Correct postures during contractions. Preparing for childbirth is the key to its success. Postures during contractions

We talk a lot about spontaneous movement during childbirth, when a woman moves as her body tells her. But sometimes the body itself needs a hint to first try, and then understand that it is in this position that you want to be or move.

Expecting the birth of her first child any day now, the cosmically beautiful Dasha o-l-o-v-o Khoreva posed for a photographer for us Zhenya Shabaeva, so that we can show you what positions and, most importantly, why, a woman can take during childbirth. This list, of course, is not exhaustive (there is also nothing here about movement during childbirth*), but the main thing can be seen in these photographs.

The information we give for each position is generally consistent with what can be found in Penny Simkin's book, The Labor Progress Handbook, a manual for midwives and doulas. Unfortunately, it is difficult to explain in a short article how this all works*. So use this information based on your common sense and sensations. The main rule of behavior during childbirth is: “If the mother and baby feel good in this position, most likely they need it. If the mother is in some position unpleasant, painful or uncomfortable, it should be changed.”

A midwife or doctor can tell you about your baby's condition by listening to his heartbeat.

Lying and reclining

1. On the side

Especially useful:

when mom is tired
when you want to sleep or just “switch off” between contractions,
when you need to take CTG readings,
when vertical postures cause blood pressure to rise to too high levels,
when you don’t want to intensify contractions,
as one of several alternating positions during epidural anesthesia.

when labor is progressing much slower than you need and you need to take an upright position,
if you lie in this position for more than 2-3 hours.

2. On the side with hip and knee support

Similar to the side-lying pose, this pose has a different hip position. This position may be more comfortable for the woman, and may also facilitate the easy “screwing” of the baby into a position favorable for birth.

3. Reclining/half sitting

On a bed with pillows or on a chair, this pose helps a woman rest without lying on her back.

Especially useful:

when mom is tired (including number to lie),
when you need to take CTG readings,
when you need to find something in between an upright and lying position,
when, in the “lying on his back” position, the baby’s heartbeat is disturbed, and the mother becomes ill.

It's worth trying something different:

when it is necessary to increase the mobility of the sacrum so that the pelvic bones allow large child to go through,
when the pain from childbirth is concentrated in the back.

Sitting

4. Sitting upright

Especially useful:

when the baby needs help to get down,
when mom is lying in a different position, and changing the position can cheer her up.

5. Sitting leaning forward

Especially useful:

to help the child lower himself, and to help the progress of labor, and to rest,
to open access to the mother’s back (for massage, warm or cold “compresses”, etc.),
to try to relieve labor back pain.

standing

6. Standing, leaning forward

Especially useful:

when you need to help open up,
if contractions become weak or irregular,

It's worth trying something different:

if it is difficult to maintain this position with epidural anesthesia,
if the baby is about to be born and the midwife/doctor asks you to take a suitable birth position.

7. Lean on a bent leg

Especially useful:

to help the baby descend and “screw” correctly into the birth canal,
for mothers with small pelvises or large children,
if a woman feels labor pain in her back.

It's worth trying something different:

when mom finds it difficult to maintain balance,
when these postures make the pain worse.

8. Standing, hanging from something or someone

Especially useful:

when the birth is going well while the mother is standing, but the mother is already tired,
when it relieves back pain.

It's worth trying something different:

when a woman's partner gets tired,
when a child is about to be born, and in this position there is no one to accept him.

On knees

9. "Cat-Cow""

Especially useful:

if the fact that the stomach “sags” makes mom feel better,
to try to normalize the baby’s heartbeat if it is disrupted in another position,
when mom wants to rock, whine, moo and puff in this position,
to massage mom's sacrum,
if a woman feels labor pain in her back.

It's worth trying something different:

if mom's knees hurt,
if she is very tired.

10. Knee-elbow position

Especially useful:

when it grieves ahead of time,
if a woman feels labor pain in her back,
when labor proceeds faster than necessary.

It's worth trying something different:

if labor is slower than expected,
to speed up efforts,
if mom feels nauseous in this position.

Squatting

11. Squatting on your own

Especially useful:

if you want to give birth to a child in this position,
to help the child get down.

It's worth trying something different:

when there is something wrong with your legs and this position causes pain or discomfort,
when the child is still very, very high,

12. Squatting with support:

This is the same as simply squatting, but you just have someone to hang on to, and many women find it easier this way. The partner can also sit behind the woman, supporting her, and she can lean on his knees and hands.

During childbirth, you will most likely come up with several of your own, completely exclusive positions that will help you. This happens all the time. However, sometimes it can be helpful to have a few options in mind in case you get lost at some point.

We wish Dasha an easy and safe birth!

* we will examine these issues in more detail.

The birth of a new life is like a miracle. However, childbirth is 15–20 hours of hard work. Help your body cope with the work by using birth positions and movements.

Birth positions- these are body positions in which a woman in labor feels most comfortable and comfortable. They are natural for a woman giving birth and help relieve pain from contractions, maintain strength and move the baby towards the exit of the pelvis.

The article talks about labor positions for resting and waiting out contractions and vertical birth positions suitable for contractions and pushing. Videos and drawings will help you understand how to move in each of the birth positions. Let's also talk about how to remember these movements in your own childbirth, and how to use them in the maternity hospital.

