Movement in Labor

Why is movement during labor important?

Birth is a natural, physiological process, but while modern medicine has helped make birth safe for complicated and high risk pregnancies, the overuse of interventions has created many unsafe birth scenarios for otherwise healthy pregnant people. Research has proven that movement during labor, which is a natural part of a healthy birth, can help negate the overuse of these interventions. An article published by The Journal of Perinatal Education discusses three leading factors that have led to the rise in cesarean sections in the United States. These factors are:

1. labor dystocia: when labor is not progressing or the cervix is dilating at an “abnormally” slow rate. I put “abnormally” in quotes because all births are different and it is okay, as long as both mother and baby are safe, for labor to progress slowly.

2. abnormal or unclear fetal heart tracings

3. fetal malpresentation: when baby is in a difficult position in the whom. It is best if baby's head is down and tucked so the top of their head is the first thing to come out, but with fetal malpresentation, baby may be leading with their butt, feet, face, or shoulder.

The article then states that all of these factors "can be potentially positively affected by mobility in labor” (2014, Ondeck). Mobility in labor refers to the use of different laboring positions such as walking, swaying, squatting, lunging, and kneeling as well as the use of birth balls and birth chairs.

How can movement in labor positively affect birth outcomes?

Part of the natural birthing process includes the progression of the baby into the mother's pelvis and down the birth canal. Oftentimes, the baby needs the mother to move in ways that can help them do this. By using movement as a way for mother and baby to work together through labor, movement can:

1. help shorten the length of labor

2. lower the risk of medical interventions creating a safer birth for both mother and baby

3. help with pain relief which causes less need for medications and creates a more positive experience for the birthing person.

How movement can help shorten labor

Like I mentioned earlier, long labors are not always necessarily a bad thing, but they can lead to maternal exhaustion and sometimes complications. This can be prevented by movement because as the birthing person moves into different positions, their pelvis is able to open up, allowing their baby to move down and labor to progress. An article written by Rebecca Dekker of Evidence Based Birth says that “MRI evidence has shown that the outlet of your pelvis actually becomes wider if you’re squatting or kneeling, or if you’re in a hands and knees position” (2018, Dekker). Using these specific positions can help baby find their way into the pelvis so baby can lower into the birth canal.

All three positions mentioned in the Evidence Based Birth article are also considered upright positions in labor, which evidence shows that upright positions can also help labor progress faster. Dekker researched an article showing data from a randomized control trial which found that “the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed to recumbent positions” (2014, Dekker). This happens because not only is the baby able to move into a position that promotes labor, but it also allows gravity to help engage baby onto the cervix which can speed up dilation.

Being in an upright position also helps the uterus to work more efficiently. Dekker writes, “when you’re upright, the uterus can contract more strongly and more efficiently, and help get the baby in a better position to pass through the pelvis” (2014, Dekker). Because the uterus can work more efficiently and the baby can descend more easily through the pelvis, being upright can help resolve issues that could otherwise result in care providers pushing for a cesarean.

How movement can lower the risk of medical interventions

Other than lowering the risk of cesarean sections through helping the progression of labor, movement can also help lower the risk of needing other interventions such as forceps and vacuum extractors (tools that clasp or suction onto baby's head to help birth the baby) and other less common interventions such as episiotomies (the surgical cutting of the vaginal tissue to make the vaginal opening bigger). All of these medical interventions are quite invasive and cause many negative effects. For example, while a cesarean can be a lifesaving surgery, it is also a very risky surgery that can lead to maternal mortality. Ondeck cites a study done by The American College of Obstetrics and Gynecology where they talk about the rate of maternal mortality compared between cesarean and vaginal birth. She writes, “The report concludes that cesarean surgery results in more risk than vaginal birth. Mortality from cesarean surgery occurs in 2.7% of births, compared to 0.9% of vaginal births” (2014, Ondeck).

But cesarean sections are not the only risky interventions. Forceps and vacuum extractors can also pose risks to both mom and baby. Mother is at higher risk of severe perineal tearing or the need for an episiotomy, and the infant is at greater risk of having injuries most commonly to their head or neck from the use of these tools. An article by The Journal of Perinatal Education states that “women who spent at least half of active labor walking decreased their chances of having forceps or vacuum-assisted births or cesarean surgery” (2007, Shilling, Romano, DiFranco).

Being in upright positions such as walking also has the benefit of allowing proper blood flow. Rebecce Dekker from Evidence Based Birth writes, “many care providers encourage a lying down position during labor even though this position has known side effects including lowering the mother’s blood pressure and increasing the chance of abnormal fetal heart rates” (2018, Dekker). One of the reasons lying down in labor, particularly lying down on your back as opposed to lying to one side, can cause such negative effects is because it can cut off blood flow in major veins which can affect both mom and baby. While it is true that side lying is a great way for the laboring person to rest intermittently throughout labor, it is recommended to still change positions frequently (about every half hour or so). In fact, Ondeck writes, “The practice of restricting women’s movement in labor is contrary to the recommendations of the World Health Organization (1996) and Lamaze International’s Healthy Birth Practices” (2014, Ondeck). Other studies have shown that even with epidurals, allowing women to be upright and move around as much as possible with safe assistance caused “lower admissions to a neonatal intensive care unit” (2014, Ondeck).

How movement can help with pain relief

There have been many studies that prove that movement is a form of pain management and people tend to need epidurals less when they are able to move freely. An article called “Freedom of Movement Throughout Labor" states that “Activity provides distraction from discomfort, a sense of greater personal freedom, and a chance to release the muscle tension that can increase pain” (2007, Shilling, Romano, DiFranco). Another study addressing the pain relieving effects of using a birth ball found that “pain scores significantly dropped when people were using a birth ball. And [another] study showed that pain scores dropped when use of a birth ball during labor was also alternated with using a warm bath” (2018, Dekker). A similar study found that dancing was a cause for lower pain scores, and even when giving birth, women felt less pain while pushing their babies out than women who were in a reclining position (2018, Dekker). Movement has this pain relieving affect because, while it is a great distraction, it also assists in the natural production of pain relieving hormones. Being in control also helps the body release pain relieving hormones because when the birthing person feels in control, they tend to also feel more relaxed which causes more effective hormone release.

Aside from helping with pain relief, using movements such as “pelvic rocks, lunges, slow dancing, and stair climbing [helped] women to participate fully in the birthing process and feel cared for and comforted” (2014, Ondeck). It especially made people feel more in control and comforted when in the pushing phase of labor. One study reported “less pain and more satisfaction with their birth experience compared with [another] group that pushed and delivered while laying on their back in a bed” (2018, Dekker). Even women who had epidurals found themselves feeling “powerful, protected, and self-confident” when in an upright position (2018, Dekker). This goes back to the power of relaxation. Because these women felt safe and supported during labor and birth, they were able to relax more effectively and therefore feel the effects of their natural pain relieving hormones.

In conclusion

Position changes and movement during labor and birth provide so many benefits, and while the practice of keeping women on their backs during labor and birth used to be a very normalized practice (and still is in some settings), it has never been in line with the natural physiology of birth. Women and birthing people are meant to move during birth. It allows both mother and baby to maneuver their bodies in a way that assists the process of birth, it lowers the risk of many medical complications such as high or low blood pressure, concerning fetal heart tones, and the use of dangerous medical interventions. It also helps decrease pain and brings higher satisfaction to the person giving birth. In someone who has a healthy pregnancy, there are no negative effects to moving around during labor and being upright in birth, especially when movement is balanced with adequate amounts of rest.

Bibliography

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/