“You get bigger than your baby” Ina May Gaskin
from her book Ina May’s Guide to Childbirth
In this session, we will look at how to prepare for an Active Birth which has been shown to have a positive effect on both birth outcomes and a woman’s satisfaction with her experience
Janet Balaskas (founder of Active Birth Centre UK and author of New Active Birth) defines it as a woman being free to follow her instincts, able to move freely, being in control of her body, and having trust in the natural function of birth.
“A woman in touch with her instinctive behavior will usually use upright positions that are gravity friendly and lessen pain. She feels free to move in whatever way helps her to manage the intensity of labour. On an intellectual level, she understands that certain positions will increase the space in her pelvis, help her baby to descend and rotate and help labour to keep progressing.
She moves her pelvis – rocking, swaying, circling – in any way that feels good
She trusts in her body and is also well informed about possible medical interventions that might be offered. She takes an active part of her labour and birth on a physical and mental level.”
The History of Active Birth
The Active Birth movement developed as a reaction against the limitations that had been put on women during labour. It is interesting to know a little bit about the history and why the movement came about.
Pictures and artifacts from ancient civilizations show women giving birth in upright positions, squatting, kneeling, and using birth stools. Before the 17th-century midwives assisted women at home and they invariably used upright positons to birth. Women all around the world were documented in the 19th century by an obstetrician who observed them using instinctive active birth positions and suggested that these were adopted in the UK! So what happened?
Lying down for birth seemed to have started by royalty, there is a story of King Louis XIV wishing to observe his mistress give birth from behind a curtain and therefore requested she lay down!
Another factor was the invention of forceps. Doctors studied pelvises of cadavers (pelvis obviously not flexible and moveable as in a live woman) and concluded that babies were not able to fit easily through a pelvis, that birth was inherently dangerous and women needed assistance. Doctors started to attend births and midwives were excluded.
Women were required to lie down to give easier access to the doctors and, since their use increased pain for women then anesthesia finally becomes allowed and encouraged. Hence “Twilight sleep” as it was commonly called then was used by Queen Victoria and therefore became popular for the upper class.(If you’ve watched the crown you may have seen Queen Elizabeth give birth to her first baby and how Twilight sleep was used!)It then made lying on the back the most common, and convenient way of giving birth. It gave doctors a good view! Therefore, women became used to that position for birthing – it is still portrayed in the majority of TV programmes and movies and therefore imprints on women that a passive supine position is “normal” and expected.
The view that doctors must always attend births as it is inherently dangerous still exists today in some circles (Medical model of care)
Even though there is no physiological reason to lie down (in fact it often complicates childbirth) reclining positions are still common today.
By the 1970s labour was routinely induced so Electronic Fetal Monitoring needed to be used and women were restricted to bed.
- They experienced increased pain being passive and immobile so there was more use of and demand for drugs and epidurals
- Women had a passive and dependent role during labour and birth – babies were “delivered” rather than being “birthed” by women
- We have clear evidence that routine “active management” of labour is not justified or beneficial for low-risk women
- Women were divided, and still are, about medical pain management – some demand as much pain relief as possible, others want to use their own resources and see birth as a transformational experience.
It remains the same today to some extent and every woman has the right to choose her preferred method of birthing and whether she wants medical pain management. However, one of the main aims of this course is to provide you with effective pain management tools that are likely to decrease your need for medical intervention.
The Active Birth movement began in Uk with Janet Balaskas and she still runs the Active Birth Centre in London and has had a huge influence, along with other childbirth educators such as the late Sheila Kitzinger. More information can be found on Janet’s website http://www.activebirthcentre.com/
The World Health Organisation (WHO) has made the following recommendations regarding positioning for birth:
- Pregnant women should not be put into lithotomy (lying flat on back with feet in stirrups) position during labour or birth
- They should be encouraged to walk around during labour
- Each woman must freely decide which position to adopt for birth
Getting to know your pelvis
The above photo shows the back (posterior) of your pelvis. The tailbone curving under and attached to the triangular-shaped sacrum and the two SIT bones. There are 2 sacroiliac joints (SIJ) that can often become achy and sore during pregnancy. Below the pelvis shown from the front (anterior). The opening in the middle is called the pelvic inlet at the top and the pelvic outlet at the bottom. This is the space the baby needs to navigate through and rotate around during labour and, ultimately, to be born.
Fortunately, your pelvis is able to expand to accommodate your baby’s journey during labour because of the hormone Relaxin which is released in early pregnancy and then during the last trimester too. This relaxin softens all the soft tissue and allows your pelvis to increase the space in the pelvic inlet and outlet (especially when combined with movement and active birth positions)
Let’s explore the pelvis. Feel for the bony SITS bones – we looked at these earlier for breathing. Then feel your tailbone and sacrum, noting how the tailbone tucks under, feel your pubic bone and the soft cartilage between the two bones.