Birth positions. Fragment of the video tutorial “Preparing for natural childbirth”

Birth positions are similar for women different nationalities and cultures. No one can tell you in advance what position you will feel good in. Try each position during pregnancy, try it on yourself, breathe. And during childbirth, listen to your body, it will tell you.

“A woman, sheltered from danger and prying eyes, often prefers to give birth in positions characteristic of mammals, for example, on all fours.”

We recommend combining birth positions with diaphragmatic breathing. This is when when you inhale, your stomach expands, not your chest. According to osteopathic doctors, healthy people They've been breathing like this since birth. During childbirth, this type of breathing helps open the cervix, expands the birth canal and relieves pain.

Labor positions for experiencing contractions and resting between them

When. Contractions are the first stage of labor. It usually lasts from 5 to 18 hours. The woman’s task is to relax, breathe and conserve strength for the next stage - pushing. Poses that help reduce pain and relax between contractions are suitable for this.

Lying on your side

For what. For rest during childbirth.
Helps ensure proper insertion of the head into the birth canal and reduces the likelihood of injury to the baby.
How. Lie on your side with the baby's back facing. Place a cushion, pillow or hand under your head. Place one or more pillows between your legs. Even if you are not allowed to move freely in the maternity hospital, this position will help you survive the period of labor. During pregnancy, this position is convenient for relaxing, exercising diaphragmatic breathing and just fall asleep. To train, lie on your comfortable side.

On knees

For what. Breathe out the fight.
Helps reduce painful sensations in back. Rocking in this position relaxes the muscles of the perineum and helps open the cervix.
How. Settle in convenient location: On a bed or on a rug on the floor. Rock back and forth - imagine yourself as one big ball. Use diaphragmatic breathing.

Pose option. Asymmetrical birth position. Helps keep baby's head occupied correct position. Get on all fours right leg put it forward, next to right hand. Rock back and forth, breathe. Change your leg. During childbirth, choose the option that is convenient for you.

On all fours with a raised pelvis

For what. To stop pushing.
Helps curb the urge to push if the cervix is not yet fully dilated.
How. From a position on all fours, lower yourself onto your forearms and rest your head on your hands. Take a double inhale and a long exhale open mouth(ugh_ugh_fu_u_u_u_u). Or breathe like a dog.

Sitting or kneeling, leaning on supports of varying heights

For what. Breathe out the fight.
You can rest between contractions if lying down is uncomfortable and you are tired of standing and walking. In this position, it is convenient for an assistant to give you a relaxing back massage.
How. Sit on your knees, toes together, heels apart, back straight. Practice in advance; if you are not used to it, your legs will quickly become numb. Remember about diaphragmatic breathing.

Variants of this pose:
sitting on your knees, lie forward on a low support,
sitting on your knees, lean your straight arms on your knees or on a high support,
kneeling, lean on a low support (back horizontal).

Birth positions on all fours are suitable for the entire period of labor. You can wait out contractions in them, rest between them, and even push. In poses on all fours with a freely hanging belly, the load is removed from the spine, back and abdominal muscles. The weight of the child does not press down, the abdominal muscles relax, reducing pain. In these positions it is easier to endure contractions and save strength for pushing.

Vertical positions during childbirth

When. IN active phase During the first period, contractions repeat every 3–5 minutes and last about a minute. The painful sensations intensify. The dilation of the cervix reaches 5–8 cm, and the time for pushing is approaching. Vertical labor positions will help speed up labor by promoting dilatation of the cervix.

For what. Vertical postures combined with diaphragmatic breathing expand the birth canal, making it easier for the baby to be born. In a vertical position, the force of gravity helps the baby move towards the exit. Normal blood supply to the uterus and placenta is maintained. (See “Guide to Preparing Parents for Having and Raising a Healthy Child”)

Standing with your back against the wall (on your partner)

How. Stand near a wall or have an assistant support you from behind. Legs wider than shoulders, bent, back straight (lower back pressed against the wall). Use diaphragmatic breathing.

Standing on a high support

How. We lean our elbows on the wall or an assistant, put our head on our hands. You can use the back of a stable chair or a tall chest of drawers as support. It's good if you have it on hand different variants, then during childbirth the body itself will choose the optimal height of support.
Breathe with diaphragmatic breathing.

Standing without support

How. Legs wider than shoulders, bent, back straight. We swing left and right. You can do it as a couple, holding hands. This dance will support you and help your baby progress. Don't forget about diaphragmatic breathing.

Squatting

For what.
How. How. Sitting in this position requires practice. Knees apart, heels on the floor, back straight without bending forward. We swing left and right. You can squat not only on the floor, but also on any comfortable and stable surface: on a bed or on a sturdy table. In this case, have your assistant and midwife support you.
Pose option. Swinging on a half-inflated fitball or soft low bag of balls. The surface on which you sit should be soft and resilient. You cannot sit on anything hard during childbirth.

During the active phase of labor, when contractions are long and painful, use vertical labor positions. They speed up the dilatation of the cervix, open the pelvis and help speed up labor. Move actively between contractions; if you are tired, lie on your side. If the midwife allows, you can push in vertical positions, helping the baby to be born.

