Upright Birth Positions

DOES THE POSITION YOU GIVE BIRTH IN REALLY MATTER?
The time leading up to labour and birth can be an intense and exciting journey. Apart from the physical changes your body is going through, your thoughts and feelings are intensified and you may be feeling a little apprehensive about coping during labour. This is very common and very normal, however being prepared for your birth can help to increase your confidence, helping you and your birth partner to start looking forward to the big day.
The positions you use during your labour and the birth can have a huge impact on you, your baby and your labour so it is important to consider all of your options beforehand. There are some really easy positions you can use that will work with your body to help make your labour and birth experience the best it can be, and not just for you but for baby too! 
WHAT IS AN UPRIGHT BIRTHING POSITION?
Many women will often think of being “upright” as standing, and whilst this is a great position to labour and even give birth in, it is not the only upright position you should try. Others include sitting upright during labour, kneeling, on all fours or squatting using a CUB. It can also be helpful being held and supported by your birth partner, lying on your side or sitting on a birth traditional stool (or CUB in a single inflation) during pushing.  Most women will instinctively find their own position but these upright, mobile options are often more comfortable than lying down on a bed on your back with legs in the air.
WHY ARE UPRIGHT BIRTHING POSITIONS SO IMPORTANT?
There are lots of studies from around the world that have proven just how much help being upright can be when giving birth. Some of these great advantages include: 

• 28 – 30% more space in your pelvis. 

Your pelvis is made up of four separate bones and being upright enables the joints between the bones to move more freely, creating more room for your baby to be born.  More space, however small, ultimately leads to an easier birth.

• Your baby’s heart rate is a good sign of how well they are coping and whilst most babies will cope very well with labour and birth, some can become tired and this can affect their heart rate.  The good news is that research has shown that if you adopt more upright positions, you can reduce the likelihood of your baby’s heart rate showing distress by a massive 54%
• The length of both the first stage, while your cervix (the neck of your womb) is opening up, during labour and the second (pushing) stage is significantly shorter, in fact combined are on average almost 2 hours shorter!
• Mothers who use upright positions reduce their risk of needing an emergency Caesarean Section by an incredible 29%
• Being upright has been shown to result in a 23% reduction in medically assisted births –With more space, less distress and a shorter labour ultimately means fewer necessary medical interventions.
• Mothers who give birth in upright positions such as kneeling, side lying or all fours are less likely to tear and need stitches compared to those who give birth lying on their back on a bed.  If leg supports (stirrups) are used the mother is much MORE likely to have a serious tear.
• Mothers who use upright birthing positions report feeling less pain so reduce their need for an epidural. They also report better satisfaction with their birth experience than mothers who give birth lying down.

 
So a shorter labour, an easier birth, a less stressed baby, fewer stitches, less medical intervention and less risk of an emergency C. section……what’s not to like?
 
Some upright positions you may like to try
If you are not planning to have a home birth, your birth centre or hospital will have a variety of equipment designed to help you use more upright positions, these might include a CUB but being upright is all about gravity as well as making space and different positions can be useful at different times.  Here are some great examples for you to try:
WALKING and/or STANDING is great for encouraging your baby into the best position for labour and birth.  You may find your contractions are less painful and more effective, which can bring labour on quicker.  The use of gravity also helps in creating that “urge to push” feeling.  Rest when you want to though or you may become tired.                                                                                                                
SITTING UPRIGHT is best used in late pregnancy and early labour, as it encourages your baby into the best position ready for birth.  Sitting upright helps you to feel relaxed and encourage the joints in your pelvis to move more freely.  It also gives you the chance to rest, whilst gravity works in your favour.  Your birth partner can also support you from behind, if needed, offering a back massage or gentle encouragement.
KNEELING can be really helpful in encouraging your baby to move down through your pelvis during labour.  Your contractions may feel less painful and be more productive.  Make sure you rest in between the contractions and stretch your legs regularly by walking/standing or you may end up with sore knees!
Many women find this ALL FOURS position particularly comfortable during labour and birth. This position is great for relieving backache and for doing some pelvic rocking. It also provides your birth partner with an ideal opportunity to massage your back or offer to apply a gentle hip squeeze. 
SQUATTING provides the maximum space in your pelvis for giving birth. It is a useful position to use in the pushing part of labour, as it encourages your baby to move down, although you may need to master the skill of keeping your balance. So trying it out beforehand and finding comfortable way to support yourself is highly recommended.  Practicing antenatal yoga may also be beneficial in helping to achieve the correct squat position.  Note that some research has shown using a squatting position whilst giving birth may increase your chance of a tear to your perineum (the space between your vagina and anus). 
The SIDE LYING position, preferably on your left side, is a good resting position for you and helps maintain good oxygen supply to your baby. You can use pillows or cushions to support you comfortably and your birth partner can help support your top leg, particularly if choose to push in this position.                          
WHAT IF I OPT FOR AN EPIDURAL, CAN I STILL REMAIN UPRIGHT?
With epidurals it can mean your movements are more restricted. However by being creative, you can still use upright positions even if you are unable to move off of the bed.  Finding safe ways to support different positions can still help you have a natural birth.  Lying on your left side or supported sitting on a CUB can be really helpful.
SO FINAL thoughts …Give you and your baby the best chance of achieving a safer, healthier, natural birth by using comfortable, upright and mobile birthing positions. With lots of research supporting the benefits of upright positions, you can make your labour shorter, make giving birth easier whilst reducing the risks of complications during the birth.  Always trust your instincts and consult your midwife if you have any concerns about you or your baby’s wellbeing.