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Oxytocin: The Love Hormone

My name is Ashton Gelzinis, and I am one of the founders of Birth Naturally Brevard, LLC, a childbirth education and doula service business. My partners, Julie O’Neill and Elizabeth McLean, and I have served women in Brevard for several years and love every minute. We are also the owners of a small retail shop called The Oxytocin Emporium where we sell merchandise to support our doula clients and sister birthworkers! We absolutely love the name of our shop because of our fascination with the hormone oxytocin. We hope that our work only raises the levels of oxytocin in the room!

During our time supporting pregnant women and their partners, we have found ourselves fascinated by the process and how women’s bodies evolve and prepare in the weeks leading up to their birth. The hormones of undisturbed labor and the role they play not only during birth, but throughout the mother’s postpartum recovery are nothing but amazing. There are lots of hormones at play during this process, but the one we all hear most often is oxytocin.

Oxytocin. “The Love Hormone.” “The Cuddle Hormone.” This single hormone plays a major role in women’s bodies throughout their lives, but most importantly in pregnancy, birth and postpartum. Oxytocin is produced in the hypothalamus and released by the pituitary gland. Outside of pregnancy and birth, oxytocin contributes to fertility, digestion, wound healing, morality, personal connection, and many other situations throughout our lives.

“Oxytocin is the hormone of love. We share it when we have a good conversation, we share it when we make love, and when we hug, and BIRTH is the biggest brightest time of oxytocin sharing.” -Robin Lim

Let’s look at how this incredible hormone contributes to birth – the way it is supposed to. It plays a pivotal role in the birth process, not only to encourage surges, but it provides the mother with space to fall in love and bond with her newborn.

While laboring, the mother’s body releases oxytocin in response to the pressure of the baby on the pelvic floor. This release of oxytocin brings on those amazing powerful surges that help to efface and dilate the cervix, push the baby down into the birth canal, and birth the placenta. Oxytocin is released throughout the pregnancy, but really reves up just before and during birth for these reasons. In certain situations, mothers can encourage a release of oxytocin with nipple stimulation, a quiet, intimate break with her partner, or clitoral stimulation. If a labor is considered “slow to progress,” trying some of these techniques may help encourage that release and speed up the process rather than using synthetic oxytocin that doesn’t work in the same ways in the body.

Once the baby is born, more oxytocin is released, the placenta is delivered and afterbirth contractions continue to help close up the placental site and slow bleeding.

When her baby is born, the mother takes one look at this new life and gets another burst of this amazing hormone to help encourage her to bond and fall in love her new bundle. Oxytocin forces us to slow down and focus on what is most important – nurturing and feeding our baby. Every latch causes another release that helps to slow any postpartum bleeding and encourages her uterus to return to its original size before baby. The oxytocin released during nursing also encourages a healthy milk supply.

Another interesting oxytocin tidbit is that not only birthing mothers release oxytocin. Partners who are involved and present for the birth of their child release higher levels of oxytocin through the end of the pregnancy. Their levels actually continue to stay higher than average for about 6 months after the birth. This hormone in partners who didn’t give birth perform a very similar job – encourages bonding and loving. It truly is the “Love Hormone.”

In any birthing room, let’s do our part to let this hormone work it’s magic. Let’s give women the space they need to birth their babies. Let’s step away from the technological additions to birth and let mothers’ bodies work. When a woman is undisturbed, her body’s hormones work together with her baby to find just the right path for them. As doulas, we hold space, we remind mothers that the oxytocin is working and her body is nothing but incredible. That truly is the honor of my life. Let the oxytocin flow!

 

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Adina’s Testimonial

Attending the BirthWorks childbirth education workshop in Mt Dora, Florida this May was way more than I bargained for! The place was absolutely stunning. A Victorian style historical hotel with sprawling grounds against a backdrop of the magnificent lake and quaint town. But even more than that was the content of this 3 day workshop given by Cathy Daub. The workshop was so comprehensive and included topics such as grieving, mother daughter relationships, optimal pelvic positioning as well as many others that are not usually included in typical childbirth preparation classes. They were all taught through hands on experimental learning and not through didactic teaching. It was the BirthWorks experience I came out with!