How to remember

During the birth process, remembering some pictures of birth positions from the Internet is not an easy task. Reinforce theory with practice. Try each pose during pregnancy, breathe in it with diaphragmatic breathing. If you practice every day, gradually memorize all the variations of birth positions. During childbirth you will not have to consciously remember anything - all movements will be intuitive. The position you like during training will not always be comfortable during childbirth. We conducted a survey of women who studied at the Vasilisa School of Parents. 10 out of 15 responded that during childbirth they preferred a different position than the one they had chosen in advance.

Anna: “During pregnancy, I liked the asymmetrical position on all fours. And during childbirth it turned out to be more comfortable to lie on your side and stand leaning on the headboard.”

The secret is simple: to remember all the poses, train and repeat them all. We offer a complex to help. It consists of birthing positions and movements that help the body adjust to childbirth. Every day, 10 minutes of gymnastics and all birth positions will become familiar and easy for you. During childbirth, you will be able to intuitively choose the most suitable and effective ones.

How to use birth positions at home and in the maternity hospital

In the maternity hospital. There are rules here. Most convenient for doctors and obstetricians generic position- motionless position lying on your back. But this position is not suitable for the woman in labor and the child because of its unnaturalness. This pose is not in the traditions of any people in the world. Therefore, a compromise is needed. Agree in advance what is allowed and what is not. Discuss with the maternity hospital staff in advance your right to choose any birth positions during contractions and defend it together with an assistant, if necessary. Examinations and CTG can be done in a lateral decubitus position.

Maria: “We agreed with the midwife that while the contractions are going on, I can stand, lie or move as I feel comfortable. The fitball helped a lot; I leaned on it while standing and sitting on my knees. And she breathed. I also liked to crawl on all fours on the bed. It probably looked funny, but it really made it easier for me.” .

When is it necessary during childbirth? medical intervention, vertical postures are undesirable. The woman in labor will be asked to lie down if:
premature pregnancy and premature birth,
rapid labor(less than 4 hours),
quick labor (less than 6 hours),
if there are signs of intrauterine growth retardation.

Lie on your side. For pain relief, use diaphragmatic breathing and sacral massage.

Movement and breathing for an easy birth

Birth positions and correct breathing- free and simple ways relieve painful contractions. Study, practice, find your most comfortable and favorite one for relaxation. Train a helper if you take him with you to the birth. Help yourself with movements, this also relieves pain:
walking with high knees,
rocking the pelvis left and right, back and forth,
circular movements,
cross crawl,
swinging on a fitball.

During the birth process, use, thanks to which the baby receives enough oxygen, contractions are relieved and trauma during childbirth is reduced. Study it in advance and practice it with a helper.

Natural birth positions and movement during childbirth help avoid injury to mother and baby and make labor easier, making it less painful.

Have an easy birth!

Many women who have given birth will agree with the statement that the process of childbirth is complex and requires some knowledge, effort and physical training. If the expectant mother is uncomfortable during childbirth, her body quickly weakens and gets tired. This situation should not be allowed, because the better the woman works, the less traumatic the birth of the baby will be.

Honestly, some women in labor intuitively take comfortable positions that are comfortable for them. In such a situation, Mother Nature had her say. But childbirth is not a situation where you can go by trial and error. Therefore, it is best to familiarize yourself with the positions that are recommended to be taken during childbirth, with different advantages and choose the best option for yourself.

If you do not experience complications, then during contractions the doctors will allow you to behave in a way that is more convenient for you. Take comfortable positions, walk around the room, use a fitball. Also, if possible, soak in a warm bath. For some people, it’s much easier to worry by standing in the shower. During contractions, pain is reduced by the position in which the pregnant woman stands with support on a table, wall, headboard, or chair. In this case, it is important to transfer the weight of the body to your arms. If a woman has back pain, the “cat” pose will be effective, when the pregnant woman gets on all fours and her stomach sags. You can also rock your hips or pelvis, creating different movements that relax the female perineal muscles and help open the cervix.

Trained pregnant women can take the lotus position. But it is prohibited to use it during active labor. If the baby's head has already dropped and is pressing on delicate tissues pelvic floor, but the cervix has not yet fully opened, the “newborn” position will be effective. In this case, the pregnant woman will have to kneel down, spread them very wide, and place a large soft pillow under the mammary glands.

Many years ago, all pregnant women gave birth lying on their back. But today modern medicine reconsidered her views on this approach to childbirth, because it has been proven that this position is convenient for doctors and uncomfortable for the pregnant woman and her baby. By the way, such a pose is not in the traditions of other countries. First of all, this is explained by the fact that when a woman in labor lies, great compression of the veins occurs, which leads to disruption of the blood supply to the placenta, which will cause dizziness. Also, in this position, the uterus contracts poorly, and the cervix opens slowly. And yet, the supine position complicates the correct insertion of the baby’s head and increases painful sensations.

There is an advantage to this position. For example, if the pregnancy is premature, the baby may show signs of intrauterine retention, in cases where labor is fast or rapid, as well as in breech presentation. Also, the expectant mother who will be given epidural anesthesia will have to take this position. Then it is necessary for the anesthetic to spread symmetrically.

