Monday, October 13, 2014

Hands and Knees Position for Advancing Labor

One of the fanciest tricks a doula has in her doula bag, is her knowledge of how different labor positions can help to ease the pain of labor and also advance the process. It's important to keep moving in labor and change positions often for a several reasons:
  1. It feels better for the laboring mother. 
  2. It helps the baby move down and avoid getting stuck in the pelvis.
  3. It progresses labor by utilizing gravity and helping the mother relax.
Hands and Knees Position for Advancing Labor

The hands and knees position for advancing labor looks pretty much as it sounds. The laboring kneels on both knees and leans forward onto her hands or other support, such as a birth ball. The birth ball can be very helpful, as the weight and pressure on the mother's wrists can get very tiring.

The hands and knees position can be done on the floor if you have a soft surface like carpet or a yoga mat, or in a bed. If you are in the hospital, make sure the mother can support herself well, and that the doula, partner or other support people are close by to ensure she doesn't fall off the side of the narrow hospital bed.

This position can be particularly helpful in natural childbirth, when the mother does not receive an epidural, but it can also be done if the mother has an epidural, as long as she has excellent support from a doula, nurse, and/or other support people. 

Variation: Open-Knee-Chest Position

A variation of the hands and knees position is the open-knee-chest position. In this position, the mother assumes the hands and knees position, but opens her knees very wide, and lowers her chest all the way down to where her hands would be.  

The open-knee-chest position is suggested to help turn breech babies during pregnancy or in labor when you suspect a baby who is stuck and needs help getting in the right spot!

Why is the Hands and Knees Position Helpful in Labor?

There are several reasons why the hands and knees position can help to advance labor. Relaxation is one of the most important needs a laboring mother has, as this ignites the labor hormones that keep things going. The more she's able to ease discomfort, the more relaxed she'll be, and the less likely you are to have a stalled labor! Some more reasons hands and knees is helpful in labor are:

  • Back Labor - If you are experiencing "back labor" or intense lower back pain during labor, the hands and knees position is very helpful. The forward leaning position takes the weight and pressure off of the mother's back. Adding a pelvic rock is especially helpful at relieving this pressure.
  • Relieving Hip Pressure - As labor progresses and the baby moves lower into the pelvis, the laboring mother can experience a lot of pressure in her hips and backside. Many women say they feel like their bottom is going to fly off behind them! In the hands and knees position, mother can rock and sway her hips and push her hips far behind her, like in a child's pose, which can do a lot to relieve that discomfort.
  • Excellent Pushing Position - The hands and knees position widens the birth canal, whereas the classic lithotomy position actually closes it. The hands and knees position also causes the birth canal to curve downward, allowing gravity to help encourage the baby down and out of the pelvis.
Other Variations of Hands and Knees Position

Movement is important even within different positions. A mother shouldn't feel like she needs to be like a statue in the hands and knees position. Here are some movements that will add  in easing discomfort as well as progress labor by using gravity and making room in the pelvis to encourage baby to move down:
  • Pelvic Rocks - front to back, like "cat-cow" yoga positions
  • Hip Sways - side to side movement
  • Lunge - kneeling on one side and bringing the other foot up
  • Crawling
Did you use the hands and knees position for your labor or birth? How did it help you?

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