On TV, the labour routine goes like this: The very pregnant woman arrives at the hospital, breathing her way through each contraction, changes into her revealing tie-in-the-back gown, and is promptly tucked into bed.
But lying in bed is rarely the best way to get through labour. Doula Julia MacNeil, of Mississauga, Ont., is Eastern Canada director for Doulas of North America (DONA) International. She says, "Movement is integral to the progress of labour. The movement of the hips while walking helps to guide the baby into the pelvic opening, and the swaying of the hips encourages the baby into the optimal position for birth."
Midwife Lorna McRae, of Victoria, says, "Moving or walking can be the perfect tool for pain management - it's the way your body helps you get through labour."
A review of the research confirms it: In some studies, when women were encouraged to walk or change position as they chose in labour, they tended to have shorter labours, more efficient contractions, greater comfort and less need for pain medications. Women who spent at least half of active labour walking were less likely to need forceps or vacuum-assisted births or Caesareans. Other studies, generally those where the women were walking or moving for a shorter period of time while in labour, found little or no difference in length of labour, although the women were more comfortable. No studies found any negative effects.
How you move will depend on the stage of labour, your baby's position, and how you are feeling at the time.
Early labour
- Early labour is all about distraction, says MacNeil. Try slow dancing with your partner, or sitting on an exercise ball and watching TV.
- Doula Jalana Grant, of Langley, BC, who is Western Canada director for DONA International, adds: "In early labour, I remind women to rest. Walks are great, but not to the point of exhaustion." If you start labour at night or when you're tired, and contractions are mild, lying on your side in bed can be a good idea - you might even be able to take a nap, or at least get some rest between contractions. A pillow supporting your stomach and one between your knees may help you feel more comfortable.
- Sometimes walking helps get labour under way. Julie Larose's water broke about noon, but she was still not having contractions when she went to the hospital at 8 p.m. "My obstetrician talked about induction, which I was adamant about avoiding if possible. He suggested we wait to see if labour started overnight," she recalls. Larose, who lives near Prescott, Ont., started walking the halls of the hospital, chatting with her husband. Contractions began sporadically. At 11 p.m., her husband went to sleep and she kept walking.
"When I walked, my contractions came more regularly," she says. "After a while, they were strong enough that I had to lean against a wall to cope with them." Later, as she began to feel more tired, she sat down to rest, but found "this slowed the contractions down and, when they did come, it felt extremely painful, so I got right back up and continued standing."
Active labour
When Larose hit active labour, early in the morning, she woke her husband so he could walk with her and provide some support. "I was getting tired and starting to feel like I couldn't go on," she says. With him to lean on during contractions, she was able to keep moving.
You may need to move differently once active labour begins:
- As contractions get stronger, listening to your body will help you find the most comfortable ways of moving.
- If you were resting during early labour, now it's important to get upright, says Grant. "It's important that your cervix dilates, but equally important that the baby's head moves into the pelvis." Walking can be very helpful.
- As contractions get closer together and you have less time to walk around, you might find it easier to stay in one place and rock your hips, or sway from side to side. "It's that hip movement that helps the most," says McRae.
The baby may move lower into your pelvis during this part of labour, or may be shifting position in readiness for the birth. What worked two contractions ago may be highly uncomfortable now - so try some of these positions:
- Put one foot up on a low footstool, bench or step, and lean forward in a lunging position. This may help the baby rotate into position.
- Remember your pliés from ballet class? Hold onto the railing or your partner, and bend your knees, going all the way down to a squatting position, if you can do so comfortably.
- Walking up and down stairs is one of the best things you can do to help the baby move into position to be born, according to McRae. "As you go up the stairs, move your hips like you mean it."
Back labour
With a baby in the posterior position (back of baby's head against mother's tailbone), you're likely to feel a lot of pressure and pain in your back during and between contractions.
- Rika Alvo of Toronto found that being in a hands-and-knees position in active labour made her more comfortable with her posterior baby.
"I had a big pile of pillows under my chest, so my weight wasn't just on my hands," she explains. "I would sway my hips in a figure-eight pattern. And my husband rolled a tennis ball around on my lower back with quite a lot of pressure because I was having a lot of back pain."
- Sitting backward on a chair and leaning forward against the back of the chair can also help take some of the pressure off your back.
- Your partner can do a "double hip squeeze" by putting his hands on the back of your hips and squeezing together.
Transition
"By 6 a.m., I was nauseous and shaky," says Larose. She didn't feel up to walking anymore, but found the most comfortable position was sitting up in bed. By 6:30, she was 10 centimetres dilated and ready to begin pushing.
Here are some positions that may help you through transition:
- Sitting on the toilet (perhaps facing the back of the toilet if you are having back labour) can help you relax your pelvic muscles.
- Squatting or sitting supported by your partner can also work well. Some women find they like to lie on one side. Your partner can rock your hips as you are lying there, and this may help you stay relaxed.
Because every labour is different, Grant says that women need to find the "labour rituals" and ways of moving that work for them. She recalls one mother who, when a contraction started, needed to lean forward and rest her head on her husband's chest, while he held her shoulders. At the same time, Grant rubbed the mother's lower back and the mother wrapped her arm around Grant's neck, pulling her close in a headlock position. That's what got her through the contractions.
Julie Larose may have used a simpler approach - just walking and leaning on her husband - but it also got her through a long night of labour. Just a few pushes, and her son, Martin, was in her arms. "He was born sunny side up," says Larose, "so all that walking not only got labour going, but helped me get through back labour."
What to bring
Here are some things to bring to hospital with you to help you move through labour:
- Midwife Lorna McRae reminds mothers to bring comfortable shoes - you may be on your feet for many hours. (She once used maxi-pads to make the hospital-supplied slippers more cushiony for a labouring mother.)
- Your own nightgown or bathrobe from home will allow you to retain some modesty if you're walking in the halls.
- A birthing or exercise ball can help you sit and rock your hips.
- Extra pillows can make a window ledge soft for leaning on, or cradle your face when you're in a hands-and-knees position.
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