One of the really vital things was teaching and facilitating using open ended questions and letting the other party find their inner guide to direct them. That evening I had a chance to really practice this skill. Being a doula, I had a client in labor and sent a backup.  Right before pushing, my backup called me asking if I could speak to the client as she was panicking about pushing. Instead of going into my long speech about why she shouldn’t be scared to push and how she’s done this in the past, I asked her what her fear was. She said she’s afraid she can’t do it. I asked her what she felt she needed to be able to move forward and she said she thought she needed help from the doctor. I said what kind of help. She said she remembered from her last birth that the doctor did supra pubic pressure because the baby’s shoulders got stuck. I gently reminded her that the only reason the doctor did that was to help the shoulders but the head was out already. So she said, “oh ok, but I’m still scared.”  So I asked her, “What do u want?”  She said she wanted her baby to come out without pushing. I said great. Imagine it. She said she can’t because she  has no energy. So at that point I told her to visualize G-ds energy as she inhales coming into her uterus and as she exhales pushing out her baby. She said,”Ok you visualize it for me!”   I said sure and she hung up empowered and pushed her 9 and half pound baby out with one push!!!

It was such a great lesson for me and I can’t thank Cathy and BirthWorks enough!

Earlier that day this same client was laboring pretty slow so I instructed my backup to do the rocking technique we had just learned that morning and she progressed very quickly to 10 cm!

Recently I had a prenatal meeting for a client who had 2 previous c sections and I used the grieving process we learned, asking her if she wanted to share anything that was hurting her  and she ended up telling me about a few childhood moves her family made when she was in school and how she was afraid to get too close to anyone and then have to move again and she came up with the idea that she was scared to carry something through to the end, the finish line. Explaining to her how we birth the way we live, both her previous births she stalled at 3 cm and wasn’t able to progress further. That awareness was amazing for her and it’s all due to the skills I learned in the grieving session.

Thanks a lot!

Adina Hoffman

 

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Janell’s Reflections

Intimate, Connecting and Peaceful, these are the words that come to mind when I reflect back on the 2019 BirthWorks Conference in Mt. Dora, Florida.  The speakers were inspiring and loving as they shared their knowledge and extensive experience with conference attendees.  The location was nostalgic and charming, worth the visit as well.

I personally was in awe of listening to Amber Price and the work she is doing to pave the way for better maternity care.  She shared many thought provoking facts that were spoken in truth and hope as she continues the momentum of a better and healthier maternity system.  She cares so deeply about her passion for improved maternity care and her professionalism in her administrative role is above and beyond “industry standards”.  I truly appreciated the information she shared regarding things that a hospital has control over in relation to addressing a concern or issue with a specific physician having privileges at a specific hospital.  Amber is like the first baby coming through the womb to pave the way for next generations to continue trusting the process of the journey of healthier and less interventions for better birth outcomes for all birthing families.

Another incredible session included Lori Barklage on Trauma Healing.  She emphasized how important it is to understand and to have tools to share with others that have experienced trauma in their childbirth journey.  She shared her heartbreaking stories of her past birth traumas and how she was able to heal those traumas and take those healing journey steps forward and help many others experiencing trauma in birth and other aspects of their lives.  The tool she provided in the workshop was so simple and easy to apply that I will be able to share and utilize its simplicity during the BirthWorks grieving and healing portion of the classes.  She is taking great strides in restoring the healing from trauma and does it in such a caring and loving way.

There were so many great guest speakers and keynote speakers that I just simply could not do them justice on a simple forum as this.  Having Nils Bergman, Michel Odent along with other local experienced and knowledgeable birth-field experts is always a unique quality that BirthWorks offers during the conferences. I highly recommend and encourage anyone thinking about attending a birth conference that is small, but mighty, to give thought to attending next year’s BirthWorks conference in southern California.

 

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Ultrasounds – Risks, Benefits, and Ethical Considerations

Submitted by Sally Dear-Healey, PhD, PPNE, CCE(BWI), Doula(BWI)

Years ago, X-ray was the diagnostic procedure of choice in pregnancy but today we understand more about the harmful effects of radiation so ultrasound is used as a safer alternative.  What we do know today is that every medical procedure has inherent risks known and unknown.  Therefore it is not wise to perform any procedure except if the known risks are higher than the risks of not doing anything.  However, instead of progressing cautiously and limiting exposure, more and more doctors/OB practices order repeated ultrasound scans for most of their patients/clients.

