Part 1 of this Guide to Make Birth Easier introduces fetal positioning, what it means for your labour – even if baby is head down – and how fetal positioning techniques can help reduce labour time, and make birth easier for you and your baby.
It also covers the benefits of birth preparation, and touches on reducing your pain levels and boosting your labour progress with your naturally produced labour hormones, a.k.a. oxytocin.
If you haven’t read it yet, you can find it here.
Below, in Part 2 of the Guide to Make Birth Easier, you can find out HOW TO…
Fetal positioning techniques are not only for turning back to back, or breech babies. Even a labour with a baby in a seemingly ideal position (HEAD DOWN and facing mummy’s back) can be overly long and difficult, or contractions can slow down or stop.
Fetal positioning techniques, gently relax and release tight ligaments and muscles, and balance the uterus, giving baby space to do the subtle movements it needs to and help align the smallest part of baby’s head with the pelvis to make birth easier and shorter.
This Guide to Make Birth Easier focuses on the 4 particular techniques which have the widest variety of uses.
A. Learn techniques 1 to 3 below (referred to as the Three Sisters of Balance on SpinningBabies.com).
B. Print out the pages and read thoroughly. Follow instructions carefully to make sure they are appropriate for you and they are done correctly for safety and to make sure they work well (some don’t do anything if not done correctly).
C. Practise during pregnancy, as per the instructions, to balance your uterine area and so that they’ll feel easy and comfortable during labour.
D. If you are right at the end of your pregnancy it is not too late as you can use them right up to the start of labour and during labour itself.
E. USE THESE TECHNIQUES DURING LABOUR for:
A great technique with many uses. Helps to release tight ligaments and muscles so baby has more freedom to rotate into a better position and engage. I would also do this one before any of the others to help them be even more effective.
2. FORWARD LEANING INVERSION
Helps to give your uterus balance so baby can align well with your pelvis, and gives baby space to do the movements it needs to before and during labour. This technique can be done throughout pregnancy – even preconception. I used this during both of my pregnancies. Some of the photos in the link show this technique being done from stairs or a high level but I only used this off a low level sofa. Go with what feels comfortable to you.
Please note that this video clip of the Forward Leaning Inversion is almost ten years old and shows the mum walking down on hands and knees to the floor afterwards. The instructions these days have been changed to going back up onto the sofa and sitting on your heels for a moment. This is found to be more effective. Also, it is not advisable to do this technique for more than three breaths (about 30 seconds).
In my mind this technique is the most important one to learn as it has so many uses, particularly if labour is taking a long time or if contractions slow down or stop. Unfortunately this is also the one that doesn’t work at all if not done correctly so do pay attention to the details and do take the time communicating with your helper to adjust your position and get it right for maximum benefit. Practising this during pregnancy will help you feel more comfortable doing it during labour as it feels rather unsteady at first (if it doesn’t feel unsteady you’re doing it wrong!). I used this during my first labour after doing the rebozo, and my labour changed dramatically within minutes. Do it on BOTH SIDES.
This is the best technique for turning a ‘back to back’ baby (baby facing your tummy) and also for helping a high baby come down and engage in your pelvis. Also if baby is stuck on the brim (top edge) of the pelvis this is good for helping baby move into the pelvis. Indicators for a back to back baby can include irregular or stop/start contractions. I used this technique in the early stage of my second labour to turn my back to back baby in an hour and regulate my own contractions so that I could cancel my induction appointment!
If previous labours have been fast – only do this if you have your care provider nearby.
I reiterate that techniques 1,2, and 3 can be done during pregnancy AND labour, and technique 4 is for labour only as it needs contractions to work.
For clarification I’ve given a few translations for some of the medical terminology from SpinningBabies.com below. For further explanation you could contact a medical professional. SpinningBabies.com is written by a midwife for other midwives so the language can be quite medical.
Abdominal fascia: abdominal tissues.
Oxytocin: a naturally produced hormone essential to labour progress, and important for bonding with baby and milk production.
Pitocin or Syntocinon: induction drugs (synthetic oxytocin) used to induce labour or strengthen labour contractions during childbirth, and to control bleeding after childbirth. Synthetic oxytocin does not behave in the same ways as the naturally produced hormone.
Crown: the smallest diameter of the head.
Flexion: the degree to which baby’s chin is tucked in to the chest (tucked in is best)
Asynclitic head: head is presenting first and is tilted towards the shoulder.
Posterior/Occiput Posterior (OP): back to back baby (occiput = back of the head, posterior = back).
