"Cynthya was our doula for the birth of our third child in April 2016. As this was my third birth, and I had been attended to by a doula at the first two, I knew that finding the right doula was crucial to a successful and satisfying birth." - Winter Wheeler-Young
Benefits of Upright and Spontaneous Pushing and How to Get Support For What You Want
The female body is designed to give birth and has been doing so successfully for years. All too often, medical interventions are used unnecessarily leading to more interventions, medicine, and possibly, complications. In recent years, with increased technology and medical interventions, women have been being limited to giving birth on their backs with guided pushing by their care professionals in recent years. Evidence does not support these restrictions.
No matter which birth option you choose - medicated or unmedicated - the key takeaway is to have the right support around you to optimize your birth outcome. Throughout the course of labor, including the pushing stage, women benefit from frequent position changes and ideally, should be free to select them at will.
Lamaze’s Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Urges to Push
In order to avoid giving birth on your back, following the Healthy Birth Practices of allowing labor to begin on its own, changing positions throughout labor, having continuous support, and avoiding unnecessary interventions really come into play.
First and foremost, allowing labor to begin on its own is a key ingredient of avoiding unnecessary interventions that in turn could cause you to have to give birth on your back because it avoids the use of synthetic drugs to get your labor started. Changing positions and having continuous support throughout your labor will also help you avoid interventions like medical pain management by easing the intensity of contractions.
Throughout history, women have been pictured giving birth in positions that are much more suitable for positive birth outcomes. Squatting, sitting, and standing all use the help of gravity to move the baby down and open the pelvis so the baby has more room to descend. Being able to freely change positions is much needed during labor, not only to ease discomfort but to promote the natural descent of the baby. Freedom of movement and working with your body will allow you to determine what position is optimal for you to push.
Many care providers prefer women to birth on their backs with their legs up in stirrups simply because it's easier access to see and catch the baby. Laboring on your back generally comes with directed pushing because it's likely that you've had an epidural which caused you to have to be on your back in the first place, otherwise you’d likely need/want to move during the pushing phase. (With an epidural, you may not feel the urge to push and need guidance on when and how to push effectively.)
Directed pushing is exhausting and according to the Lamaze website, “Goer and Romano (2012) found evidence to demonstrate that directed, forceful pushing had the potential to increase pressure on the baby and the umbilical cord, and the tissues of the perineum, resulting in more tears and a weaker pelvic floor musculature which can result in urinary incontinence."
To help ensure you can birth in the position you choose, follow these tips:
Talk to your care provider and choose one who fully supports any position for labor and birth.
Hire a doula or be sure to have continuous labor support available to help you avoid unnecessary pain medications. A doula is also very helpful with positioning if you do end up needing pain medication that limits mobility.
Get educated by taking a birth preparation class. The more you know about birth and what's normal, the more confidence you will have in the birth process and the more comfort measures you will learn.
Labor at home for as long as possible. The earlier you get to the hospital, the more likely you may be to use pain relief medication. Think of it like a kid in a candy store. If the "candy" is there, you may want to sample it!
When NOT lying on your back while giving birth, you oxygenate your body so you won't be lying on your aorta. Since the evidence is not strong enough at this point to recommend one specific birthing position over another, you should receive support to birth in whatever position feels right to you. However, flexible sacrum positions—those where you don’t put your weight on your tailbone—appear to be more helpful to normal vaginal birth.*
No matter what birth option you choose, medicated or unmedicated, the key takeaway is to have the support around you who will optimize your birth outcome. Throughout labor, including the second (pushing) stage, women benefit from frequent position changes and ideally, should be free to select them at will.
This post is part 6 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for our final post in this series, Keep Parent and Baby Together.
Read part 2, Hormones and the Waiting Game
Read part 3, Make Labor Productive
Read part 4, When Childbirth Moved Into Hospitals
Read part 5, Avoid Routine Medical Interventions
Read part 6, Benefits of Upright and Spontaneous Pushing
Read part 7, Keep Parent and Baby Together
Resources cited:
https://www.lamaze.org/Connecting-the-Dots/book-review-optimal-care-in-childbirth-the-case-for-a-physiologic-approach-reviewed-through-a-childbirth-educators-eyes
https://www.lamaze.org/Portals/0/HBP%20%235%20Avoid%20Giving%20Birth%20on%20Your%20Back%20and%20Follow%20Your%20Body%27s%20Urges%20to%20Push.pdf
*Excerpt from Evidence Based Birth Handout, Evidence on Birthing Positions.
https://evidencebasedbirth.com/evidence-birthing-positions/
Related articles:
5 Labor Tools for Pa
Postpartum Expectations
5 Reasons to Hire a Birth Doula
When Childbirth Moved Into Hospitals Labor Support Was Left Behind
The 2013 Cochrane Review concluded that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
Part 4 of 7, written by Christina Thomson, Certified Birth Doula and Lamaze Childbirth Educator
Healthy Birth Practice #3: Bring a loved one, friend, or Doula for continuous support.
