Helpful Tips For An Easier Birth

Sometimes the presentation of the baby before or during labor is less than ideal. Doula Cindy Harmon-Jones offers you some of her tips for moving the baby into the best position. (See part one of this feature here.)
Cindy Harmon-Jones

Influence the process
Women having their first babies often run into problems caused by a malpositioned baby. Malpositions can include posterior positions (back of baby's head toward mother's back), a deflexed head (baby's head lifted instead of flexed onto her chest) or asynclitic (crooked) head, but since posterior babies are most common, we often call all malpositioned babies "posterior." Posterior babies can cause a multitude of labor problems for women having their first babies, including postdate pregnancy (going overdue), rupture of membranes with no labor, a labor that is more painful than normal, a prolonged latent phase, slow progress in active labor, arrest of progress, and a prolonged second stage. Cesareans for failure to progress are common. Karen, a friend of mine and experienced doula, says, "The only time I'm ever in the c-section room is when the baby is posterior." For some reason, for women who have already had at least one vaginal birth, a posterior baby may make labor more painful, but usually not longer or more complicated.

Fortunately, a pregnant woman can do much to influence her baby's position. The third trimester is the best time to get the baby into a good position, since avoiding problems is easier than fixing them. The best position for your baby is head down, with the back of the baby's head toward your front and on your left side (left occiput anterior, or LOA). When your baby is in this position, you will feel the smooth back on the left side of your abdomen, and the baby's kicks on your right side. If, instead, you feel kicks on your left side or in the front, using fetal positioning techniques would be wise. A woman who is planning a VBAC and whose original cesarean was for failure to progress, especially, could benefit by getting her baby into the best possible position before labor begins.

Positions to avoid
The woman in late pregnancy should avoid all reclining positions, which encourage the baby to flop onto its back. Instead, she can relax in forward leaning positions. She can do 100 pelvic rocks on hands and knees, several times per day (100 pelvic rocks takes about 1-1/2 minutes). Pelvic rocks are a quick rocking motion of the pelvis, without much arching or movement of the back. A woman can assume a knee-chest position (knees, head and chest on the bed, with buttocks up in the air) for 20 minutes, three times per day.

The best position for sleeping is left-sided Sims, the position recommended by Bradley childbirth classes (on the left side, but rolled over almost onto the stomach, left arm behind the back, right leg bent and propped on a pillow, left leg straight).

Some positioning techniques
If you go into labor with a malpositioned baby, you have an excellent chance of converting the baby into a good position using similar techniques. Even if you don't think your baby is posterior, please try positioning techniques if you have any of the signs of a malpositioned baby. These include lots of painful prelabor contractions, rupture of membranes before labor begins, slow progress in labor, very painful labor (with or without back pain), contractions that are irregular, closely spaced and short, an arrest of labor or a swollen cervix.

Positioning techniques may feel good immediately, or they may temporarily increase the amount of pain you experience while the baby is turning. However, the temporary pain is worth it, in order to avoid the complications that come with a prolonged, painful labor. A baby in a posterior position will almost always rotate into a good position and be born vaginally, given enough time and patience. However, the road can be long and painful. As Jen, another doula friend of mine, says, "Why walk 30 miles when you could walk ten?"

First, spend about 45 minutes in either the knee-chest position or left-sided Sims. After this, continue to labor in forward-leaning positions, either on hands and knees, knee-chest, knees and elbows, sitting while leaning forward or standing and leaning forward onto a chair or table. Forward leaning positions encourage the baby's back to swing around toward your belly. Avoid reclining in a semi-sitting position, which encourages the baby to assume or remain in a posterior position.

Perform pelvic rocks on hands and knees frequently. Stomping hard on the floor, or stomping up and down a flight of stairs, can sometimes quickly jar the baby's head into a good position. If you have chosen to hire a doula, she may know many more advanced techniques for helping the baby into a good position, but these simple techniques work very well in most cases.

Other interventions
If possible, try to avoid artificial rupture of membranes (AROM) until you are sure that your baby has rotated to anterior, since AROM can cause the baby's head to quickly descend into your pelvis, while still malpositioned. An epidural is another intervention that can prevent a posterior baby from rotating, since epidurals decrease the muscle tone of the pelvic floor and limit the woman's mobility.

However, avoiding an epidural is difficult when the baby is posterior because labor is so much more painful than when the baby is in a good position. If you can, use the positioning techniques described above before requesting an epidural. Your baby may rotate and you may find that you don't need one! If you receive an epidural while your baby is malpositioned, you can still ask your support people to help you into a Sims position, instead of the semi-sitting position that is commonly used.

First labors can be wonderful
I have attended many lovely births of first-time mothers and of women VBACing for the first time. When women have well-positioned babies and can remain relaxed through early labor, first labors usually flow smoothly and quickly to a joyful birth, without too much pain or worry.

I hope that these suggestions will help many women to have first births that are as relaxed and comfortable as the most wonderful births I've been privileged to

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