Tuesday, September 16, 2014

Texas Roll Position for Advancing Labor

One of the most important things to focus on when in labor, or when supporting a woman in labor, is encouraging the process of Normal Birth to take place. Now, I'm not just in love with the idea of labeling birth as normal or abnormal, but what we're getting at is
the goal of supporting physiological birth. A great way to do this is to focus on the different labor positions a mother can use to find comfort during labor and also to advance labor or keep things running smoothly. One of those positions is one many refer to as the "Texas Roll" or "Sims'" position.

What is the "Texas Roll" position?

The "Texas Roll" is also known as the "Sims'" position, or may even be referred to as an exaggerated side lying position or lateral recumbant position. It's called the Sims' position, named after American gynecologist James M. Sims.

Texas Roll Position, Labor Positions, Sims' Position

Why encourage physiological birth?

First, let's talk a bit about why we want to encourage and support the physiological birth process. Encouraging the process of physiological birth, regardless of whether or not your goal is natural childbirth, means avoiding costly and painful interventions. There are a few things that help support the Normal Birth process.

  • Changing positions often - Position changes help the baby avoid getting "stuck" in the pelvis, encourages fetal rotation and navigation into the birth canal, and helps the laboring mother manage her pain.
  • Utilizing gravity - Upright positions work with gravity to help the baby move down and out. Activity also encourages contractions to stay strong enough and close enough together to make cervical change.
  • Opening up the pelvis - Positions and movements that widen and open the pelvis make room for the baby to move down into and out of the pelvis and help the mother avoid interventions.

How does the Texas Roll help?

The Texas Roll or Sims' position aids physiological childbirth specifically by widening the inlet to the pelvis. There are several pregnancy exercises and labor positions that open the pelvis such as tailor sitting, squatting, lunging and others. 

The Texas Roll causes the hips to become asymmetrical and opens up the backside, as well as the legs. Think of a Texas cowboy with wide, bow legs rolling over in bed! This makes the pelvis and birth canal wider and easier to enter as the baby rotates and makes its way down and out! 

How to do the Texas Roll: 
  1. Lie on one side or the other, with the bottom leg (closest to the bed) as straight as possible.
  2. Bend the top leg, raising the knee as high as possible, toward the chest.
  3. You may prop the top leg up with pillows, a peanut ball, or one of the stirrups of the hospital bed if you are laboring in a hospital.
  4. Roll as far over, towards the bottom leg, and try to get as close as possible into a stomach lying position. Obviously you cannot lie directly on your stomach, but as you fall forward with one leg raised, the rotation causes a deeper opening of the pelvis.

Helpful Tips:
  1. This position is especially helpful for laboring mothers who receive epidural analgesia for pain relief. Since they typically have extremely limited mobility from the waist down, they cannot get up and move around to assume various labor positions to advance labor. The Texas Roll position can be assumed with the help of doulas, family and nurses. It's important to change from one side to the other, alternating between this position and other upright positions to utilize gravity and promote physiological childbirth as much as possible.
  2. For mothers who have not received an epidural, propping the top leg with the stirrup or a peanut ball can be uncomfortable and awkward. If propping the leg in those ways is too painful, prop the leg as much as possible with soft pillows, rolled blankets and pads to achieve the wide legs with top knee pulled up high.

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