As humans, we do better when we’re surrounded by those we love and trust, with people who are positive and encouraging. Historically, women were helping other women as they labored and gave birth. Since most births were happening in the home with a local midwife delivering the baby, the laboring mother took comfort and support from her female relatives or close friends.
As we moved away from home births and into hospitals, this tradition wasn't as common. Your support person became your doctor or nurse. In modern hospitals, however, it is difficult for staff to offer the continuous support that you need during labor and delivery. According to the Journal of Obstetric, Gynecologic, and Neonatal Nursing, women expect their labor nurses to provide information, comfort, and support, but research shows less than 5 percent of a nurse's time is spent doing that.
Credit Lamaze International
What does good labor support look like?
According to The Official Lamaze Guide, it's “making sure you are not disturbed, respecting the time that labor takes, and reminding you that you know how to birth your baby.” Your support person “should spin a cocoon around you while you're in labor – create a space where you feel safe and secure and do the hard work of labor without worry.” Good labor support might include: helping you change positions or move around, offering words of encouragement, reminding you to eat or drink, and offering you cold cloths if you are hot. “Good labor support tries to respond to all your physical and emotional needs throughout labor.”
The 2013 Cochrane Review finds that women who received continuous labor support had the following positive outcomes: more spontaneous vaginal births, fewer cesarean surgeries or instrumental vaginal births, less use of epidurals and other pain medications, slightly shorter labors, and greater satisfaction with their birth experiences. Babies of these mothers were less likely to have low Apgar scores at birth. They conclude that all women should have continuous support during labor, and further state that the services of a person, such as a doula, with some training, who is experienced in providing labor support, is the most beneficial.
“The doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them.”
In Penny Simkin's book, The Birth Partner, a birth doula “guides and supports women and their partners continuously through labor and birth.” According to Lamaze International, a doula is “trained to provide continuous physical, emotional, and informational support to a mother before, during, and just after she gives birth.” A doula isn't going to replace your birth partner.
In fact, the doula’s presence allows your birth partner to participate in the birth in a way that is meaningful to them. If your partner wants to be more active in supporting you, your doula can gently remind them about techniques they learned in your childbirth class, assist them in physically supporting you, and model ways to provide emotional support. If partners prefer to let the doula be the primary support person, the doula can take the lead and help partners to participate in the birth to their level of comfort, while ensuring that the mother’s needs are met. The doula may even give the partner a break to go to the bathroom or to get something to eat.
The true value of having a doula is that a doula knows birth. She brings a quiet confidence in the process of birth, which allows you and your support team to relax and find strength as you do the hard work of meeting your baby. Research has shown doulas to be so effective that neonatologist and researcher John Kennell says, “If a doula were a drug, it would be unethical not to use it.”
Continuous labor support is an essential component of safe, healthy care during labor and birth. All women should be allowed and encouraged to bring a loved one, friend, or doula to their birth.
In both Atlanta and Tampa, we teach an "intensive" preparation for childbirth - the 3 Hour Labor Lesson. You can schedule a private prenatal lesson here. Registration includes weekly follow-up emails to further learning, and access to our online Learning Center where you may watch videos, review current evidence, and download sample birth plans. This is an excellent opportunity for you and your birth partner to gain knowledge on healthy birth practices to help you have the safest birth for you and your baby.
This post is part 4 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for upcoming posts in our series, How To Alleviate Fears and Manage Labor Pain.
Read part 2, Hormones and the Waiting Game
Read part 3, Make Labor Productive
Read part 4, When Childbirth Moved Into Hospitals
Read part 5, Avoid Routine Medical Interventions
Read part 6, Benefits of Upright and Spontaneous Pushing
Read part 7, Keep Parent and Baby Together
Related posts:
How Taking a Childbirth Class May Prevent Birth Trauma
5 Reasons to Hire a Birth Doula
6 Points For Birth Partners to Consider When Hiring a Labor Doula
5 Reasons Your Labor Nurse Cannot Be Your Doula
How to Make Healthy and Safe Decisions During Pregnancy and Parenting
This new resource is great for expecting parents and their partners to help them keep track of important events, questions to ask, and even has a contraction timer.
