6 Alternative positions for childbirth

There’s no set rule that requires you to lie on your back during natural birth. Midwife Xoli Makabane offers advice on alternative positions. By Marianne Malone

Whether it’s movies or a general misconception that has led us to believe that lying down during natural birth is the only or best way, there are many more options available. “These options will increase your level of comfort, maximise your effort to push, and minimise your chances of having an assisted birth, such as vacuum extraction or an episiotomy,” explains midwife Xoli Makabane.
She adds that many moms feel vulnerable lying on their backs, and more mobile positions may help them to feel empowered during the birthing experience.
“It’s true that lying down makes it easier to see if the perineum is about to tear, in which case an episiotomy would be needed,” says Makabane. “But it’s assumed to be the best position for the caregiver, and not necessarily comfortable for the mom.”
Makabane advises changing positions during each stage of the delivery as this will help your baby’s head descend, and speed up the dilation of your cervix.

1st stage of labour

During this stage you’ll progress from early to active labour and then the transition. Your contractions will go from being light to the most intense, dilating your cervix between five and seven centimetres.

1. Supported standing
If you feel more comfortable standing, you’ll need support. This position will involve placing your arms around your birthing partner’s neck while facing him.
This position:

  • Increases the descent of the head as the force of gravity helps to bring the head down
  • Is a possible option if you choose a mobile epidural.
  • You can also lean over a table with your elbows supported by a pillow and have your birthing partner massage your back to relieve the pain.

2. Sitting

  • You can sit facing the back of a normal chair, with a cushion in front of you. This is a good option if you choose pain control, because the chair will offer support.
  • This position encourages your pelvis to open up.
  • It allows your birth partner to massage your back to alleviate the pain in the area.

3. A birthing ball

  • The birthing ball is a standard physiotherapy ball.
  • Sit on the ball with your knees open, or lean over the ball with your knees on the floor. You’ll instinctively rock your pelvis which will encourage your baby to move down the birth canal.
  • This movement will offer relief from lower back pain.
  • The ball places your spine in the correct position.

Walking
Walking creates a rocking motion in the pelvis which helps the baby’s head find a comfortable angle to engage. “Walking around will also help to combat the feeling that you are a patient in a hospital bed,” says Makabane.

2nd stage of labour

This stage begins when you reach about 10cm dilation and your baby moves through the birth canal. Lying on your back during this stage could give your baby less space to manoeuvre. You’ll probably be tired at this stage and need encouragement to move around.

4. Full squatting position
This is especially good for a water birth. You start by placing your feet on the bottom of the bath, supporting yourself using the sides. You can also squat facing your birth partner and use his legs for support. But this position requires strength and stamina, so be prepared.

  • This position increases the narrow angle of the pubic area and encourages your baby to move down.
  • It allows the head to pivot into the best position for birth.

5. Kneeling on all fours
“This is a good option for births that produce back pain and it also increases the rotation of the head, which is in a posterior position,” says Makabane.
If you’re birthing at home, kneeling and leaning over a couch or soft chair can be an excellent position.

  • This position opens your pelvis.
  • It can prevent the need for an episiotomy.

6. Birthing chair
The birthing chair is good for delivering from a sitting position. You can also use a normal chair.

  • This position allows your legs to open as wide as possible.
  • Gravity can assist in the delivery and even speed up the process.
  • It can result in tearing the perineum as your pelvis is under pressure from your baby’s head.
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