Find the hip bones in the front and trace them back behind
Activity: (as in the yoga session) You can discover the position of your pelvis impacts on the space your baby has to move through your pelvis
Place one hand on the pubic bone and one hand low down on the sacrum, fingertips over the crease of your buttocks. Lean back and then forward a few times and see if you can feel which position creates more space between your hands. What did you find?
When you lean forward you may have noticed more space and when you leaned back less space. So we can open out the space between the front and the back of the pelvis by leaning forward – this is important to know for labour.
Next, let’s feel how to widen the SITS bones – it is easier to stand for this one.
Place your hands on each SITS bone and keep your feet close, then step out to have the hips more than hip-width apart. Try not to turn out your feet too much as this will lessen the space.
Can you feel more space with legs apart?
So… leaning forward, feet apart, or upright and feet apart will help to create more space during the first stage of labour for your baby to navigate the journey through your pelvis. Think about whether your position feels “open” or “closed” and ask your partner or support person to remind you or help you into positions that are likely to increase space for the baby.
Other great benefits of using Active Birth during labour
#1 It reduces pain! Ask any woman having a contraction to lie down on the bed and after a couple of them, she will definitely want to up and moving again. The uterus contracts forward (and usually slightly to the right) and it feels natural to lean forward or be upright while this is happening. When lying on your back your uterus needs to work harder and it won’t feel good.
#2 It feels empowering to be moving around. There is a psychological difference when a woman is face to face with her caregivers, able to choose her positions and movements, including finding a private space (often the bathroom). Feeling equal to one’s caregivers is considered an important factor in reducing stress and pain according to Dr. Michel Odent
#3 It will encourage you to use instinctive movements and behavior. Gets you in touch with that inner “Birthing Wisdom” so you follow what feels right in each moment
#4 You are using gravity to help your baby descend. It makes sense that if you are trying to move an object through a vessel of some kind (imagine wanting to geta marble out of a bottle) you would not hold it horizontally, you would naturally hold it upright. It’s the same with your body – being upright as much as you can helps your baby’s head stimulate the cervix (where there are oxytocin receptors sending messages to the brain to release more oxytocin to keep contractions going), as well as help the baby move downwards
#5 There is no compression on the major blood vessels. Just as lying on your back in the later stages of pregnancy is not recommended because of this compression so too it is important during labour to not compromise in any way blood and oxygen supply to you, your baby, and your uterus
#6 Your sacrum and tailbone are free to move. Your tailbone will need to move backward as your baby is being born so you don’t want to be sitting on it!
#7 Being upright allows for the joints of the pelvis to expand evenly as well as the perineum. Semi-reclining can increase the pressure at the back of the perineum – even pressure is preferable to reduce the chances of tearing. (Upright positions have been shown to reduce the need for episiotomies, as well as forceps or Ventouse). Being in upright positions allows for movement of the pelvic joints as well as expansion
#8 It has been shown to shorten both first and second stages.
Adding Movement to Active Birth positions
If you’ve done the yoga video for Session 2 you will have some ideas of effective and fun ways to move your hips during labour. When you add movement you are increasing the benefits of your positions even more and helping your baby to rotate down through your pelvis {Think “rotate to dilate”!)
It feels so good to sway your hips, circle them, do figure eights, lift one hip and you’ll see some movements in labour and birth positions in the Session 7 video – Courage and Transformation
So have fun and practice!
- In the shower rock and circle your pelvis, use your slow breathing with the movements for labour practice
- Stamp, walk on the spot in the shower or anywhere – great for labour
- When sitting at work or any time you can still do hip circles and pelvic tilts and it can relieve stiffness and pain
- Do the pelvic movements in other positions too such as Cat (all fours), kneeling, even side-lying
- Buy a Birth Ball if you don’t have one and sit on it every day
- Put on some music and dance!
Further Benefits of Movement
- Movement increases endorphins – the body’s natural pain killers (200 x stronger than opiates). You want lots of these!
- It is likely to help you relax internally – try hip circling whilst holding your pelvic floor tight!
- Circling and rocking may help your baby to move into a more favorable position for labour (more about Optimal Foetal Positioning in Session 7)
- Movement when combined with good positions makes even more room for the baby. Women often instinctively lift one hip or find a particular way of moving that enables a baby to maneuver that passage a bit more easily
- It will increase blood flow to your belly and uterus
- Pain is usually reduced even more when movement is added to position, especially movement which will create a distraction (such as stomping in the shower) and/or stimulate nerve endings – there are 7,000 on each foot. We will talk about the Gate Theory of Pain in Session 5!
A final word on Active Birth
No-one knows how long labour their labour will be – prepare yourself as much as possible with walking, swimming, or any appropriate exercise to improve your strength and stamina.
Try out different labour positions and watch the Active Birth video in Session 7 with your partner/support person
Circle your hips in the shower and combine with long, slow breaths as if in labour
Regularly practice wall squats or semi squats away from the wall (10-15 a day)
Sit on a birth ball to watch TV or practice some sitting postures on the floor