Women in labor can shorten the first stage by about an hour by walking, kneeling, standing, or otherwise avoiding lying in bed, according to a review of 21 birth studies covering over 3700 births.
“This shortens labor by about an hour and, for a lot of women, an hour would be really important.” – Teri Stone-Godena, director of midwifery at Yale School of Nursing
The review also found that those women who were out of bed for the labor during its early stages were 17% less likely to choose an epidural for pain relief. No difference in birth outcomes, such likelihood of a C-section, was detected in the review, which means that women can feel safe using any position during birth without worrying about negative effects on the outcome.
“The ability to change positions, to utilize a wider variety of positions, and try other options, such as hot showers, birthing balls and beanbag supports, may help reduce overall pain and give women a greater sense of control over the progress of their labor.” – Annemarie Lawrence, lead review author and research midwife
Why does staying out of bed and avoiding the supine position reduce the pain and shorten labor? According to the authors, when the mother is upright, the diameter of the pelvis expands slightly, which means there is also more room for the baby to move downward, putting less pressure on nerves in the spine.
“The physiological advantages of upright positions and mobility include the effective use of gravity, which aids in the descent of the baby’s head. As the head is applied more directly and evenly against the cervix, the regularity, frequency, strength and therefore efficiency of uterine contractions are intensified.” – Lawrence
When the mother is moving, this also hastens birth by using gravity to help the baby to get into the best position. “As the head is applied more directly and evenly against the cervix, the regularity, frequency, strength and therefore efficiency of uterine contractions are intensified.”
Conversely, lying flat on the back during labor puts a great deal of pressure on blood vessels in the abdomen. “There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor.” said Lawrence. When in the supine position, the entire weight of the pregnant uterus is on the blood vessels supplying oxygen to mother and child, which has the potential to lead to problems for both.
Another positive side to staying upright or choosing the position that feels best to the mother is that it is empowering for her. Some studies have found that being able to make choices and be in control of the situation can reduce pain and feelings of mental stress.
“I think this research is very vindicating of women being allowed to assume positions of comfort. Listening to their bodies is what they need to do. Most of time when we limit people’s activity, it isn’t for reasons that are soundly based on evidence. This clearly shows that there are no advantages in staying in bed unless that’s where you want to be.” – Stone-Godena
The study is published in the latest edition of the Cochrane Library.
Image: nagobe at Flickr under CC License
Great topic! I know for me it most definitely made a difference to be upright. Bouncing on the birthing ball and using the squat bar on the bed were the best decisions I made during labor. Well, besides going all natural. 😉