Anterior/Occiput Anterior (OA): baby facing mother’s spine (occiput = back of the head, anterior = front).
Left Occiput Anterior (LOA): baby facing between the mother’s right hip and her spine with its back on the mother’s left side (occiput = back of the head, anterior = front). Other variations are ROA and so on.
Breech baby: baby with head up and bum or feet down.
Transverse baby: baby lying sideways with head on one side and bottom and feet on the other.
Oblique baby: baby in a diagonal lie with head in mum’s hip.
Antenatal or Prenatal care: care while you are pregnant.
Contraindication: medical reason not to do something.
Malposition: head down but not in an ideal position.
Malpresentation: crown of the head is not down first i.e. another part of the body is presenting at the cervix such as feet or bottom (breech), side (transverse), shoulder (oblique), or forehead/face (brow presentation).
First stage: the neck of the womb (cervix) gradually opens up to 10cm. Described in two phases (latent and active or established labour).
Latent phase: early labour.
Active/established phase: contractions are regular, every five minutes and lasting for at least a minute.
Second stage: baby descends through birth canal and out of the vagina – transition from 1st to 2nd stage is at full dilation (10cm).
Third stage: delivering the placenta or afterbirth.
Transition: cervix reaches maximum dilation of 10cm and baby starts descending.
Gravity, Movement and Balance are your friends. Let them help you.
Lying flat on your back makes labour/birth more difficult for you and your baby in many ways – so STAY OFF YOUR BACK.
Being on your back is a position which makes things easier for the birth attendants (better view), not for you or your baby and certainly not for labour.
Being upright, walking, crouching, being on your knees leaning forward on your arms/bed/couch/birth ball – all help labour be shorter and easier. Move around.
If you are tired, you can hang on to your birth partner or lie on your side. Left side is the best lying down position if you are going to spend much time in one position – either side is fine if you move around periodically. Never stay on your back for long if at all. Try to change positions fairly regularly.
Even if they want to strap on the monitors, or put in an IV you would still need to stand to go off to the toilet so it is possible to be upright and monitored even if the upright part is for short periods of time. You do have the right to stand up if you want to, or sit on a birth ball (exercise ball) or turn around and kneel or lean on the bed. Be more active – even if it’s not super comfortable at first, it will be of benefit to your labour and is likely to reduce pain. Use your instincts and find positions that work for you.
If for any reason you cannot stand up then LIE ON YOUR SIDE. Even with epidural you can be on your side and midwives can help you to change positions periodically even if some positions are just moving your legs as this changes the angle of your pelvis. Ask them to help you move.
If you do have epidural or other limited mobility, a great way to aid labour progress is to use a peanut ball. Unfortunately only a few NHS units currently have these available to use. It has been suggested that if a woman knows in advance that she will be having an epidural, she could consider getting her own to take into hospital with her.
Click here for a great blog post from scienceandsensibility.org describing peanut balls.
Some generally helpful positions in labour, even with monitors on, are shown at betterbirths.rcm.org.uk. Click here to view.
Bending your knees, squatting, rotating on an exercise ball, doing pelvic tilts, lifting one foot up/putting one foot on something low or high (depending on your comfort), walking up stairs sideways – all help to open your pelvis and let baby through more easily. The pelvis is not a straight tunnel and your movement lengthens and shortens the passageway quite considerably so moving around really does help your baby navigate down and out.
A wonderful way to get your pelvis moving is to dance. Yes, I did say dance! Rotating your hips in a figure of eight shape or belly dancing are fantastic for helping your baby come down. This is also a great way to relax a little more and you can do it alone or with your partner for support and added oxytocin releasing closeness. If you need sturdier support you could lean against a wall or a chair. Maybe put some music on!
These movements can have a positive effect on baby’s position during pregnancy as well as during labour so get going now!
Hold onto your birthing partner. Closeness helps your labour progress well because it helps you release the crucial birthing hormone oxytocin. Your birthing partner doesn’t need to be male.
Even being around other sympathetic women can help you release oxytocin so having a female friend or relative, or an independent midwife (http://www.imuk.org.uk/) or doula (https://doula.org.uk/), there for you as a trusted advocate, to help you relax and communicate with your care providers can be of great help to you and your labour.
A constant presence such as this can feel particularly supportive to you on a busy labour ward where midwives may be very busy or changing shifts and unable to stay with you throughout your time there.