Lamaze launched its first-ever mobile application for parents, Pregnancy to Parenting. This unique app is complete with evidence-based weekly development updates, daily tips and helpful tools developed by Lamaze Certified Childbirth Educators. This new resource is great for expecting parents and their partners to help them keep track of important events, questions to ask, and even has a contraction timer. The best part is that it is free to download - try it today.
Lamaze Leads The Way: The Trusted Source of Childbirth Education
It is definitely advantageous for you to take a childbirth class but even more so to take a class taught by someone who has a lot of real-world knowledge and experience such as a Labor & Delivery nurse from the busiest hospital in the US.
by Lauren King, RN, Certified Lamaze Educator and DONA Birth Doula
For 55 years, Lamaze International has been the leading provider of evidence-based education programs that prepare childbirth educators to teach with skill and confidence. The Lamaze childbirth education certification is the only childbirth educator program that has passed rigorous standards set by the National Commission for Certifying Agencies (NCCA). The Lamaze certification program has been designed to meet the highest professional standards, with quality education offerings that help candidates develop as skilled, trusted LCCE educators.
I worked a labor and delivery nurse for 6 years before becoming a childbirth educator and doula. However, that alone didn’t make me a professional educator. In order to become certified through Lamaze as a Lamaze Certified Childbirth Educator (LCCE), I had to first attend a 2-day seminar. The seminars are not cheap, and they’re usually not nearby – making them even more of an investment. I drove to Raleigh, NC and stayed in a hotel for 3 nights to attend the seminar that led me on the path of certification.
In my seminar were people from all walks of life, but I was (surprisingly!) the only nurse! I couldn’t believe it. All these other people who had NO prior medical knowledge – very limited history on anatomy, maybe no formal knowledge of physiology, and most people in the class had extremely limited knowledge on labor and birth. My advantage to having medical experience was further made clear when we did a “medical lingo” activity. Do you know a “ctx” is? How about a toco? Do you know what pit stands for? (Contraction(s), uterine monitor and Pitocin.) So, yes, it is definitely advantageous for you to take a childbirth class, but even more so to take a class from someone who has a lot of real-world knowledge and experience.
“I chose Lamaze because around the world, it is a well-known and trusted name in childbirth for the past 55 years.”
After my seminar was complete, I had a mentor observe me teach a class. Afterward, I was permitted to sign up for the certification exam. It is only offered twice a year and has around 150 questions. I sat in a little closet (literally) with a desk, a chair, and the computer in front of me. Talk about stressful! A few weeks later, I was notified that I had passed the test, and I was officially a Lamaze Certified Childbirth Educator.
Now, to maintain my certification, every 3 years, I must submit 25 hours of approved continuing education, as well as make another monetary investment. (This is on top of the 30 hours and monetary investment I have to submit every two years to maintain my nursing license!) Lamaze does an awesome job of offering a lot of those hours through various seminars and workshops. The courses I take must relate to one of the seven Lamaze Childbirth Educator Competencies:
Competency 1: Promotes the childbearing experience as a normal, natural, and healthy process which profoundly affects women and their families.
Competency 2: Assists women and their families to discover and to use strategies to facilitate normal, natural, and healthy pregnancy, birth, breastfeeding, and early parenting.
Competency 3: Helps women and their families to understand how complications and interventions influence the normal course of pregnancy, birth, breastfeeding and early postpartum.
Competency 4: Provides information and support that encourages attachment between babies and their families.
Competency 5: Assists women and their families to make informed decisions for childbearing.
Competency 6: Acts as an advocate to promote, support, and protect natural, safe and healthy birth.
Competency 7: Designs, teaches, and evaluates a course in Lamaze preparation that increases a woman’s confidence and ability to give birth.
Don’t take childbirth education too lightly!
As your educator, I LOVE teaching you everything I possibly can about pregnancy and birth. I do it because it is my passion! I chose Lamaze because around the world, it is a well-known and trusted name in childbirth for the past 55 years. Lamaze International stays up-to-date on all the current research and recommendations, and I pass all of this on to my students.
Knowledge is power but only if you know how to apply it to your situation. Schedule a private childbirth lesson in your home to maximize your chances of a having a comfortable and relaxed birthday party.