Ultrasounds are a form of electronic fetal monitoring that have become a normalized part of mainstream obstetric practice.  In fact, practically every pregnant woman in the U. S. will have at least one ultrasound scan during her pregnancy and most will have electronic fetal monitoring during their labor and delivery.  These women tend to be influenced by popular magazines, social media,  internet medical media, mainstream pregnancy books, news articles, and oftentimes friends and family members that purport that ultrasounds are necessary to ensure the safety and healthy development and birth of their baby. This article reviews a sampling of the issues, concerns, and benefits related to ultrasounds.

There are multiple issues and problems associated with the routine use of ultrasounds in pregnancy:

  • Most women today don’t question the procedure or educate themselves on its risks and benefits. Even if they have, few feel they have the right or ability to refuse the test(s).
  • Doctors may not have the time or knowledge to educate their patients about the risks and benefits of the procedure.  However, all women have a right to informed consent and should be encouraged to ask any questions they may have.
  • The number of scans is an issue. Instead of one ultrasound, many women have multiple ultrasounds over the course of their pregnancy in addition to “routine” scanning during labor and delivery (Electronic Fetal Monitoring and Dopplers are forms of ultrasound).
  • The integrity of the scanning machine, the length of the scan time, as well as interpretations of the results can be problematic.
  • “Gender reveal” parties based on the result of these scans are becoming more common and some parents have even purchased their own ultrasound machines so they can track the development of their unborn baby.
  • The financial cost of these scans is a significant concern for individuals and for the health care industry overall.  The average cost of an ultrasound in the U.S. is $250 – $300 without insurance.

Thirty years ago, there were concerns about ultrasound based on animal research, as in 1984, Doris Haire’s article in the Journal of Nurse-Midwifery titled “Fetal effects of ultrasound: A growing controversy,” which cited Dr. Melvin E. Stratmeyer, of the Center for Devices and Radiologic Health (CDRH), as saying “Increasing concern has arisen regarding the fetal safety of widely used diagnostic ultrasound in obstetrics,”  but to this day concerns about such things as neuromuscular development, anomalies, and genetic alterations have not been substantiated on animals or humans. In 1985, ACOG (The American College of Obstetrics and Gynecology) issued a technical bulletin that stated, “No well-controlled study has yet proved that routine scanning of all prenatal patients will improve the outcome of pregnancy.”

As a long-time birth worker, and having taught classes in human development and child and family studies for over two decades, I share their collective concerns and argue that, even though it has been thirty-five years since Haire’s article came out, we have yet to fully understand or appreciate the long-term impacts of prenatal ultrasound exposure.  Yet, there is research out that can be drawn upon to make an educated decision.

Nyborg (1987) writes, “Alterations to cell membrane structure have been reported by a number of investigators.  Some alterations include increased density of microvilli and ruffles in cell membrane following exposure that may alter growth characteristics” and “The persistence of a hereditable disturbances in cell motility after ultrasound exposure is especially important and investigations need to be conducted to determine if these effects occur in vitro” (256).

Sarah Buckley, MD, is also very clear about ultrasounds, stating that “Although ultrasound may sometimes be useful when specific problems are suspected, my conclusion is that it is at best ineffective and at worse dangerous when used as a ‘screening tool’ for every pregnant woman and her baby. […] Treating the baby as a separate being, ultrasound artificially splits mother from baby well before this is a physiological or psychic reality.  This further…sets the scene for possible but to my mind artificial conflicts of interest between mother and baby in pregnancy birth and parenting” (as quoted in West, 2015).

In 2000, Professor Ruo Feng, of the Institute of Acoustics, Nanjing University, who holds a PhD in physics and has published over 186 scientific papers summarized human studies of prenatal ultrasound and suggested five points of protection.  They are:

  • Ulltrasound should only be used for specific medical indications.
  • Ultrasound, if used, should strictly adhere to the smallest dose principle, that is, the ultrasonic dose should be limited to that which achieves the necessary diagnostic information under the principle of using intensity as small as possible and the irradiation time as short as possible.
  • Commercial or educational fetal ultrasound imaging should be strictly eliminated and ultrasound for the identification of fetal sex and fetal entertainment imaging should be strictly eliminated.
  • Avoid ultrasound in the first trimester of pregnancy. If unavoidable, minimize ultrasound.  Even later, during the 2nd or 3rd trimester, limit ultrasound to 3-5 minutes for sensitive areas, e.g. fetal brain, eyes, spinal cord, heart and other parts,
  • For every physician engaged in clinical ultrasound training, their training should include information on the biological effects of ultrasound and ultrasound diagnostic dose safety knowledge (West, 2015).

