Sunday, January 9, 2011

Tips for Labour

Best positions for labour

When your labour starts, you'll probably feel quite restless. You'll want to move around and keep busy. Try to stay mobile without wearing yourself out. Have short rests, in a chair or lying down. If your contractions start at night, try to stay in bed and relax for as long as possible.

As contractions get stronger, you'll need to concentrate on them, focusing on what is happening to your body and your baby, and practising your breathing and relaxation exercises.

Now is the time to find the positions that best help you to cope with your contractions. Your nurse or midwife should encourage and help you to move and find a comfortable position, preferably one that is upright.

You might think that you'll be most comfortable lying on the bed, perhaps because you've seen lots of women in labour on the TV doing so. However, keeping as upright as you can will help your labour to progress and will help you and your baby to cope better during labour.

Upright positions can help lessen the pain of the contractions and make it easier for your labour partner to massage your back or breathe with you through the contractions. You could:

• lean onto a work surface or the back of a chair;

• put your arms round your husband's neck or waist and lean on him;

• lean onto the bed in the delivery room (with the height adjusted for your comfort) or a window-sill;

• kneel on a large cushion or pillow on the floor and lean forwards onto the seat of a chair;

• sit astride a chair, resting on a pillow placed across the top;

• go onto all fours;

• kneel on one leg with the other bent.

Don't forget to rock your hips backwards and forwards or in a circle to help your baby through your pelvis and to comfort yourself. You'll be more likely to use these positions in labour if they are familiar to you so try them out for comfort while you are still pregnant.

Why not labour in bed?

If you are upright rather than lying down, gravity can help push your baby's head down onto the cervix (neck of the womb) to help your cervix dilate and then assist your baby's progress through your pelvis.

Research, though limited, has shown the following disadvantages to lying down in labour, including:

• more painful contractions;

• less effective contractions;

• longer labour;

• reduced blood flow to your baby, particularly if you lie flat on your back;

• narrower passage through the pelvis for your baby.

Changing position

Upright positions help make your contractions efficient and you feel in control. If you want to change position as your labour progresses, you may need to ask your birth partner or nurse midwife to help you. Their job is to keep you mobile and make you comfy with pillows and cushions wherever you choose to be.

When you are in very strong labour, you will probably find that you don't want to move around a great deal. You'll need all your strength simply to cope with each contraction as it comes along. Don't worry: you will naturally find the position that suits you best.

Just keep rocking, leaning forwards during contractions and straightening up in between. If you feel it helps you cope, ask your birth partner or midwife to massage your back with each contraction.

If you get really tired and bed seems like the best place to be, use pillows or wedges to lie down on your side. Remember that contractions can be more painful in horizontal positions, so you'll need to balance your need for rest with how you're coping.

If you feel rested after a little while, push yourself up with your hands into a sitting position and get into a comfortable upright position again.

Position for backache labour

If you have backache in between as well as during contractions, your baby might be in a posterior position. You'll find labour very hard to cope with unless you get the weight of the baby off your spine.

To do this, go on all-fours with pillows under your knees and hands to keep yourself comfortable. Adopting this position can reduce back pain and may help your baby get into a better position for the birth.

If you find that the blood is rushing to your head, try resting your head, shoulders and forearms on a birth ball so that your head isn't hanging down.

Positions for pushing

Finding a comfortable upright position is recommended for the pushing stage of labour. You are less likely to need help with instruments to deliver your baby if you're upright than if you lie down. The combination of the muscular action of your uterus, your pushing efforts, a wider outlet through the pelvis and gravity is a powerful one.

If your obstetrician prefers you to give birth on the bed, kneel on the mattress and lean against a large pile of pillows placed at the top end. Some doctors are happy for you to do this, while others prefer a more traditional approach - that's why it's important to discuss this with your doctor during one of your antenatal appointments.

If your doctor is happy for you to give birth on the floor, try kneeling. When the time comes for your baby's head to be born, all fours is an excellent position. Because gravity is not so effective in this position, your baby's head is able to emerge very gently from the vagina, reducing your risk of tearing.

What can I use to help me?

Some private hospitals have a "birth wheel", which can be manipulated into sort of a stool. Others have beds that can be maneuvered into sort of a chair so that women are in slightly more upright position that make pushing easier. Check if any of these are available at your hospital.

Positions for not pushing

Occasionally, you may feel like pushing but your doctor may ask you not to push. This may happen if:

• your cervix is not fully dilated;

• your cervix hasn't opened up evenly leaving a "lip" of cervix round your baby's head.

It can be very difficult not to push when nature is telling you to. You could try lying down on your left side or going into a knee-chest position (with your face on the floor and your bottom in the air) and/or "panting" through your contractions. It's not elegant, but it does tip your baby off your cervix and should reduce your desire to push. It is important to cooperate with the medical staff who will guide you. A not-fully-dilated cervix can tear and a woman can have massive blood loss as a result.

What if I have an epidural?

You'll have to stay in bed if the epidural has made you completely numb from the waist downwards. If you have a mobile epidural, you will have some sensation left and can still move around a little, so your midwife may encourage you to keep mobile and upright. You could try sitting in a chair with your knees wide apart and leaning forward with every contraction.

If you have to stay in bed, avoid lying flat on your back as in this position, your baby's oxygen supply is may be reduced. Your nurse midwife should help you get comfortable in a sideways or semi-recumbent position using pillows or wedges. When you're ready to push, you can put your legs onto the stirrups attached to the hospital bed.

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