To find out more about oxytocin and the effects on your labour of having it and of not having it, see Part 1 of this Guide to Make Birth Easier here. Hugs all round!
Research shows that paracetamol can make your labour much longer because it inhibits the release of prostaglandins which have hormone like effects that your labour needs to progress properly.
Many midwives are not yet aware of the new research available on this, and so they are often telling mums in early labour to take a couple of paracetamol for the pain.
Avoid paracetamol in late pregnancy and during labour. If you want to learn more about paracetamol in labour click here.
Early labour may not be as you expect.
Care providers usually advise that you stay at home for as long as possible unless there is some medical reason you should come in early. This is because home is more comfortable and quiet which helps you to release more oxytocin and so helps your labour progress.
If you are feeling anxious because things aren’t happening as you thought they would – call your care providers for advice. A five minute phone call may be preferable to travelling to hospital and being sent home again.
I expected contractions to happen every 20 minutes or so and get closer together and longer in length. Instead, at the start of my first labour, I had painful contractions very close together which were long but not long enough. I didn’t know what was happening or why which made me tense and made things more painful. I phoned the labour midwives for some advice. They told me this was quite normal in early labour and to go and have a warm shower and go to bed. I thought they were crazy (“how am I supposed to sleep like this?!”) until I did it and wow did it work. The warm shower reduced the pain and regulated my contractions so much I actually got some sleep! Relaxation!
Early labour the second time for me lasted for a week, with very irregular contractions starting and stopping again and again because my baby was back to back.
You don’t know when you will have your next opportunity, so make sure someone reminds you to:
The more anxious or tense you are, the more pain you feel. Refer back to Part 1 of this Guide to Make Birth Easier to find out why.
Relaxing your mind and body literally (and immediately) reduces pain and allows labour to progress.
It’s not hippy stuff – it’s biology.
Deep breathing (lots of focus on this – see the section below on breathing techniques), warm showers, warm bath, cuddles/closeness with your partner: all these things help to relax your body and help you release the necessary labour hormones (oxytocin and painkilling endorphins) into your body, helping make birth easier, less painful and shorter.
I am well known by family and friends for being VERY easily stressed, so if I can RELAX, YOU can too. Here’s how…
If you have previously practised any meditation this is extremely useful to use during labour. See Part 1 of this Guide to Make Birth Easier to learn a bit about Hypnobirthing which I used to maintain my calm. See also the section below on breathing techniques.
Light Touch Massage, is quite strangely effective. Your partner runs their fingers gently across your back, arms, neck etc. Click here for a clip showing how to use light touch massage. This a proven pain reducing technique, not just for labour either. I found it very helpful during my second labour and wished I had tried it during my first. Have a practise with your partner in advance so they can get used to how you like it. Again everyone is different and this type of massage can be really annoying if it’s not done the way you like it. You may also find that during labour you have changed your mind about how and where you like it, so communicate this gently (yes gently!) to your partner in order to maintain your calm.
Laughing is also a brilliant way to relax your mind and your body. No I’m not kidding, it is allowed to laugh during labour!
I mention earlier in this Guide that rotating your hips like a belly dancer helps baby’s progress through the pelvis. Well if you dance around with your partner you may find you’re relaxing more, laughing, moving and releasing those essential labour hormones all in one go!
Water in labour is fantastic for relaxation and reducing pain levels. I really felt the difference in early labour in the shower and later at the end of labour when I got into the birthing pool. I entered the pool towards the end when things got very intense. Some people like to get in and out more than once. You may find getting in very early in labour isn’t as powerful as later on but everyone is different so if you want to get in early, go ahead.
Small note here – if you are using a TENS machine (also helpful for a time) – remember to turn it off before trying to remove it or your fingers will get zapped… Yes ok, not the brightest move (especially while climbing into the pool) but in my defence I was a bit distracted! At least it made us all laugh at the time!
Imagine your body opening up and letting your baby out. Visualisation can be a very powerful tool if you give it a chance. Your body is designed to open up. Trust that it can and it will.
I have listed several relaxation techniques here – basically find something that works for you in each stage of labour and use it, whatever it is. If you have something else that you find helps you relax, so use that. Remember to have something fairly powerful up your sleeve for active labour and transition to keep you calm, focused and internalised as labour is surprisingly intense.
Breathing techniques – you may be thinking “yeah whatever” – but seriously they work!
Click here for a clip showing how to do the Hypnobirthing breathing techniques 4 in / 8 out, 20 in / 20 out, and J Breathing.