This pose should be taken at the end initial period childbirth The position is comfortable, especially when the cervix is almost fully dilated, and labor needs to be monitored every second. This is very important when the fetus is premature or small. To correctly assume this position, you need to lie on your right or left side and bend your knees. You need to put a pillow under your feet. Many pregnant women squeeze it between their legs. During the birth of the child, the mother remains lying on her side, and the upper leg is raised in a bent form. For better comfort, you can hold your leg with your hand.

Posture during childbirth - “high squatting”

To take this position, you need to squat, hugging your knees and spreading your legs wide. The woman's torso needs to be tilted forward and her head down so that the baby is not born much faster. Therefore, when the baby's head appears, you need to straighten your knees. The doctor must support the baby. A woman must rest her hands on someone or something to maintain her balance. This position allows the pregnant woman not to push. The baby comes out on his own.

Position during childbirth: giving birth standing

The pose is very similar to the one described above. During childbirth, you need to bend your knees, spread your legs wide and tilt your torso forward. There should be someone behind her to help the woman not lose her balance. Until the baby's head appears, it is recommended to make light rotational movements with the hips. Then, the baby's head fits better down the abdomen. By the way, in this position the contractions of the uterus are much more effective and occur more intensely. It is important that in this position the woman in labor independently controls the pelvic muscles. The risk of ruptures is reduced, because the perineum relaxes much better.

This situation requires an assistant. The woman in labor independently controls the birth process. Another advantage of this position is that the pregnant woman does not give birth quickly, and in some cases this is important. For example, such a position can play a special role during the second birth, when the natural birth canal is already wide. If a woman in labor, standing on all fours, spreads her legs and lowers her pelvis down, leaning against the edge of a table or bed, then the baby’s head will most likely fall down the abdomen. And if it is necessary to hold the baby, the woman in labor will be advised to raise the pelvis. In this case, as soon as the baby’s head appears, the woman in labor will be asked to get back on all fours.

Whatever position you give birth in, don’t forget that you always need to relax. You should especially not squeeze during the period of approach and at the time of contractions. Listen to your obstetrician, have a positive attitude, and everything will definitely work out for you.

For quite a long time, there was an opinion among obstetricians that a woman should lie on her back during childbirth. However, as life shows, this is far from the most successful position for a woman in labor. But a comfortable position is one of the important components of a successful and painless course of childbirth!

Historical reference

Long before the birth of modern obstetrics and gynecology, being at the origins of the art of midwifery, people tried to ease the work of the mother and child during childbirth.

In Rus', during labor, a woman usually walked around the hut, leaning on benches. Often a woman in labor was forced to literally crawl on the floor, washing the corners of the hut, or unlock all the locks, bowing to low chests. In this position - “on my knees” - the stomach sagged, put less pressure on large vessels, blood supply to the uterus and fetus improved, and pain decreased. Good help They were in hanging poses: they threw a towel over the largest ceiling log - the matitsa. The resulting loop was passed through armpits women in labor so that the woman was hanging on the towel. The labor assistant supported the laboring woman, helping her to remain in a hanging position. If there were high thresholds in the house, the woman in labor was forced to step over them, raising her legs high, during the entire first stage of labor. When the attempts approached, the woman was taken to some secluded, darkened place, where the baby was born. Most often this place was a Russian bathhouse. Our ancestors gave birth mainly in a kneeling position.

Who is comfortable with childbirth “lying on your back”?

When studying postures during childbirth among various peoples, it turned out that the position on the back that is familiar to us is not in the traditions of any country. This position is very convenient for doctors and obstetricians, but is completely unsuitable for the woman in labor and the baby.

A horizontal posture on your back significantly slows down the process normal birth, interfering with the effective contraction of the uterus, the opening of its cervix, the correct insertion and rotation of the baby’s head, increases the woman’s painful sensations. In addition, when a woman in labor lies on her back, the uterus presses with all its weight on the large blood vessels, often causing compression of the inferior vena cava. This leads to disruption of blood supply to vital important organs and in the placenta, can cause dizziness, a feeling of lightheadedness - inferior vena cava syndrome.

Only in a number pathological situations The position on the back is necessary for safety and prevention of complications on the part of the mother and child. Indications for a woman in labor to stay in bed are cases of premature pregnancy and premature birth, the presence of signs of intrauterine growth retardation, rapid or quick birth. In these cases vertical position for a woman in labor can speed up the labor process and lead to trauma to the baby. With a breech presentation in an upright position, the risk of umbilical cord prolapse increases - an extremely serious obstetric situation that requires urgent attention. surgical intervention, since this may compress the umbilical cord, stopping the supply of blood to the fetus, and therefore oxygen and nutrients - this situation is critical for the fetus. With epidural anesthesia, when the anesthetic is injected into the space above the hard meninges, due to the increased likelihood of developing adverse reactions(dizziness, “weak legs”), it is often also recommended to lie down. The horizontal position is also traditional for caesarean section. However, even in the above situations (with caesarean section, with the development of inferior vena cava syndrome or when using epidural anesthesia), the optimal position is lying on your side rather than on your back.

Choosing a position for contractions

So, in the absence of contraindications to active position During childbirth, the main thing is to choose the position in which you will be as comfortable as possible. It is impossible to give universal advice on choosing a position: every woman and every birth is unique. That's why best pose in childbirth - the one that best suits you!

