part of labor progression is fetal station. This is the baby's descent into and through the pelvis.

Movement is the best way to support fetal station progression.

This is because movement manipulates the pelvis and allows it to create opportunities for your baby to move through it. The pelvis is not one solid bone in a fixed position. We can tilt our pelvis in different directions and move our bodies in ways that create wider openings for a baby to pass through.

Here are some movements that are great for helping your baby move through the pelvis:

• sitting on a birth ball and doing hip circles, tilting the pelvis forward and back, or figure 8s

• cat cows and hip circles in a hands and knees position

• standing or kneeling lunges to the side or the front of you

• shifting your weight from one hip to the other

• standing, leaning forward, and dipping one hip down and then the other - think of bending one knee and straightening the other, then switching

• walking or curb walking - walking with one foot on a raised surface or curb and make sure to do both sides!

• standing pelvic tucks - tucking the tail under

Movements like these can help your baby engage into and move down the pelvis, which can help labor progress faster. Movement also can speed things up because it can help you release tension from your body. When tension is released, it allows your tissues to yield to the pressure of your contractions.

We will talk more about tension release more throughout this post because it plays a factor in each of these points.

If you get an epidural at any point in your labor, you may be actively moving less, but you can still do position changes every 30 minutes or so, so you can get the benefits of movement even though you will have limited mobility. Some of these positions include:

• laying on your side with your top leg over a peanut ball or stack of pillows - do one side and then the other

• lying on your side with a peanut ball in between your knees - also do one side and then the other

• flying cowgirl position is great if you are having trouble getting your baby to move into the pelvis, but it is uncomfortable for most people so I try to avoid it if possible - it can be a game changer though!

• thrown position - sitting up with the bottom of the birth bed lowered so you are sitting like in a thrown, and you can open your knees wide and toes pointing out

• if you are able to, with support, getting yourself into a hands and knees position is great!

How movement can lower the risk of medical interventions

There are many reasons why medical interventions can be suggested during labor. But some of these interventions can be avoided by movement.

For example, if your baby is not progressing lower into the pelvis, you might be offered pitocin to increase the strength of your contractions to push your baby harder through the pelvis, or in desperate times, you might have interventions like an assisted vaginal delivery - the use of a vacuum extractor - or even a cesarean suggested to you. By moving and allowing your baby opportunities to engage into the pelvis, you are already lowering your chance of needing these interventions.

In a Spinning Babies blog post called The Levels of the Pelvis, founder Gail Tully writes, "Helping a baby engage when not yet engaged at the start of labor is the most effective action to avoid an unnecessary cesarean."

Movement can also help prevent interventions because, as I mentioned earlier, certain movements can release tension from your body. The bum jiggle, for example, can release tension in the pelvic floor. Pelvic floor tension can make it hard for the tissues your baby is trying to pass through to yield and open.

How movement can help with pain relief

Movement is a form of non-medical pain management in labor.

When you move, you can feel into your body and focus on the sensations of the movements rather than on the sensations of labor. You can also sync up with your breath as you move, which can help promote relaxation.

Movement can also help reduce pain because it can help regulate your nervous system.

Your nervous system is responsible for the fight-or-flight response and the rest-and-digest response. When you are in fight-or-flight, your nervous system is upregulated. Your body perceives what is happening as a threat and will automatically tense up. That tension can cause labor contractions to feel more painful because your body is fighting against them rather than yielding to them,

To get out of this, you want to get your nervous system into a downregulated state. And movement is one of the ways you can do this.

The parasympathetic nervous system is the part of the nervous system that regulates you. It is responsible for the rest-and-digest response. The parasympathetic nervous system is located at the top and bottom of your spine - at the base of the skull and at the lower back and sacrum.

You can activate your parasympathetic nervous system with slow and controlled head movements, neck massage, or neck rolls.

You can also activate the parasympathetic nervous system by moving your pelvis - like doing hip circles, cat cows, moving in and out of child's pose, or even the bum jiggle.

This is especially useful when you add in breathing with your movements. You can sync your movements to your breath, or just breathe slowly and with control, which helps further regulate the nervous system.

As you do these things, you might ding yourself relaxing a bit more. You will no longer be resisting your contractions, the tissues in your body will soften and yield more effectively, and useful hormones such as endorphins - the pain relief hormone - will start to flow better through your body.

In conclusion

Movement is a great tool in supporting labor progression, avoiding unnecessary interventions, and coping with pain in labor. I suggest practicing movement during pregnancy so you can find what movements feel good in your body and become familiar with movements that might feel foreign to you. You are also more likely to use movement intuitively if you practice it during pregnancy.

But while movement is SO important during labor, make sure you also give yourself opportunities to rest. Birth - like life - is a balance. Rest is just as important as movement! Try not to get stuck only doing one or the other.

If you get an epidural, rather than doing active movements, make sure you are changing positions every 30 minutes so you can still be giving your baby plenty of opportunity to move through the pelvis.

And the positions suggested for an epidural are great resting positions for when you take a break from active movement to reserve your energy.

References:

Dekker, Rebecca,RN, PhD. “The Evidence on: Birthing Positions,” Evidence Based Birth. 2 October 2012, updated11 July 2022. https://evidencebasedbirth.com/evidence-birthing-positions/

Dekker, Rebecca, RN, PhD. “Positions during Labor and their Effects on Pain Relief,” Evidence Based Birth. 12 March 2018. https://evidencebasedbirth.com/positions-during-labor-and-their-effects-on-pain-relief/

Ondeck, Michele, RN, MEd, IBCLC, LCCE, FACCE. “Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor,” The Journal of Perinatal Education. Fa;; 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235058/

Shillings, James, MS, CD (DONA), IBCLC, LCCE, FACCE, Romano, Amy M., CMM, and DiFranco, Joyce T., RN, BSN, LCCE, FACCE. “Care Practice #2: Freedom of Movement Throughout Labor,” The Journal of Perinatal Education. Summer 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948086/

Tully, Gail, "Three Levels of the Pelvis," Spinning Babies, March 2016. https://www.spinningbabies.com/optimal-maternal-postions-at-the-levels-of-the-pelvis/#:~:text=The%20baby%20turns%20three%20times,the%20size%20of%20the%20baby.