Movement and body position in labor, body positioning and childbirth

Body position

Maternal movement and position changes

Changing position in order to reduce pain makes sense. After all, many of us used positioning to reduce a headache or some other pain in the body. Patients with renal stones which, according to some patients, may cause as much pain as giving birth, are often found in the most amusing positions.

Historically, laboring women have always tried to find comfort by using a variety of movements and body positions. With slow labors, severe pain, or life-threatening problems, their caregivers have moved them in particular ways or into specific position, sometimes even using devices such as ropes, poles, and chairs. As the place of birth shifted from home to hospital during the first half of the 20th century, many changes took place. Many women in labor have intravenous drips, are connected to monitors and get injections of narcotics or nitrous oxide. Because of that the use of movement and various positioning in labor is not used to the degree is had been used in the olden days.

In the 1950s and 1960s, R. Caldeyro-Barcia and his team of researchers in South America began investigating the effects of maternal position on the progress of labor. They found that being upright caused more intense and frequent contractions and more rapid cervical dilation compared to lying down. Unfortunately, in these early studies, the effect of position on pain was not assessed.

More recent studies confirm the initial findings: allowing and encouraging the woman to freely move during labor has numerous benefits. Women who are upright – standing, walking, sitting upright – use less narcotic or epidural analgesia, had shorter first stage of labor and need less oxytocin to accelerate labor compared to those who remained supine – lying on their backs. The intensity and efficiency of contractions is apparently also better in freely moving women. As the result, their labor is shorter.

As far as our topic is concerned, namely pain relief in childbirth, I am not aware of studies on movement and position in labor specifically addressing pain. One of the reasons is that such studies are fairly difficult to conduct. For one, how do you quantify the position during labor? Time spent upright? Sitting? Moving around? It is also likely that the effect will be different for different patients: some will be more comfortable standing up, while others will find more relief leaning forward, lying on the side or walking around. The ability to move around also adds to the feeling of control and may make the pain of childbirth more bearable. Shorter labor also means that less time is spent in pain. In any case, changing and finding most comfortable position cannot cause much harm, and if at least some patients find it helpful, they should be encouraged to use it.

References:

1. Simkin PP, O’Hara M. Nonpharmacologic relief of pain during labor: Systematic reviews of five methods Am J Obstet Gynecol 2002; 186:S131-59.

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Dr. Eugene Smetannikov is a practicing anesthesiologist with the interest in obstetric anesthesia. He is the author of the most comprehensive book on the subject, The Truth About Labor Epidural