Given the freedom to choose a position during childbirth, most women give preference to one of the vertical positions: sitting, standing, walking. The vertical position creates a number of advantages. Firstly, unlike the prone position, there is no compression large vessels, therefore, normal blood supply to organs, including the uterus and placenta, is maintained. By intuitively choosing the most comfortable position, a woman in labor helps her baby: thus, some asymmetry of postures, achieved by moving forward or slightly lifting the pelvis or one leg, contributes to the correct insertion of the baby’s head and its rotation, i.e. correct course of labor. Secondly, in a vertical position, the force of gravity helps the baby move through the birth canal. Thirdly, the vertical position contributes to some expansion of the birth canal and easier passage of the child through it.

The most long period labor is the first, during which regular, gradually becoming more frequent and intensifying contractions lead to dilatation of the cervix. Active behavior can greatly help during this period, creating the conditions for the most effective contractions. During the period between contractions, the chosen position should allow the woman in labor to relax and rest.

Most women experience the onset of labor easier while walking. Walking, especially with high legs, helps to increase blood supply and increase the delivery of oxygen to the uterus and baby.

During the contraction itself, standing posture with support on a wall, table, back of a chair or bed helps reduce pain. All the weight is transferred to the hands. If your husband is present at the birth, you can lean on his back or hang, clasping his neck. Poses in which the stomach moves forward and sags (pose on all fours - “cat pose”; pose hanging on your husband’s neck; bending forward) help reduce pain in the back. In addition, during a contraction it is useful to sway your pelvis and hips, as if dancing. Such movements relax the muscles of the perineum and help open the cervix.

When choosing a sitting position, it should be taken into account that the surface of the seat should be quite soft, or better yet, elastic. For this purpose, the use of large inflatable balls and children's swimming rings during childbirth is effective. Such devices help relax the muscles of the perineum and promote more effective dilatation of the cervix. During contractions in a sitting position, you can also lean on your arms, pillow, or headboard. It is necessary to ensure that the legs are not closed during contractions, as this position interferes with the opening of the cervix. For greater effectiveness of the fight, you should spread your knees to the sides as much as possible.

A squatting pose with your knees spread wide apart is very effective. This position helps the child to insert the head correctly and move along the birth canal. This is facilitated by a certain pelvic tilt angle achieved when squatting. This position is most effective in cases where the cervix is fully dilated and the baby’s head has not yet descended to the pelvic floor. The disadvantage of the squatting position is the instability of the woman in it. In such a situation, the help of a husband or other loved one, present at the birth, who support the woman, helping her stay in the right position. You can also hold on to the back of a chair or bed in this pose.

One of the most famous yoga poses, the lotus pose, is also very effective posture during childbirth. However, for a long stay in it, training is necessary even during pregnancy. In this case, during childbirth, the lotus position will not cause tension, but, on the contrary, will help relax the muscles of the perineum and correctly insert the baby’s head at the beginning of the birth canal. In addition, sitting cross-legged relieves back muscles, relieving pain and tension in the back. lumbar region. These positions can be taken at the beginning of labor, when the intervals between contractions are still quite large, the contractions are not very painful, and the cervix is just beginning to open. When active labor activity If the cervix is too open, you cannot sit on a hard surface: this prevents the fetus from moving through the birth canal.

In some African tribes, who have retained maximum closeness to nature and its laws, women still give birth in a squatting or kneeling position. These traditions are preserved in Brazil and a number of other countries Latin America. In European countries: the Netherlands, France, childbirth in an upright position and birth in water are again becoming a tradition. In some Dutch families, the bride still receives a special birthing chair in her dowry, which helps her to take a comfortable position.

In a situation where the baby’s head has dropped and puts pressure on the tissues of the pelvic floor, and the cervix has not yet fully dilated, the “baby pose” helps, which imitates the position of the child in the mother’s womb. You need to get down on your knees and spread them wide. A large pillow is placed under the chest for support. You can put your hands under your head. In this position, the pelvis is higher than the mother's head. In this position, the baby’s head does not exert intense pressure, which helps reduce discomfort.

If you need to lie down comfortably during labor, choose the side-lying position.

Often, intuitively, a woman chooses an asymmetrical pose - a runner's pose. In this position, place a pillow under one of the legs, bent at the knee. You can hold a pillow between your legs. This position is the most gentle for the baby and helps the head to correctly insert into the birth canal.

Posture during pushing

Currently, in a number of maternity hospitals, women are allowed to be active in the first stage of labor. However, at the end of the period of cervical dilatation, when contractions become more frequent and when pushing begins (the second stage of labor), the woman in labor is placed on her back. In this case, be sure to connect a special device that allows you to monitor the heart rate of the fetus or, in the intervals between contractions, listen to the fetal heartbeat using an obstetric stethoscope (tube). At the moment of birth of the head, the midwife carries out special moves aimed at preventing perineal ruptures. These manipulations are only possible with the woman lying on her back. In addition, in the supine position, a position has also been developed that promotes the greatest effectiveness of pushing: the woman must bend her head so that her chin is pressed to her chest, the woman in labor pulls special handrails towards herself, and rests her feet on the supports, while she needs to sit down on a chair. . Only a few maternity hospitals have special chairs for vertical birth. In this case, the fetal heartbeat can be monitored using telemetric devices, which relieve the woman in labor from being “attached” to the bed. Unfortunately, all these devices have not yet become widespread in our maternity hospitals.

