Physical Preparation for Birth

A recent research article on birth positioning [1] and a policy paper on reducing interventions in labor [2] reinforced my thinking that how we prepare women for labor and birth needs updating. As we learn more and more about the physiology of labor and birth [3], we are learning which practices are productive for a healthy birth and which practices work against birth.

Augmenting our knowledge and skills, as well as encouraging exercise components that improve outcomes truly prepare women for the intense challenges of giving birth. So here are some up and coming tips:

Hands and knees is mechanically efficient for mom’s body to “cradle” the fetus.

Why is this pregnant woman on her hands and knees?

Hands & knees can help low back pain in pregnancy & labor. It also reduces risk of injury to the pelvic floor during birth [1].

This position innervates transverse abdominal support of the abdomen. It opens SI joint via knee press effect. Practicing breathing, pelvic tilts, and modified planks in this position improves hands and knees endurance.

Why are these pregnant women squatting with partner support?

The most common reason given for practicing squats is that this action “opens the pelvic outlet.” This is true. But knowing how valuable kinesthesia is in executing challenging actions, I find that I must first teach women (and their partners) to sense where the target outlet is – between the sitsbones! This helps them learn to release the pelvic floor muscles and know where to focus their pushing efforts.

Also, having the support partner understand what is happening, as well as learning to support this action, is equally valuable to mom. It creates an important bonding and trusting activity. Explaining, illustrating with charts, and then teaching the ability to release, then bulge or distend the pelvic floor in the target area turns out to be one of the activities for which both partners are most grateful.

Why is this woman taking big strides and really moving out?

Aerobic fitness helps provide endurance in labor

Moving is a complicated neurological phenomenon and requires large afferent fiber pathways. The gate-control theory of pain states that movement deters other sensations that must travel up smaller pathways to reach our attention. Example: When you hit your elbow funny bone, you are likely to move around and rub the area, NOT sit and focus on the discomfort.

Labor is an endurance event, so if a mom is going to use movement (and gravity – another big helper) for 10 or 12 hours in labor, endurance fitness is a key preparation. Whether she jogs, swims, spins or dances, cardiovascular activity is possibly the most valuable exercise component she can acquire.

Some Quick Tips, based on recent research:

  • Encourage moms in early labor to stay out of the hospital as long as they can, unless they are given a significant medical reason to go in by their care provider. Once in the hospital, try to minimize the procedures that she must undergo [2]. The hospital or birthing center where she gives birth can, itself, be a factor in how she births [4].
  • If this is a healthy pregnancy, encourage her to eat in early labor and maintain her fluid intake throughout labor [5]. Endurance drinks can be useful to help maintain electrolyte balance during this long event.
  • Let her know she can ask to have hands-on support of her pelvic floor as the baby descends in pushing. Have her discuss this ahead of time with her care provider. This is another method that has been shown to reduce injury [6].
  • She can also ask to “labor down” rather than push for a few contractions after she is fully dilated, if she feels she needs to regroup once the head is through the cervix [7].
  • A good resource for positioning for birth and for recovery exercise is a Physical Therapist who has a PT certification in women’s health. For more information, go to PTPN.com or their Physiquality Blog.

REFERENCES

These references are worthy reading on our changing concepts of pregnancy, labor and birth practice. All of us who work with pregnant women are important influences in helping them gain skills and confidence to cope with this intensely physical, challenging experience.

  1. Zhang H et al. A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery July 2017 50:117-124. http://www.midwiferyjournal.com/article/S0266-6138(17)30236-X/abstract
  2. ACOG. Approaches to Limit Intervention During Labor and Birth. Committee Opinion Number 687, February 2017. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth
  3. Buckley SJ. Hormonal Physiology of Childbearing: Evidence and implications for Women, Babies, and Maternity Care. Childbirth Connection, 2015. PDF: http://www.nationalpartnership.org/research-library/maternal-health/hormonal-physiology-of-childbearing.pdf
  4. Shah NT. System Complexity and the Challenge of Too Much Medicine, Annual Meeting ACOG 2017. http://annualmeeting.acog.org/growing-c-section-rates-can-be-mitigated-by-counteracting-hospital-complexities/#.WRCbmxRaHFK
  5. ASA Press Release. Most healthy women would benefit from light meal during labor. Nov. 6, 2015. http://www.asahq.org/about-asa/newsroom/news-releases/2015/10/eating-a-light-meal-during-labor
  6. Leenskjold S, Hoi L, Pirhonen J. Manual protection of the perineum reduces the risk of obstetric anal sphincter ruptures. Dan Med J May 2015; 62(5). pii: A5075. https://www.ncbi.nlm.nih.gov/pubmed/?term=Leenskjold+S%2C+Hoi+L%2C+Pirhonen+J.+Manual+protection+of+the+perineum
  7. Brancato (Ozovek) RM, Church S, Stone PW. A Meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor, JOGNN 2008; 37(1):4-12. https://www.ncbi.nlm.nih.gov/pubmed/?term=Brancato+RM+A+Meta-analysis+of+passive+descent

Pregnancy Exercise – The Evolutionary Imperative for Vigorous Activity

I have long wanted to write this post. Recently two articles appeared in the NY Times prompting me to move forward. One article dealt with how it is that ongoing vigorous exercise produces brain enhancements. The second article dealt with how running creates its “high” and explained why the resulting addiction is an evolutionary benefit for human survival.