CALM BREATH 4 in / 8 out
I practiced the 4 in / 8 out technique when I went to bed and it helped me to sleep throughout pregnancy when other mums-to-be were struggling. Because I practiced it every night, it came naturally and easily during labour. I still use this technique years later to help me to get to sleep when I need it.
This technique is for throughout early labour and between contractions during active/established labour.
SURGE BREATH 20 in / 20 out
During the active/established phase of labour, when contractions are much more intense, I used the long, slow breathing technique during contractions (surges) where I tried to count to 20 on the in breath (while blowing my tummy up like a balloon) and then 20 on the out breath (releasing my tummy). This is pretty difficult to do – it’s supposed to be. The concentration and effort you need to achieve this is key in relaxing you as you are focused more on your breathing than on yourself. Focusing on more than two things at the same time leaves no room in your head for thoughts, worries, fears. It’s distraction, and it works. You may prefer to count to ten very slowly rather than getting frustrated trying to count fast through the teens to 20. Stick with it and have your birth partner supporting you by keeping an eye on you and regularly reminding you to breath, count and move your tummy – this will make a big difference to your pain levels, works with the movement of your contractions and keeps oxygenated blood flowing to your uterus.
J BREATH Pushing
J Breathing is a directed breathing technique to help you avoid tiring yourself out. Apply pressure using your uterus not your whole body. Use only your abdomen/belly/groin to push – as if you are trying to poo – sorry for being so graphic but it’s true. You would not tense your whole body to poo – you’d only use your poo muscles!
Focus on/visualise three things at the same time – long slow breaths; the top of your uterus pushing baby down and; widening your birth canal for baby to come through. The J Breath is a big breath in, and then the out breath is directed down and outwards like a J shape. This is something you can practice during pregnancy while you’re sitting on the toilet. Follow your instincts when it comes to how strong your pushing is. You may find yourself pushing or just breathing baby down. Go with what your body is telling you.
Use normal breathing whenever you are comfortable to do so.
If you get mixed up which type of breath to use, just go with your intuition and what feels comfortable. Whatever keeps you calm. The breathing isn’t a source of frustration but it is a source of relaxation, so go with what works for you. Direct the breath however you feel it is helping you.
Using any of your breathing techniques, include putting your tongue against the roof of your mouth just behind the teeth. Weirdly, doing this actually helps to relax your vaginal area and it is something I used during my labours! I had it on my reminders list for my birthing partner to remind me to do.
You can politely say no thanks to vaginal examinations (VE). It is routine for midwives to do them but they do not help your labour progress. They can introduce infection (particularly if your waters have broken) and can increase pain and anxiety, which can slow down your contractions. A VE may be appropriate if there is some kind of complication and baby’s position needs to be assessed.
I only ever had one VE during each of my two labours, which was done when I first met with my midwife. Just one. You can ask the midwives/doctors kindly to keep VEs to a minimum so that you can remain more calm and relaxed and help your body progress naturally.
In some cases, medical intervention is absolutely necessary. Sometimes it may not be.
If the doctors/midwives talk about inducing you; ‘speeding things up’ by breaking the waters or giving drugs; having instrumental delivery (ventouse / forceps); or having a csection – ask if there is a medical reason for this.
You can ask if it is safe to take a little more time while you try some of the fetal positioning techniques like 1 and 3 above or 1 and 4 depending on the issue, or simply change position. You can ask what would happen if you just wait. Many times, using fetal positioning techniques to help baby adjust its own alignment can reduce labour time by hours and avoid any need for medical intervention.
Here are some questions you can ask to help you make a more informed choice:
Previous Cesarean Birth – Vaginal Birth After Cesarean (VBAC) is not a reason in itself for csection. Talk to sympathetic care providers about what the risks are for both options, specifically for your current pregnancy.
BIG Baby – If they say baby is big, remember that petite women birth large babies naturally and safely every day. It is not a reason in itself for medical intervention. Many times delays in labour are due to baby not being in the best alignment with the pelvis (head being tilted a little to the side, chin not being tucked in to the chest, or very tight pelvic floor muscles can add hours to your labour and give the impression that baby is stuck). It is also not certain that your baby will be big. Ultrasounds are notoriously unreliable for determining the birth weight of babies. Baby being too big for the pelvis is actually fairly rare and associated with previous pelvic injury or malnutrition. There is a very in depth article explaining the research on intervention associated with big babies which I will not put the link to here, but if you would like to read it I will be happy to send you the details.
