Why is movement during labor important in improving birth outcomes?
For natural birth to occur, your baby has to move through your pelvis and put pressure on your cervix so it dilates, which allows your baby to be born. You and your baby's body are perfectly designed for birth, but your bodies need to work together to do so in the most efficient way. Using movement as a way for you and your baby to work together through labor, movement can improve birth outcomes by:
helping to shorten the length of labor
lowering the risk of medical interventions
helping to manage pain during labor
How movement can help shorten labor
Long labors can lead to maternal exhaustion and sometimes complications. This can be prevented by movement because as you move into different positions, your pelvis is able to open up, allowing your baby to move down and labor to progress.
We want to move in ways that allows your baby to engage into the pelvis. Having your legs externally rotated so your knees are wide and your toes are pointed outwards will help create more room in the top of your pelvis for your baby to descend.
You might try sitting on a birth ball with your legs wide and rocking your hips forward and back. This tilts the pelvis, widening the pelvic inlet and allowing your baby to move downwards.
I love recommending leaning over in a wide standing stance in between contractions, then standing and tucking your pelvis forward during contractions. Once again, that pelvic tilt forward is great for giving your baby the opportunity to drop down into the pelvis.
I also love recommending hands and knees positions with legs wide and feet pointing outwards. This is a good position for when you need rest. You can lay your chest over a CUB chair (Comfortable Upright Birthing chair) or a birth ball or pillows so you are not holding yourself up with your arms.
Lying on your side with pillows or a peanut ball in between your legs is a great resting position that also opens the pelvis for baby to move downwards. You really want to make sure your knees are opened wide though, so use multiple pillows if you don't have a peanut ball. Doing this on one side and then the other every half hour or so is a great way to utilize movement with an epidural since epidurals can make it unsafe to get out of bed.
How movement can lower the risk of medical interventions
Getting baby engaged into the pelvis is huge when it comes to speeding up labor, but also in preventing medical interventions such as cesarean surgery. In a Spinning Babies blog post called Three Levels of the Pelvis, Gail Tully writes, "Helping a baby engage when not yet engaged at the start of labor is the most effective action to avoid an unnecessary cesarean" (citation).
But, to minimize the risk of needing interventions, you don't only want your baby to be engaged in your pelvis, you want them to be engaged properly in the pelvis.
What does that mean?
Most people know that a breech position is when your baby's head is up by your ribs rather than down by your cervix. This can create certain complications with birth. It does not mean that a vaginal birth cannot be achieved, but you should have an experienced care provider who is comfortable and confident in vaginal breech deliveries to achieve a vaginal birth.
But, even with a head down baby, there is still a position that can raise the risk of needing medical intervention.
This position is called Occiput Posterior or OP, which is when your baby's back is facing towards your back. If your baby settles into the pelvis and descends for birth in this position, their head will measure larger than if they were in OA (occiput anterior) where their back is towards your bellybutton. This can cause labor to be longer and harder, and may lead to complications such as assisted delivery, a greater chance of tearing, and in some cases, a cesarean surgery.
While it is normal for your baby to turn in different directions during pregnancy and even during labor, movement can assure that your baby is settling into your pelvis in a position that makes birth easier. In OA, which is the optimal fetal position, you and your baby's bodies work in harmony during birth and the chances of needing medical interventions are significantly lowered.
How do you achieve this with movement?
Being in forward leaning positions such as hands and knees or leaning over in a standing position can be great for allowing your baby plenty of opportunity to settle into the OA position.
Spinning Babies recommends a Dip the Hip move that I love using with clients to move OP babies into OA, or to encourage an OA baby to stay in that position.
How movement can help with pain relief
Movement during labor is a form of pain management that supports the natural physiological birth process. In the natural birth process, the body releases oxytocin, a hormone that causes labor contractions, as well as endorphins, a natural pain relieving hormone.
This natural hormonal process can be interrupted by fear and tension in the body. Studies have shown that movement can not only provide you with a sense of power and control during labor which decreases fear, but also can help you to release tension in your body.
How does movement help you release tension in your body?
Partly, because it offers distraction from the discomfort of labor. Rather than tuning out of your body, you are tuning into the way you are moving your body and focusing on the sensations and coordination of movement. This shift in focus can help you to release tension in your uterus and pelvis that may actually be preventing labor and the natural production of labor hormones.
And, to come full circle, by releasing that tension, you are again helping speed up labor and decreasing your chances of needing medical intervention. It's an endless positive loop when you are able to move your body in labor.
In conclusion
Movement and position changes in labor supports the natural birth process, which means that your body is more likely to naturally birth your baby without needing interventions. Your body is built to birth, and it is built to move in labor and birth.
By giving your baby plenty of opportunity to lower into the pelvis, turn into the best position for birth, and by giving your body the freedom of movement to cope with labor sensations, you are setting yourself up for success. You are following your body's natural process. And nature truly knows what it's doing!
References:
Dekker, Rebecca,RN, PhD. “The Evidence on: Birthing Positions,” Evidence Based Birth. 2 October 2012, updated11 July 2022. https://evidencebasedbirth.com/evidence-birthing-positions/
Dekker, Rebecca, RN, PhD. “Positions during Labor and their Effects on Pain Relief,” Evidence Based Birth. 12 March 2018. https://evidencebasedbirth.com/positions-during-labor-and-their-effects-on-pain-relief/
Ondeck, Michele, RN, MEd, IBCLC, LCCE, FACCE. “Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor,” The Journal of Perinatal Education. Fa;; 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235058/
Shillings, James, MS, CD (DONA), IBCLC, LCCE, FACCE, Romano, Amy M., CMM, and DiFranco, Joyce T., RN, BSN, LCCE, FACCE. “Care Practice #2: Freedom of Movement Throughout Labor,” The Journal of Perinatal Education. Summer 2007. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948086/
Tully, Gail, "Three Levels of the Pelvis," Spinning Babies, March 2016. https://www.spinningbabies.com/optimal-maternal-postions-at-the-levels-of-the-pelvis/#:~:text=The%20baby%20turns%20three%20times,the%20size%20of%20the%20baby.