Every day in Africa a gazelle wakes up.
It knows it must run faster than the fastest lion or it will be killed.
 Every morning a lion wakes up. It knows that it must outrun the slowest gazelle or it will starve to death.
 It doesn’t matter whether you are a lion or a gazelle.
When the sun comes up, you better be running.

Abe Gubegna
Ethiopia, circa 1974

The pregnant mom who exercises vigorously and regularly – the one who runs or swims or does aerobic dancing – is not the one at risk, or whose infant is at risk, of a lack of tolerance for the rigors of labor or for lifestyle health problems. It is the sedentary or low activity mother and her offspring who are at risk. I have written at length on this reality in my chapter on Women and Exercise in Varney’s Midwifery.

This realization has plagued me for ages, and the two articles in the Times convinced me to make this statement, explain why it is true and exhort women of childbearing age to become aerobic animals.

In the contemporary world, we are not as active as previous generations. Few women exercise to the extent required to develop the capacity to withstand the rigors of birth. It is little wonder that so often health care providers hear that women are afraid to exercise, and childbirth educators hear that pregnant moms are afraid of birth and don’t have confidence in their ability to do it. There are solutions for these issues…

The biggest bang for the buck is aerobics. This gets almost everything that helps you in labor. It increases endurance, strength and range of motion. It improves breathing capacity (you get more oxygen + less fatigue). It reduces your need to tap your cardiac reserve (your body works hard in labor but not to the degree it must if you are not fit). Plus, regular participation in a good cardio or aerobic workout gives you the mental toughness and confidence you need to know that your body is capable of the work and the recovery – what we call body trust. Fit Pregnancy has discussed the myths surrounding how hard a pregnant woman can work out.

Learning useful positions and movements is extremely helpful. Be sure that your workout also includes strength and coordination movements – such things as squatting, core movements for pelvis and spine, and other motions that aid your progress in labor. Being upright and moving are keys to a healthy labor. These require strength and coordination.

Mental focus and being present teach you to work with your body. Activities such as relaxation training, yoga, pilates for pregnancy and dance help you develop the mental skills (mindfulness and deep breathing) that accompany your movement. Learn to recognize your body’s signals so you know when it’s time to push.

A truly effective use of your time is a one hour class a couple times a week that combines all these elements. We have known this for decades. The evidence is clear that it works. Keep moving…right into labor and birth!

Find a safe and effective class or trainer.

Pregnancy – Coping Tips for Dads or Partners

This is a guest blog by The Pregnancy Zone.

Expectant dads or partners can feel out of the loop during pregnancy, with a spate of unfamiliar feelings and anxiety over what to do. But there is a lot he can do for his partner and baby during this period. As a mom to be, here are ideas you can suggest to your partner to help him feel more involved and included.

Become Informed

Pregnancy is fascinating! To find out what is going on with mom and baby, read one of the many books on the subject, do some internet research and talk to experienced dads. This will brighten his experience. Just knowing about common pregnancy discomforts, and suggestions to alleviate them, can help a partner feel the experience more keenly.

Get Involved

Go to the prenatal check-ups with mom. Be there for support and reassurance that all is well. It is educational and helpful. If there is an ultra-sound scheduled, it can be deeply moving to ‘see’ the baby for the first time.

Attend Classes Together

Birth Preparation classes, such as natural birth preparation, can help the couple bond and will be of great value when labor happens.

Go Shopping

If mom is shopping for baby necessities—booties, onesies, tiny hats and socks—go along. Indulge mom a bit. It might even be a surprise to see how enjoyable shopping for baby can be!

Get the Nursery Ready

Putting together a bassinet or changing table or arranging for storage space for mom and baby are concrete projects that can give dads-to-be some real, solid purpose. This can be a hugely interesting DIY project as well.

Create a birth plan

The father-to-be needs to discuss with the mother what kind of birth she would like and help make necessary preparations in advance. If considering a home birth, both parents will need to study the risks and benefits, along with getting to know the midwife well. If it is water birth that the mother desires, the new dad should consider the logistical requirements of this and prepare accordingly.

Make sure finances are in order

Both parents need to be aware that a new baby means new expenses. To avoid surprises when baby arrives, get involved in making provisions beforehand.

Be patient

Partners can feel confused and out of control since there is little one can do to help a pregnancy along. Some moms develop an aversion to sexual intimacy, while others have a heightened libido. Dads, don’t take it personally! Things are never for ever!

Also remember that men can fall prey to pregnancy related depression, so both future parents need to take care of themselves – and each other! – and don’t ignore signs that either partner may need help.

Author Bio:

This is a guest post by ThePregnancyZone.com. The blog offers complete Pregnancy week by week information and topics relating to Preparing for the Pregnancy, Pregnancy Stages, Labor & Delivery, Pregnancy Issues, Health Issues, Parental care etc.