In terms of benefits, diagnostic ultrasound may be useful where there is a true medical need, although it is reasonable to conclude from the evidence that many of these conditions auto-correct themselves prior to the birth.  It could also be argued that for the mother who has experienced baby loss, either during a pregnancy or shortly after birth, seeing and hearing her unborn child may help to alleviate stress and anxiety in a subsequent pregnancy, which could also positively influence the well- being of the baby due to decreased cortisol levels.  On the other hand, scanning too much can actually create stress.  Jeffrey Ecker, M.D., chief of the department of obstetrics and gynecology at Massachusetts General Hospital, notes that “It’s important to have a specific question you are trying to address.  If by chance someone thinks they see something off, it can cause unnecessary worry” (Miller, 2016).  According to an article in the Journal of Ultrasound Medicine (2012), Miller et al. report that “Safety information can be scattered, confusing, or subject to commercial conflicts of interest.”

While some of the research presented is dated, it is widely acknowledged that very little has changed, and we still don’t have definitive answers.  If you do decide to have a prenatal ultrasound, it is wise to do the following:

  • Limit the number of scans
  • Have the procedure done by an operator with a high level of skill and competence
  • Have the shortest scan possible.
  • Be clear about what questions you have and be sure to ask them.
  • Most important, remember that it’s your baby and your choice.

 

References

  • American College of Obstetricians and Gynecologists (ACOG). (1985). Diagnostic Ultrasound in Obstetrics and Gynecology.  Technical Bulletin No. 63; October.
  • Haire, D. (1984). Fetal effects of ultrasound: A growing controversy. Journal of Nurse-Midwifery; Vol. 29, No. 4.
  • Mendelsohn, R. Dr. Robert Mendelsohn on Pregnancy and the Dangers of Ultrasound. https://www.youtube.com/watch?time_continue=208&v=YfaUQCp6L1s
  • Miller, D., Smith, N., Baily, M. Czarnota, G., Hynynen, K, Makin, I. (2012). Overview of therapeutic ultrasound applications and safety considerations. Journal of Ultrasound Medicine: 31(4):623-34.
  • Miller, K. (2016). This is How Many Ultrasounds You Actually Need During Pregnancy. Self.com https://www.self.com/story/this-is-how-many-ultrasounds-you-actually-need-during-pregnancy
  • Nyborg, W. L. (1987). Research Priorities in Ultrasound.  In: Repacholi, M.H.. Grandolfo, M., Rindi, A. (Eds.). Ultrasound. Springer: Boston.
  • West, J. (2015).  “50 Human Studies in Utero, Conducted in Modern China Indicate Extreme Risk for Prenatal Ultrasound A New Bibliography.”  Harvoa.org
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Ten Tips to Change the Course of Your Birth

By Brittany Sharpe McCollum, CCE(BWI), CD(DONA)

 

A positive laboring experience has the potential to increase satisfaction with the overall birth process, deepen parent and infant bonding in the first few weeks, and set the stage for a healthy transition into the postpartum experience (Simkin).  One’s outlook on their birth, however, has less to do with how the process happens or whether it goes “according to plan” and more to do with how involved the laboring person feels in the decision making process and supported they feel in using their voice (Elmir).  Although prenatal preparation, such as nourishment and hydration, movement, and conscious decision making regarding providers and birth support, is an incredibly important component of a healthy birth, it is also important to remember that circumstances and choices made during the process can also help to keep the labor on a positive course. Here are a few tried and true suggestions for preparing for an empowered and healthy childbirth experience.

 

Keep it to yourself.

As the saying goes, “A watched pot never boils.”  Texting friends and family or posting contractions on social media is a quick way to invite anxiety and fear into a birthing space.  Unfortunately, many people – even those whom have given birth before – are not aware of the normal physiological process of labor, the myriad fluids that the body excretes, and the wide range of normal in length of time of labor.  This means that a flood of questions will need to be fielded (or ignored) if the first contraction is shared with too many people whom have too little info about the variations in healthy birth.

 

Distract yourself…

until you can’t be distracted any longer.  Paying too much attention to the pattern of contractions or the variations from one wave to the next only wears the laboring person out mentally and physically.  Think of early labor as the end of pregnancy and conserve mental energy, relax the thinking brain, and get last minute loose ends tied up instead.

 

Call your doula. 