Do something in uncomfortable position extremely difficult: tired and tense muscles quickly make themselves felt. Childbirth is a rather long and labor-intensive process. Therefore, it is so important to choose the position that is most suitable for you, in which you will be comfortable and the baby will be born easily.

Change of body position, acceptance comfortable poses, walking around the ward and other active behavior of the woman in labor during labor are integral parts of the concept free behavior in childbirth, quite widely used in modern obstetrics and gained approval from both obstetricians and women in labor. In the past, the instructions for the management of childbirth were unambiguous: the woman lay both during the first stage of labor - during the dilation of the cervix, and in the second - during the expulsion of the fetus. With the introduction of free behavior during childbirth, as well as various non-drug methods of pain relief, there were significantly fewer cases of protracted course birth process, which can have a very adverse effect on the flow postpartum period, condition of the fetus and newborn, increases the risk postpartum hemorrhage etc. In women in labor who changed their body position, there was a shortening of the duration of labor, relief labor pain and even improving the child’s condition at birth, which became the impetus for the active widespread implementation of this concept.

The advantages of free behavior during childbirth are the following:

When moving, taking different body positions, the blood supply to the uterine muscle improves, which creates favorable conditions for its normal contractile activity and prevents the development of complications, such as weakness of labor, promoting a good rate of dilatation of the cervix.
One of the most important positive effects of free behavior during childbirth is a pronounced analgesic effect. This is explained by several mechanisms. The main component that determines the severity of pain is the saturation of blood with oxygen, which is consumed during the powerful muscular work of the uterus during childbirth. If the woman in labor is in a stationary position - lying on the bed without moving - then the blood supply to the uterine muscle is reduced, and the supply of cells with the main energy fuel becomes insufficient. This leads to the development of hypoxia - oxygen starvation tissues, restructuring of biochemical processes of contraction muscle fibers, which significantly increases pain.
Improved blood supply to the uterus, observed with free behavior of the woman in labor, helps not only to optimize labor, but also to improve uteroplacental blood flow, and, consequently, the intrauterine condition of the fetus.
With the help of various body positions accepted by the woman in labor, it is possible to regulate the course of the labor process - to speed up or, on the contrary, slow down labor, which is necessary, for example, in case of excessively violent labor or premature birth, when, in order to prevent trauma to the premature fetus, careful, gradual opening of the uterine pharynx and slow advancement of the baby is preferable.
Vertical postures help accelerate the movement of the fetus along the birth canal, stretching them well, which shortens and facilitates the process of childbirth.
This method of conducting childbirth requires virtually no financial investment; widespread availability and the absence of adverse effects on the fetus contribute to the widespread use of free behavior during childbirth.

Prepare in advance

A reasonable step for the expectant mother would be to prepare for childbirth in advance, to practice taking various positions that she will take during the birth process; fortunately, now almost all courses for pregnant women include classes on free behavior during childbirth and non-drug methods pain relief.

The advantages of practicing positions in childbirth in advance are beyond doubt:

Practicing postures will help a woman understand which positions are convenient for her, since there are many options, and which postures a given woman in labor will choose depends on the characteristics of her physique, the size of her abdomen, physical fitness, etc.

Future mom learns and practices in practice those poses that are preferable to take depending on various features the course of labor, since it is difficult to know exactly in advance how her labor will proceed - quickly or, on the contrary, with weakness of labor.

The woman will be able to work correct options positions during childbirth, bringing them to the point of automatism, since during contractions there may no longer be time or opportunity to learn how to correctly adopt positions. This will help the expectant mother not to get confused during childbirth and feel confident.

Postures during contractions

Postures in the first stage of labor - when the cervix dilates - are quite varied. They can be divided into vertical, horizontal - lying on your side, as well as poses using a fitball - a large inflatable gymnastic ball, widely used in maternity hospitals to ease contractions and pushing.

It must be remembered that if childbirth proceeds without complications, then the choice of comfortable positions remains entirely up to the woman in labor: she can behave freely during childbirth. If there are deviations during labor, the obstetrician-gynecologist leading the birth will give recommendations on what body position is advisable to take so as not to harm the woman in labor or the baby.

Vertical positions

As a rule, having freedom of choice, most women in labor in the first stage of labor instinctively choose vertical positions, feeling relief in this particular position. This occurs due to the fact that the fetal head and amniotic sac they put quite a lot of pressure on the cervix, which helps it open better and less painfully, and the pregnant uterus does not put pressure on large vessels, which helps to provide the baby with good oxygen and nutrients in childbirth. In addition, the longitudinal axis of the uterus and fetus coincide: the force of gravity helps the correct insertion of the head into the pelvic cavity.

At the beginning of the opening period, when contractions are not yet very strong and frequent, you can stand and walk around the ward.

It is important to remember that in order for the poses to be effective, it is necessary not to freeze in a static position, but to make movements - rock or rotate the pelvis, as if drawing circles or figure eights, step from foot to foot, squat shallowly, dance. All this helps to improve blood circulation, and therefore has a beneficial effect on the process of dilation of the cervix and on the intrauterine condition of the fetus.

