5 Reasons to Plan an Active Birth

The idea is simple: deliver in the most comfort with the least amount of risks. One dream, one team, amirite? But how do we do that?

When you think of women giving birth in America, what do you picture? When you think of THEE moment of delivery? For me, it honestly conjures this picture of a mother sitting in a semi-reclined position, feet in stirrups, gowned completely, with her birth partner by her side squeezing her hand, mother yelling loudly or having completely uncontrolled and sporadic breathing. I have attended dozens of births. Yet, Katherine Heigl giving birth is my picturesque American delivery.

Now if I ask you to think of a woman in indigent South African giving birth, what comes to mind? My image: a naked woman squatting, surrounded by women of her community, giving encouragement, working with her body. She’s quiet, composed and maybe lets out one final birth cry as she reaches down and brings up her baby to her chest. Why is this picture so drastically different than even my own birth experience? Did you know women in impoverished countries often have narrow hip development from childhood undernourishment and frequently experience dystocia (or a “stuck” baby in childbirth)? Did you know this is exactly why those women choose upright positions in labor… because they allow for the greatest opening of a woman’s pelvis to allow baby to pass through?

What are our greatest fears in birth? That our babies cannot pass, that we cannot dilate efficiently, that our babies will “decel” (heart rates drop) and an emergency intervention will be required. So what if you as a laboring mother had a significant impact in decreasing those risks?

Active birth. It’s simple, really. Spend your labor in upright positions or ones that relieve the weight and pressure off of your pelvis. Standing, swaying, slow dancing, sitting on the birth ball, hands and knees, squatting. And what’s more… consider giving birth on hands and knees, squatting or even standing.

Uterine contractions are stronger, more regular + frequent, leading to more efficient cervical dilation.

The pull of gravity brings baby down for greater pressure on your cervix, which in turn has it dilate a little bit quicker. The uterus also tends to tilt forward when it contracts. In an upright position, the mother can lean forward like when slow dancing with a partner, thereby assisting her uterus to work without resistance. If she is lying down or leaning back, the uterus has to work harder, since it is pulled back by gravity when it tries to tilt forward during a contraction to bring baby down.

What’s more… the entrance of your baby’s head to the inlet of your pelvis is easiest when you are upright. In this position the pelvic inlet points forward and the oulet (think exit) faces downward. This provides your baby the best angle of descent in relation to gravity through the pelvic canal.

Here’s a real life illustration of how this works. I don’t know about you, but my vacuum hose gets clogged CONSTANTLY. Maybe I should be vacuuming popcorn. But eh, oh well. When the hose is clogged however, there are a few different methods I can use to try to clear it. I can attach it to another vacuum like our shop vac that is a little more powerful and try to suck the clog out. I can try to palpate for the block and push it out. Or I can use a marble or other heavy, small and round object to drop into it and put pressure on the block, causing it to break free and all the contents come out.

Now stick with me here— that marble doesn’t come out without a little help, right? I can’t lay the hose flat on the ground, put the marble in one side and expect it to magically find it’s way to the other side. It needs gravity to help it. Maybe a little jiggling. The more I use gravity, the less work I have to do to get the marble to come down and the blockage to come down and out.

… Your baby is the marble. You cervix is the blockage. Your pelvis is the hose. The direct application of your marble onto the blockage is assisted by gravity when the hose is upright. Is this making sense yet?

Women relax more completely between contractions and the pressure of baby’s head on the cervix during a rest phase between contractions is HIGHER.

This is science. I promise you. And I can show you by a simple pelvic floor exercise. We’re all adults here, so I can mention this exercise can be completed with or without your partner so you can have some real feedback ;) (sex… I’m talking about sex). Start by kneeling with your knees separated by about a 1-2 foot space. Contract your pelvic floor and pull it up like with a kegel. Hold it for a few moments and release. Take note of how strong your contraction is, how long you can comfortably hold it for and how deeply you can release those muscles into loose relaxation. Now lay flat on your back and do the same. Contract, hold, release. If this is your first baby, you may have a killer pelvic floor still and the difference may not be as notable to you as it is to your partner. But let me tell you… after three children, uh— there’s a big difference. This complete relaxation is just as important as your ability to hold your kegel though. Being able to release tension in all parts of your body in rest phases is needed to keep you going through hours of labor and to keep your prepared for the next wave of pain.

The first and second stages of labor are shorter (some studies show over 40% shorter).

The first stage of labor is all the contractions that bring you meeting your baby. The second stage of labor is the actual delivery of your baby. The third and final stage is the delivery of your placenta. So… I mean, do I really need to explain why having a short first and second stage is great? Probably not. Moving on!

Women feel greater comfort and less stress and pain, also requiring less analgesics (medicated pain relief).

The pelvic nerves that supply the pelvic cavity and uterus arise from the lower part of the spinal cord and enter the pelvis through the sacrum (think tailbone if ya don’t know ya body parts). When a woman avoids lying on her back, there is no direct pressure on these nerves, so she feels less pain. When she puts her weight on her sacrum, the nerves are compressed and her pain is increased.

During pregnancy hormones soften the ligaments around the pelvic joints to make the joints more flexible. As long as the mother is upright for the birth, the pelvic joints are free to expand, move and adjust to the shape of the baby’s descending head. When the mama squats, the sacrum is free to move, allowing the pelvic outlet (remember, the exit?) to widen by as much as 30% more than it would if mama’s weight were resting directly on it (or semi-reclining).

The incidence of fetal distress in labor is lower, and the condition of the newborn is generally better.

There are two methods of fetal heart rate monitoring in labor. Auscultation is a method of periodically listening to the fetal heartbeat. Electronic fetal monitoring is a procedure in which instruments are used to continuously record the heartbeat of the fetus and the contractions of the mother's uterus during labor. If you do not have any complications or risk factors for problems during labor, either method is acceptable per the American College of Obstetrics and Gynecology. You only need to have your baby’s heart rate checked once every thirty minutes per ACOG guidelines if you are a low risk, spontaneous (not induced) labor.

Placental circulation is improved when mothers choose upright positioning, giving better oxygen supply to baby. In our area hospitals you will be subjected electronic fetal monitoring unless you discuss this procedure with your provider before delivery. Constant fetal monitoring is not evidenced based medicine unless you are being induced with medications (which automatically increase your risks of non-reassuring fetal heart rates, requiring cesarean delivery). Oftentimes nurses will struggle to keep your baby on the monitor when you are active in labor as these discs were designed for high risk deliveries in which mothers are most often lying down or have had epidurals and are more confined for safety. Your nurse may state, “You are going to have to lie down if I can’t get baby on the monitor”. This is not true. A low risk mother experiencing a spontaneous delivery without medication being used to augment her labor only needs her baby’s heart rate monitored once every thirty minutes throughout labor. This is supported by ACOG, your OBGYN’s certifying body. Many women still choose electronic fetal monitoring because they do not see the harm, or they just want to ensure their child is safe in labor. Research actually shows that constant fetal monitoring does not improve outcomes in low-risk mothers and leads to increased instance of medical interventions and cesarean delivery. If you have been given no reason to believe that you are not expecting anything but a healthy, full-term baby… what benefit is there in increasing your risk of medical interventions, cesarean delivery, and fetal distress?

Take some time this week to ask your family and friends: how did you give birth? How did you labor? How do you feel about your birth, was it a positive experience? Did you feel empowered by it or did it fall in line with the birth stigma: pain is the only event worth remembering from your birth and the only event that matters. Come back to me. Tell me what it is that you hear. What stories can I find for you that help you feel prepared and ready to participate in your birth experience?