It's generally accepted now after many research studies and years of experience from both care providers and labouring women, that using active positions during your labour and birth is a win in regard to many factors.
We know that research shows consistent reduction in pain, decreased risk of intervention and much more, is associated with active birth. But did you know that one particular active position has been demonstrated to be particularly effective?
That's right, the hands and knees position.
A study in 2005 set out to demonstrate the effectiveness of this position in turning a baby from a posterior to an anterior (optimal) position.
Not only did the study show a clear increase in the number of babies in an anterior position when mum was allowed to use the hands and knees position, it also demonstrated a reduction in back pain, better APGAR scores, reduced labour time and minimised risk of operative delivery.
Sounds pretty good, doesn't it? So why aren't more women encouraged to use this position and how can we implement it in our own birth experience?
The tricky thing with a hands and knees position is that it requires mum to be mobile. If baby or mum are being monitored or mum is receiving pain medication or fluids through and IV, they will generally be required to remain relatively still.
For this reason, many hospitals will be unable to allow free movement to a mum in labour who is attached to any cords or tubes.
The other reason is that most Ob/Gyns haven't been trained in birthing a baby while mum is upright, so they will encourage a supine or 'mum on her back' position to make delivery more convenient for them. This is thankfully starting to change to allow more movement.
If you want to utilise the hands and knee's position, here are our TOP TIPS on making it happen.
1. Be proactive.
Speak to your care provider (ie. doula, midwife, obgyn or hospital) and ask about their policies and procedures.
2. Express your wishes.
Make sure your team know what you want and how they can help achieve it.
3. Have the research handy.
This can be a huge help when up against care providers who want you to follow their guidelines, regardless of if they are up to date or not.
4. Have lots of natural pain relief first.
As mentioned above, once we're connected to tubes or cords, it can be hard to use a hands and knees position. So to increase your chances, we encourage women to have a range of tools to use for natural pain relief before heading to medications.
5. Take your time.
Although experience shows us that this position is great for pregnant and labouring women in any amount of time, the research does specify at least 30mins spent on hands and knees.
1. Ina May's Guide to Childbirth - Ina May Gaskin
2. Stremier. R et al. Randomised Control Trial of Hands-and-Knees positioning for occipitoposterior position in labour. Birth 2005. Dec;32(4)243-51.
3. New Active Birth - Janet Balaskas