On initial stages during childbirth, you can sit on a chair facing its back, leaning and leaning towards the back at the moment of contraction, or sit in the “lotus” or Turkish position. During active contractions and cervical dilatation of more than 4–5 cm, it is impossible to sit on a hard surface, as this prevents the correct insertion and advancement of the fetal head along the birth canal. If you want to sit, then during childbirth they use either a fitball - an inflatable gymnastic ball, or a bed placed on a low stool; Some maternity hospitals have special chairs with a round hole cut out in the projection of the presenting part of the fetus to eliminate pressure on it.

When the contractions become more active, postures with the torso tilted forward bring relief: you can lean on the windowsill, wall, headboard, kneel down, and focus on the edge of the bed. You can not only rest your hands on the support, but also put it on it top part torso - chest, arms, head: in this position, due to the anterior deviation of the abdomen, the load on the spine is well reduced, which allows you to relax as much as possible and rest between contractions.

If you are giving birth with a partner, they can be invaluable in helping you decide comfortable positions bodies. You can stand with your back to the assistant, then at the moment of contraction he will be able to massage your stomach in a clockwise direction. You can turn your face to your partner and grab him by the neck and “hang” on him while the uterus contracts.

When the period of cervical dilation comes to an end, it is convenient various options squatting positions (it should be noted that this position is indicated only for cephalic presentation of the fetus), since the legs widely spread to the sides contribute to the physiological angle of the pelvis and the correct insertion of the fetal head. You can squat, leaning on the edge of the bed or chair. When your partner is sitting, you can squat with your back to him, leaning on his knees. A variant of the squatting position is the “karate” pose: the woman in labor squats with her knees spread to the sides and leans on her outstretched arms, while her hands are clenched into fists.

The negative aspect of the squatting position is the rapid fatigue of the leg muscles, therefore, to make it easier to stay in such a position, some maternity hospitals have special chairs with a hole for the fetal head or are asked to sit on a bedpan placed on a low stool.

Also an option vertical positions are kneeling poses with legs spread wide apart with the torso tilted forward and resting on a chair or bed, you can lean with outstretched arms on the floor. Such positions, as well as squatting positions, contribute to a sufficient expansion of the birth canal; In addition, gravity helps the baby move faster through the birth canal.

Horizontal positions

Postures in which the axis of the spine is parallel to the floor are, as a rule, necessary in cases where the woman in labor wants to push due to the low position of the fetal head, but this cannot be done, since the cervix has not fully opened and may rupture. In these situations, the position on all fours comes to the rescue, in which you can lean on a pillow or folded arms so that the head end is located below the pelvis - this effectively reduces the pressure of the fetal head and reduces the urge to push.

A variant of the horizontal position is the position of the woman in labor lying down. It should be noted that during pregnancy, lying on your back is extremely undesirable, as this leads to compression of large vessels by the pregnant uterus - the aorta and the inferior vena cava, located behind it. A sharp decline blood flow in such large vessels reduces the flow of blood to the upper body, which leads to fainting.

Considering this circumstance, optimal position for a woman in labor, the position is lying on her side, and it is best to lie on the side where the back of the fetus is facing, as this helps improve the blood supply to the fetus by eliminating compression of the blood vessels of the placenta and umbilical cord. If the baby is in a breech position, then the position lying on the side, corresponding to the position of the fetus, serves as a prevention of untimely effusion amniotic fluid, and therefore helps to avoid such unfavorable complications as prolapse of the umbilical cord and small parts of the fetus, such as legs. In the lateral position, not only does the blood supply to the fetus improve due to the absence of compression of large vessels, but there is also a decrease in the frequency and intensity of contractions, and due to the fact that the presenting part of the fetus does not exert significant pressure on nerve plexuses pelvis, its movement along the birth canal occurs more smoothly and slowly.

In some obstetric situations, it is recommended to be in this position in order to, if possible, prevent the rapid progress of labor, not force the descent of the presenting part, and protect the fetus as much as possible from oxygen starvation - hypoxia, which inevitably develops with overly active labor.

Indications for the side-lying position are the following situations:
Childbirth in the breech presentation of the fetus - to prevent the prolapse of umbilical cord loops and small parts of the fetus - arms, legs - after spontaneous rupture of amniotic fluid. Loss of umbilical cord loops can lead to compression between the pelvic bones and the presenting part, a pronounced decrease or complete cessation of blood supply to the fetus, which is dangerous for the development of acute hypoxia - oxygen starvation, and even intrauterine death of the fetus. Prolapse of small parts of the fetus (with a breech presentation there is a risk of the baby's leg or legs falling out) can cause infection to enter the uterine cavity. Due to the fact that the prolapsed leg does not allow the large presenting part to be well fixed at the entrance to the pelvis, prolapse of the umbilical cord may occur.

Premature birth or delayed fetal delivery intrauterine development– to protect the weakened body of the fetus from overly active labor and hypoxia.

Rapid and rapid labor - to try to weaken violent uterine contractions and prevent ruptures of the soft tissues of the birth canal, which are possible with the rapid advancement of the fetus.

