The advantages of mobility during labor

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In the late 19th Century, the American obstetrician Engelmann noted that in cultures not influenced by Western society women frequently squatted, stood up and kneeled during labor, sometimes alternating between these positions.

Representations of upright birthing positions are also frequently found in ancient art, as well as in 17th-19th century drawings. Birthing chairs of the 17th-19th century also indicate a preference for the upright or semi-reclining positions during birth. It therefore seems that the recumbent position for labor and delivery was only made popular by modern western Obstetrics during the 20th century. 

 

Modern Obstetrics has brought many important advances to women’s health, particularly with the marked fall in maternal and perinatal mortality that have changed the way modern society looks upon labor. However, this does not necessarily mean that all introduced measures are beneficial, and some excessive medicalisation of labor appears to have occurred. 

 

The rationale for the upright and mobile positions during labor and delivery, is that gravity aids the descent of the fetus, uterine contractions are intensified, there is less uterine compression of abdominal vessels, transverse pelvic diameters are increased with squatting and kneeling, and mobility usually provides increased distraction from pain and a greater sense of control. On the other hand, most western women prefer to lie down once they have reached 5-6 cm dilatation, and they cannot maintain squatting or kneeling positions for long periods of time.

While in the past continuous fetal monitoring and epidural techniques limited women’s mobility during labor and delivery, the most recent technologies no longer interfere with this, so they can no longer be seen as a reason to limit women’s movements.

While in the past continuous fetal monitoring and epidural techniques limited women’s mobility during labor and delivery, the most recent technologies no longer interfere with this, so they can no longer be seen as a reason to limit women’s movements. 

 

The two major questions raised in the last few decades concerning mobility during labor are: 

 

  1. Should women in labor be encouraged and assisted to adopt upright and mobile positions during labor?

  2. Should women be encouraged to deliver in an upright position? 

 

Regarding the first question, there is evidence from randomised controlled trials that mobility and upright positions reduce the duration of the first stage of labor by an average of 1h22, reduce the incidence of cesarean delivery by 29%, and reduce the use of epidural by 19%.

 

Regarding the second question, there is evidence from randomised controlled trials that the upright position is associated with a 54% decrease in abnormal fetal heart rate patterns, a 22% reduction in instrumental vaginal deliveries, a 21% reduction in episiotomies, but a 35% increase in second degree perineal tears and a 65% increase in blood loss over 500 ml. It therefore seems that delivering in the upright position has both advantages and disadvantages.

 

In conclusion, there appear to be many advantages of encouraging and assisting women to adopt upright and mobile positions during the first stage of labor, although the majority may prefer to lie down once they have reached 5-6 cm. Delivering in the upright position appears to have both advantages and disadvantages, so it preferable to allow women to choose their position for delivery, or alternatively encourage them to adopt a semi-recumbent position, where healthcare professionals retain the control of perineal support during delivery of the fetal head.

 

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(8):CD003934.

Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anesthesia. Cochrane Database Syst. Rev. 2012, (5): CD005073

Learn more about mobility during early stages of labor, for a moving birth experience

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