A doula can offer suggestions and guidance for coping with labor even before they arrive in person.  The reassurance of this professional birth support can help decrease fear and anxiety in partners, friends, and family members so that they are able to offer the best support possible to the laboring person and the hands-on comfort techniques, position change suggestions, and encouragement can help create an environment of serenity, confidence, and progress.

 

Make an evidence-based decision when/if your water breaks.

Yes – your water may not break!  Or it might, at any point in labor.  If the amniotic sac releases before consistent contractions and after 37 weeks of pregnancy, it is given the name “Term PROM” (premature rupture of membranes with a baby greater than 37 weeks gestation).  Although the majority of people have their water break at some point during consistent contractions, about eight to ten percent of people have their water release first.  Unlike the movies, where the water breaks and hard labor begins immediately, research shows that between 77 and 95% of people will begin labor within 24 hours.  Nope, not necessarily 24 minutes.  And studies also suggest that inducing labor with PROM is just as valid a choice for most people as is waiting up to 72 hours for labor to begin on its own.  To read more about the research and extenuating circumstances, check out this thorough article at Evidence Based Birth.

 

Get in the tub…and then out of the tub.

In the vein of Michel Odent, the tub will either get your labor moving or slow your labor down. When used early on, immersing oneself in water can be a great way to relax and allow for some rest before things get more intense.  However, used for too long of a time in active labor, water immersion may keep things from progressing and slow the pace of contractions at a time that is not ideal.  The use of the tub in transition?  Go for it!  The relaxation at such an intense point of labor may help move the birthing person right into pushing.  And evidence shows that water immersion can have a significant effect on decreasing one’s perception of pain.  Bottom Line: The tub may be best used at the beginning and towards the end of the first stage of labor and can be a great tool for managing discomfort.

 

Know your rights. 

Know your rights.  Know your rights.  Know your rights.  It can’t be said enough.  No matter how one chooses to give birth or what the circumstances leading up to the decisions are, it is crucial that the laboring person be aware of their rights during labor so that they can remain as in control of the decision making and as involved in the process as possible.  Research shows that it’s not how someone gives birth or whether things went “as planned,” but how someone feels about how they give birth which is tied to their feelings of control over decisions made in labor (Listening to Mothers).  And without a solid knowledge of what one’s rights are (and whether they in fact line up with birth place policy), it can be quite challenging to…

 

Use your voice.

Birth place policies are set up to serve the mode of birthing that is least liable for the birth place and most common among its clients.  If a laboring person is doing something differently than the norm in that space, they must understand that staff may not be familiar with the evidence-based way of supporting those choices and clients (or their personal birth support team – friend, partner, family, doula) may have to do a fair amount of assistance in advocating for the birthing person’s wishes.  Practicing asking questions and stating one’s choices is an excellent activity in preparing for birth.

 

Move your body.

Changing position and laboring and birthing upright have the potential not only to shorten the duration of labor but can also lead to more positive birth experiences (Dekker).  And here’s a not so little secret – upright birthing positions and movement in labor are possible even with pain medication!  Knowledgeable clinical staff and non-clinical support people can help, if assistance is needed, the laboring person into a variety of postures, both with and without pain medication, including but not limited to hands and knees, lunges, and seated positions.

 

Stay hydrated by mouth.  Although intravenous fluids have benefits when epidurals are given and when severe dehydration occurs, hydrating orally is an option supported by professional organizations worldwide.  “The American College of Nurse Midwives, World Health Organization, National Institute for Health and Care Excellence guidelines in the United Kingdom, and the Society of Obstetricians and Gynecologists guidelines in Canada all recommend that people be able to choose whether or not they want to eat and drink during labor” (Dekker).  Although IV fluids increase hydration, they also increase the birth weight of the baby which can lead to the appearance of excessive weight loss after birth and subsequent pressure to supplement human milk with formula.  Adequate fluid intake by mouth has been shown to be just as effective as IV fluids at shortening labor duration by about 30 minutes, while also helping to decrease tension in the throat and mouth and encourage feelings of normalcy in birth.

 

Understand the limitations of research.  Research is one part of the three components of evidence based decision making (the other two being client’s values and provider’s recommendation/experience).  Recently, a large study, called the ARRIVE study, looked at the effects of induction at 39 weeks on birth outcomes and called for the recommendation of induction at 39 weeks for healthy low risk pregnancies.  Henci Goer, medical analyst offers some fantastic insight into this research, discussing the limitations it has in regard to values and intentions of the laboring person in preparing for their birth.  Factors that may affect if this study applies to a specific person is whether they are planning for a medicalized birth, their desired use of pain medication, the prioritization of freedom of movement, and more.  An excellent infographic by Goer can be viewed at ARRIVE Study Infographic.

