If given the choice, most women prefer to move about and change position when they are in labor. Being mobile and upright decreases pain perception, shortens labor, an decreases the need for medication and interventions. Unfortunately, many women assume that they must remain in bed once they are admitted to the hospital, or they wait for the nurse to recommend a position change. If you are connected to an electronic fetal monitor or intravenous fluids, it becomes more difficult to move about freely. You may request intermittent monitoring or being monitored while out of bed. The use of IVs may not be necessary, or you may request a heparin lock or saline lock.
Trust your body and get into the position that makes you feel most comfortable. Try several positions during labor, and change your position frequently. Certain positions can encourage proper rotation of the baby as he moves through the pelvis.
Being upright during labor takes advantage of gravity and pulls the baby into the pelvis. Standing decreases the perception of pain while producing more effective contractions, which may help to shorten labor. This position also encourages the proper rotation and descent of the baby through the pelvis. If a shower is available, using it will give you the added benefit of warm water on your body. Some facilities even provide a hand-held showerhead, which allows you to direct the spray over your lower back.
The upright position includes standing next to the bed or a wall, walking between contractions, and lunging. If you stand next to the labor bed, you can lean over and use the side rail or bed for support. A fetal monitor can be applied, and your partner can easily massage your lower back in this position. If you stand next to a wall, place your fists into your lower back if you experience back pain.
If you walk between contractions, your partner can support you by holding onto your arm. When a contraction begins, face your partner, bend your knees, place your arms around his neck with your head on his shoulders, and allow him to support your weight. If your partner is taller than you, lean your head against his chest and allow your arms to drop to your sides as he places his hands around your waist for support. Some women have found that swaying their hips, as if dancing, can be soothing during a contraction. Another variation of standing is to press your back against your partner and have him place his arms around your abdomen. You can also sway in this position.
The lunge position can help to widen the pelvis, especially if the baby is in a posterior position. To get into the lunge position, stand beside the bed or a chair. Place one foot on the bed or seat of the chair, and one foot on the floor. If you know which side of the pelvis the back of the baby’s head is facing, lunge with that leg. If you do not know the position of the baby, lunge in the direction that is most comfortable. You should feel a stretch in the inner thigh. During a contraction, repeatedly lunge sideways and hold for 5 to 10 seconds, using your partner for support.
Sitting in the labor bed or on a chair provides the benefit of gravity, although not as much as standing does. It is a comfortable position for most women and can be used with the fetal monitor. The rocking motion when sitting in a rocking chair is especially soothing. If your back is sore, you can straddle or sit on the edge of the bed or chair, and lean forward so that your partner can rub your lower back.
Side-lying is a comfortable position for most women. It is beneficial in a long labor if the woman needs to rest. Place pillows under your head and abdomen, and between your legs, or you can just use a pregnancy pillow for this purpose. Side-lying does not restrict the use of the fetal monitor or other interventions. It also helps to lower blood pressure and can be used if the woman is medicated.
Kneeling on the hands and knees is the most comfortable position for back labor. It takes the weight of the baby off the spine and may encourage proper rotation. Your partner is able to apply firm counterpressure to the painful areas. You can also perform the pelvic rock in this position. If you are out of bed, you can kneel in front of a chair, with your upper body resting on the chair seat. If you are in bed, raise the head of the bed and lean your upper body on the elevated section, using pillows for support. Some women have found that a birthing ball (an extremely large, flexible ball that can be used for a variety of positions during labor and birth) is comfortable to lean against.