Lamaze Health Birth Practice #2: Freedom of Movement Throughout Labor

When you stub your toe – what do you do?  Stare at it and think (insert deadpan voice) “Ouch, I stubbed by toe.”?  Or what if you slam your finger in a door? Or have some other type of  acute pain…imagine it….  What do you do?  Usual reactions are to potentially let out some choices words like “Dag nabit” or “Sugar peas” or whatever else might come to the tip of your tongue.  But very quickly following or even perhaps simultaneously – is MOVEMENT.  Shaking your foot or hand. Pacing back and forth. Walking it off (as I tell my kiddies when they get a bump). We typically want to move in response to discomfort. It is common to address the pained area with physical touch.  We rub the toe. We suck that finger in our mouth.  These again are physiologically soothing acts that we don’t think about, we just know it feels better when we do them.

So how does this apply to childbirth?  Well, let’s talk about that!  Ask anyone in 2016 what they think about when contemplating their upcoming labor and #1 answer will be…..pain.  As defined by Mirriam-Webster: Pain – the physical feeling caused by disease, injury, or something that hurts/harms the body. With that definition, there is no pain in labor!  AWESOME!!! I just removed all pain from your labor!!!  Whoo Hoo!!!  This is a big point – it is NOT disease, injury or harm.  It is normal.  That being said, it has been known to hurt a little bit.  The PAIN we talk about in our childbirth classes are intense physical feelings (contractions) that are:

P – Purposeful – they are doing something – like dilating your cervix and moving your baby down

A – Anticipated – I just told you that it is going to happen – so no surprises! J

I – Intermittent – HUGE!!  They come and go!  Average first time labor is 15 hours.  About 3.5 hours of which is contracting (“coming”). Thus the “going” part equals approximately 11.5 of NOT feeling contractions/intensity/waves of powerful awesomeness.  11 and a half hours!!!

N – Normal – it’s ok, the human race has been doing this song and dance for a while. It is normal and necessary to bring the baby out.

Luckily, movement is a super big helper with the perception of discomfort.  I say perception, because technically the muscles are still contracting – the nerve endings are still sending signals to the brain that are recognizing discomfort and a baby is still moving down and out.  These things do not change; however, a woman in labor has the ability to feel the intensity differently – less – with the introduction of comfort measures and movement is a good one.

How does movement change perception of “pain”?  Our body helps us out a lot in labor.  From the release of endogenous opioids (a.k.a. endorphins) to the presences of mechanoreceptors, we have a loaded tool box of physiological assistance in moving the perceived pain farther away from our point of focus.  When you are free to move in labor, you stimulate your mechanoreceptors.  These are sense organs or cells that respond to the mechanical stimuli of touch.  There are Pacinian corpuscles, Meissner’s corpuscles & Merkel’s discs and are activated with different pressures as they are located at different depths within your skin.  These are stimulated by light and deep pressure/touch.  They are located in your joints (as you walk and move), palms of your hands (rubbing, making a fist or better yet a nice hand massage) and soles of your feet (walking or nice foot massage), lips (remember sucking on that hurt finger…) and in the genital regions (sitting on a birth ball works great) as well as hair follicles (having your head stroked or hair brushed).  When these receptors are activated or stimulated, they send signals to the brain faster than the “pain” and create a more dense perception making it less intense by closing the “pain gate”.

Why does movement help in labor?  According to Teri Shilling, Amy Romano & Joyce DiFranco in their article for The Journal of Perinatal Education, “Freedom of movement is important in making the birth of your baby easier.  It is the best way for you to use gravity to help your baby come down and to increase the size and shape of your pelvis. It allows you to respond to pain in an active way, and it may speed up your labor process (Simkin & Ancheta, 2005)”.

What does the evidence show?  In all of the research studies published on freedom of movement in labor, none showed that walking in labor was harmful to healthy women with normal labors. In addition, it found that women in the study who did walk in labor, 99% stated satisfaction and in fact would walk again during future labors.  No study showed women stating she was more comfortable on her back. Care providers and facilities that had policies encouraging women to walk or change positions in labor found higher findings of:

• Shorter labors
• More efficient contractions
• Greater comfort
• Less need for pain medicine in labor (Simkin & Bolding, 2004; Simkin & O’Hara, 2002)

What’s in a name? Just the name Freedom of Movement gives a sense of power.  Freedom. Choices. It expresses the innate desire to move in response to the “pain”. To work together with your baby to find the most efficient way down and out.  A study by Storton in 2007 found that restricting women’s movement may result in worse birth outcomes and may decrease women’s satisfaction with their birth experience. In all of our births we have witnessed as BBC doulas, every woman has their own path.  They each move in different ways to different rhythms at different times with different breaths. It is fascinating and amazing to watch as they open up to their own power and birth their child.

Here are some ideas on positions to try in labor and having experienced labor support like a doula will help facilitate movement and position changes during your labor in person.