 

Let your intuition guide you.  No one knows the body and the baby better than the person experiencing the pregnancy and no one can speak for anyone else’s values or philosophies, which are a key component of true evidence based decision making.  Prenatal preparation and awareness of the importance of an active birth – as the laboring person defines it – offer a strong foundation for moving forward through labor and integrating the birth experience into a healthy and positive postpartum.

 

Sources:

Declercq, Eugene R. et al. Childbirth Connection. “Listening to Mothers III: Pregnancy and Birth.  Report of the Third National U.S. Survey of Women’s Childbearing Experiences.” May 2013. http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf.

 

Dekker, Rebecca.  “Evidence on: IV Fluids During Labor.” Evidence Based Birth. 24 May 2012; updated 31 May 2017, https://evidencebasedbirth.com/iv-fluids-during-labor/.

 

Dekker, Rebecca.  “Evidence on: Premature Rupture of Membranes.”  Evidence Based Birth. 20 November 2014; updated 10 July 2017, https://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/.

 

Elmir, R. et. al. Women’s Perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing, 2010 Oct; 66(10):2142-53.

Goer, Henci.  “Parsing the ARRIVE Trial: Should First-Time Parents Be Routinely Induced at 39 Weeks?” Lamaze. 14  Aug 2018,

https://www.lamaze.org/Connecting-the-Dots/parsing-the-arrive-trial-should-first-time-parents-be-routinely-induced-at-39-weeks

 

Odent, Michel. Childbirth and the Evolution of Homo Sapiens. Pinter & Martin Ltd; 2nd Revised ed. edition, 2014.

 

Simkin, P. Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part I. Birth, 1991 Dec; 18(4):203-10.

 

Simkin, Penny. Pain, Suffering, and Trauma in Labor and Prevention of Subsequent Posttraumatic Stress Disorder. Journal of Perinatal Education, 2011 Summer; 20(3): 166–176.

 

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By Cathy Daub, CD, CCE (BWI)

Laboring in birth is hard work but today we are making it harder than it needs to be. The secret is to find ways to create optimum space for the baby to move into and through the pelvis.  BirthWorks philosophy believes that “Birth is Instinctive” and that includes the baby knowing how to move through his mother to be born.  Remember that the baby was conceived in the uterus while low in the pelvis.  As he grows he moves up through the pelvis with the uterus into the abdomen where there is more room to grow.  So in an instinctive way, we can know that since the baby has already made that journey once, it is familiar to him.  What is familiar feels safe.

After moving up to his mother’s abdomen and reaching his birth weight, he is ready to move back down through the pelvis to be born.  But now there is one difference – he has grown.  At this time it is essential that a mother positions herself in ways to optimize the space in which he can move.

One position to avoid is the deep squatting position.  In this position, the pelvis is tipped backward as western women squat sitting on their heels which moves the pelvis into a posterior position.  This is a way to decrease space in which the baby can move.  Any position that tips the pelvis backward is a way to make descent of the baby through the pelvis more difficult.  It is desirable to have a forward pelvis in labor which offers more room for the baby.

There is another reason to avoid a deep squatting position in labor.  In labor, it is advantageous to increase the angle between the mother’s spine and the opening of the pelvis so the baby can position himself optimally. In order to do this, the woman in labor needs to keep her knees below her waist.  In a deep squatting position, the knees are above the waist. Keeping the knees below the waist is the BirthWorks Third Principle of Optimal Pelvic Positioning that all women of childbearing age need to understand.

There is a great position called “The Dangle Squat.” (see diagram)  In this position two people can sit on the bed or high chairs with a space in between.  The woman in labor stands between them and places her forearms on their thighs.  Then she drops down into a partial squat, keeping her knees below her waist.  She can feel the stretch in her upper body so that the forces going up are balancing the forces going down.  This is a position that opens the pelvis. She stays there for the duration of the contraction and then comes back up to a standing position and walks.  The Dangle Squat is an easy one to maintain for her helpers as well which is an important consideration in any birth.

Saying “No” to positions that decrease space in the pelvis and saying “Yes” to those that increase space in the pelvis makes a significant impact in the birth experience.   Mom, baby and family will be thankful.