Severe polyhydramnios - to avoid spontaneous discharge of a large volume of amniotic fluid, along with which a loop of the umbilical cord and small parts of the fetus may fall out. In addition, due to the sharp contraction of the uterus, the risk of placental abruption increases. After the waters have receded and the presenting part has pressed well against the entrance to the pelvis, the woman in labor is allowed to behave freely.

Epidural anesthesia is a method of pain relief that blocks pain sensitivity lower half of the body, which is achieved by introducing an anesthetic into spinal canal. In this situation, there is a possibility of a decrease blood pressure when getting up. Moreover, although modern drugs and do not block motor ability lower limbs, there is a risk muscle weakness in the legs, therefore, in order to avoid falling and injury, the mother in labor is recommended to lie down.

Lying on your side, you can take the so-called “runner’s pose” - the upper leg is bent at the knee, you can put a pillow between your legs, which will make being in it quite comfortable. You don’t have to lie still - at the moment of contraction, you can bring your knees in and out, sway or spring on the bed, move your pelvis, as this will have exactly the same effect. positive effects free behavior during childbirth.

Use a fitball

Currently, the use of a large inflatable gymnastic ball - a fitball - during childbirth is becoming increasingly recognized, which is used for gymnastics during pregnancy, as it helps to relieve stress from the spine, and is also used during childbirth - for taking comfortable positions and massage, taking worthy place as one of the components non-pharmacological pain relief contractions
It must be emphasized once again that for effective use fitball during childbirth, you need to familiarize yourself with the options for its use in advance, during pregnancy, since during childbirth you may not have the time or desire to study the possibilities of fitball in practice.

During contractions, you can sit on the ball with your knees wide apart to the sides. A good distracting effect is provided by rocking, rotating movements of the pelvis, rolling or springy, as if bouncing, movements at the moment of uterine contraction. Such movements relieve tension and relax the pelvic floor muscles, preparing them for the baby's advancement. Good relaxation and improved blood supply, observed when positioned on a fitball, contribute to normal course birth act.

In order to rest, you need to kneel down and lower your chest and head onto the fitball: this position significantly reduces the load on the spine, allowing you to relax as much as possible and gain strength before the next contraction.

It should be noted that in order for the fitball to be used during childbirth, it should not be inflated very much. It is in this form that it will be sufficiently soft and elastic, which will allow you to sit on it, as well as freely lean on it, without the risk of putting excessive pressure on the uterus, placenta and fetus.

Poses during pushing

Speaking about postures during the period of fetal expulsion, we need to divide this stage into two phases. During the first, the fetal head is still high, and the doctor or midwife does not need to control the standing level of the presenting part of the fetus. The second phase is the very moment of the birth of the child.

At the beginning of the second stage of labor, when the cervix has fully opened and there is a desire to push, the most comfortable positions are vertical: standing, squatting, sitting on a fitball or bedpan placed on a low stool, since in these positions gravity helps the fetus to descend faster down the birth canal and expand it.

When the fetal head has dropped low enough, the traditional position is the lying or reclining position (with the head end raised) on the delivery chair, as it has a number of significant advantages. First of all, this position allows the maternity hospital staff to monitor the progress of the head and provide obstetric assistance - a series of techniques performed by a midwife at the birth of a child and aimed at carefully removing the fetal head and preventing ruptures of the tissues of the soft birth canal. In addition, the position of the woman in labor on her back provides good access to listening to the fetal heartbeat with an obstetric stethoscope or a cardiotocography (CTG) device, which is especially important during the pushing period, since monitoring the fetal cardiac activity is necessary after each pushing.

The most effective position is the following: while pushing, raise your head and press your chin to your chest, hold your legs wide apart at this time with your hands under your knees or ankles, and when you are on the maternity chair, hold on to special handles and pull them towards you. This allows you to use your muscles as much as possible abdominals and relax the perineum, which promotes good movement of the fetus along the birth canal. A variant of the position for childbirth is the position of leaning with your back on a half-deflated fitball: it combines the convenience of a horizontal position, which allows the doctor and midwife to monitor the condition of the mother's perineum, and a vertical position of the upper body, which helps the fetus descend.

The free behavior of the woman in labor, the adoption of various positions plays an important role in the favorable outcome of childbirth, as it helps to reduce pain during the dilatation of the cervix, increase the effectiveness of uterine contractions, and, if necessary, restrain or, on the contrary, intensify efforts. An expectant mother at the stage of preparation for childbirth, having received information about the options for positions and having tried them in practice, will be able to significantly help herself and her unborn baby.

Vertical birth

An alternative to childbirth in horizontal position are the so-called vertical births, in which the woman in labor is in a vertical position not only at the beginning of pushing, but also at the moment of birth of the fetus. Vertical childbirth requires preparation as medical personnel, and women in labor, therefore they are practiced only in certain maternity hospitals that are licensed to conduct such births.

The most common position for vertical childbirth is on your knees with emphasis on the headboard, which is raised to a vertical position for childbirth. The woman in labor stands on the bed and holds the back of the bed with her hands. A variant of the position for vertical birth is the squatting position: it promotes the fastest movement of the fetus along the birth canal, but is inconvenient for the midwife to monitor the condition of the perineum, so there is a risk of perineal rupture.

If, during vertical childbirth, indications arise for the provision of any assistance, the woman in labor is transferred to the traditional position - lying on her back.