Learn about the options available to you so that you can make a fully informed decision, understanding the risks of one option over another. Every woman and family is different and every pregnancy and labour is different, so choices can vary considerably. It is your body, your baby. Decide what feels right for you. This may or may not be intervention.
If you are induced, or you have epidural, you will likely have constant monitoring and an IV drip. You could still have a smooth labour and avoid further intervention by using the techniques and tips in this Guide. Ask your care providers to help you change position, move around and feel safe and calm.
If you or your baby are not in any medical danger then you are within your rights to politely say no thanks to medical intervention.
Of course if you or your baby are in any danger then please follow your care provider’s advice!
Write a birth plan (or birth preferences as I prefer to call it). Even if this is only so that you have investigated and you understand the different options available, medical or otherwise.
I wrote a short birth preferences list, not only for a vaginal birth, but also for a csection birth, just in case I needed one. This can make things a little more comfortable for you and also can make birth easier for your baby even after the birth.
Part 3 of this Guide to Make Birth Easier is coming soon and explains how to write Birth Preferences, including some incredibly simple things you can do that make birth easier for your baby:
My midwife recommended I put a couple of drops of tea tree oil (essential oil) on my maternity pads post birth (heavy flow night pads are much more comfortable than maternity pads by the way). This helps to fight off infection while you heal, particularly if you’ve had any stitches.
I bought some arnica 30c Pillules (teeny tiny tablets) from the pharmacy which is a homeopathic remedy for reducing swelling, so this is great if you feel bruised or if you’ve had any stitches (perineum or csection).
Always consult your health care providers before taking any medication, homeopathic or otherwise.
One other thing I was VERY grateful for was a tip I had from a midwife within a day or two of giving birth. This was to roll onto my side and push up sideways to get up from a lying down position.
The abdominals separate down the vertical centre-line of the tummy to allow space for your baby to grow. After giving birth, these muscles are naturally supposed to knit back together again down the middle. Many women find that no matter how much exercise they do on their abdomen, it never recovers its former shape. This is because there is a gap between the two sides of the abdominals, and the name for this is ‘diastasis recti’. The gap can sometimes be small (measured by a finger or few) and sometimes it is really wide so your tummy has no support or shape (being asked when you’re due, two years after giving birth, is no fun).
The cause can often be that there was too much pressure put on those abdominal muscles too early following birth simply by sitting straight up forwards in a sit-up motion. Sitting up forwards literally pulls the two sides of the ‘rectus abdominis’ muscles apart instead of letting them knit back together. From lying down, if you roll over onto your side and use your arms to push you up sideways for a few weeks, you will give your abs time to grow together and strengthen again. I’ve wondered time and time again, why more women aren’t told about this simple thing (it drives me nuts that this information isn’t common knowledge). So, there you go!
For a few months after the birth of your baby, and certainly until your diastasis recti has healed properly, it’s best to avoid any sit ups (including the twisting kind) and planking. Just avoiding these exercises will go a long way to helping you in the first place.
There are other exercises you can use which to restore tone and shape to your abs. After my kids a few years ago, I would simply do standing crunches: standing feet hip width apart, curling my tailbone under, pulling my navel towards my spine, tensing my abs and my pelvic floor muscles (kegels), all while gently pressing my sides towards my navel with my hands. Sounds like a lot but you get the hang of it fairly quickly.
More recently I found this diastasis recti abdominal repair workout which seems to have some great reviews of success. Bonus! (Please let me know if this works for you or if you have any problems!)
You will probably want to first check if you actually have diastasis recti, and the extent to which you have it (width and depth) so that you can track your healing progress. Here’s how.
I would say take it step by step. You may want to spend a few days just doing the pelvic tilts at the beginning of the above diastasis recti abdominal repair workout video, to just reconnect with your abdominals. Once you’re comfortable with the pelvic tilts, then move on and include some of the other exercises in that video. When you’ve spent some time doing the beginning and middle sections of the video and feel stronger, add the last couple of exercises into your regular routine.
Again, please obtain the all clear from your doctor before doing any post partum exercises.
Part 3 – Birth Preferences
So watch this space.
Congratulations on your pregnancy, good luck with it all and I hope even some of this is helpful to you. I used pretty much all of it!
Please do feel free to contact me if you have any comments or questions. I am happy to help!
Blog written by Alix Fernando
The content of this blog is not intended, and should not be read as constituting medical advice, diagnosis or treatment. Always consult your doctor, midwife or other qualified healthcare provider before making any changes to your birth plan or recommended routine.