This article describes many helpful ways to utilize positions while laboring with an epidural.
We usually think that if you have an epidural, you can’t move. The optimal physiology for birth is when women are up and moving about, following their bodies’ signals, and helping their babies navigate their way through the pelvis. When women have an epidural, they are limited in their mobility and ability to change positions. But with light or “walking” epidurals there are actually many positions and even movements within positions that can be done.
When women move as their body tells them to, it is not complicated; they are intuitively helping the baby to descend and rotate. We want to be able to take those instinctive movements that women do during labor and birth, and then replicate or modify them, so that women who have light epidurals can still get those great benefits of movement and position changes.
First and foremost, movement is more important than any specific position. A good guideline is to change position every five contractions no matter where you are in labor. In early labor your contractions are farther apart, so you might be moving every 30-45 minutes. In active labor, you’re moving more frequently. Every five contractions, we should be trying a new position.
The four basic positions are standing, seated, all fours, and reclined. With an epidural, standing positions are often moot, but we have seated positions. We have all fours that can be done on the bed, and we have side-lying or reclined positions that can also be done on the bed. The rotation of our thighs affects space in the pelvis. How we tilt our sacrum, so basically, doing pelvic tilts, rounding or arching the lower back, helps the baby navigate through. The last piece is asymmetry, doing something on only one side of the body, rather than on both sides, and changing position really frequently.
The pelvis has three main spaces within it. The inlet is the top area/opening where the baby enters in. Then we have the mid pelvis, and then the outlet, at the bottom of the pelvis where the baby comes out. Sometimes it’s described simply as a tunnel with a heart-shaped inlet, a round or bowl-shaped cavity in the middle, and a diamond-shaped outlet.
Depending on where a baby is within those three planes, we can use specific positions to create space in order to help the baby’s rotation. These different areas respond differently to changes in pressure. When we open the top of the pelvis, the bottom/outlet, actually closes. When we open the outlet or the bottom of the pelvis, the top closes. It is extremely beneficial to have someone who knows what to suggest or encourage specific positions in labor that will open that space where the baby needs it. Labor support -doulas – are vital for this, but the capabilities and mindset of nurses are a crucial factor. ASK YOUR NURSE WHERE THE BABY IS. We need to move away from a paradigm of dilation and into a paradigm of “where’s the baby.” (Gail Tully, Spinning Babies).
Let’s say the baby is at the inlet, or top, of the pelvis, we would want to focus on having wide knees so that would be external thigh rotation and incorporating some pelvic tilts or some rounded back positions to help pull the top of the sacrum out of the way and remembering to change position often. We might take a seated position that is maybe like a butterfly position, the soles of the feet together, the thighs externally rotated. Sitting like that through five contractions with the epidural in the bed, and then maybe side-lying with a peanut ball between the thighs for five contractions.
The all fours position can be done with an epidural on the bed, adding movement. Rock your hip side to side, do circles with your hips, lean forward, lean back, do some pelvic tilts so that we wind up in a position that is helping to open up space towards the middle and the bottom of the pelvis, possibly at the top (depending on the thighs), but also we are actually moving within that position and helping the baby down and out.
With at least 40% of births in the U.S. being induced, often people think they don’t need a lot of attention at the beginning because they’re still in very early labor. But it is important to have support during those early hours of induction when you’re kind of “stuck” in bed, somebody actually helping replicate the early labor processes of moving.
With somebody on either side, providing a gentle hand, or just being present, we have that ability to change position in the bed even with an epidural. It doesn’t have to be big, drastic, dramatic movements. Just think, “Well, if I just rotate my thighs differently,” or “If I just lift one leg up.” It can be side-lying on one side and then on the other side. Hiking the leg up towards the chest and stretching at the bottom leg, and then switching it up. It doesn’t have to be really exhaustive positions and movement that seems really dramatic. These little subtle changes with the space in the pelvis make a really big difference in helping the baby with its journey.
Childbirth classes can help you prepare for physiologic birth AND birth with an epidural. Practicing and learning positions in birthing classes is possibly even more important when sensation and mobility will be limited in labor. With an unmedicated birth, your body has that innate knowledge of how to move, but sometimes our “thinking” brains that get in the way. If you’ve never been in the all fours position and you try it for the first time in labor, your thinking brain is going to say, “Whoa, this is unfamiliar. We need to get out of this position.” One of the goals in labor is to decrease that activity in the thinking brain because it can overpower the primal brain and decrease the release of hormones and stall labor out. But if you’ve practiced these positions in pregnancy, you’ve created a little bit of muscle memory, and now your thinking brain in labor is going to be like, “Oh yeah, we did this before. This is okay.” And with an epidural, we use the brain’s knowledge to mimic what the physiologic body would be doing. Birthing classes in Los Angeles like Supported Birth are the best education for your new life!