Promoting unrestricted movement during labor and birth for better birth outcomes this training is a supplement to your complete childbirth education class

“Freedom of Movement” © The “Freedom of Movement” initiative (FMI) promotes the unrestricted movement in labor and birthing for low risk mothers; this includes walking freely during laboring and mother’s choice of birthing position.

The Freedom of Movement Initiative supports physiologic birth. This means the promotion of practices during labor and childbirth that: * Are evidence-based * Improve the health outcomes for mother or baby * Shift power from provider to woman * Discourage technology or interventions without proven benefit

Unrestricted movement and freedom to choose a comfortable position, especially when in pain, allows a woman to feel empowered and in control of her own body. POWERFUL AND STRONG POWERFUL AND STRONG

This reduces stress and tension, as well as feelings of fear, demoralization, being submissive and dominated so…. so….

With less stress and fear, a woman’s body can more easily relax and release her baby This allows labor to proceed in a timely manner and reduces negative or traumatic experiences, that could lead to longer recovery and/or postpartum depression

The feelings, attitude emotion of a mother induces anxiety in labor, leading to fear, which in turn causes muscular and psychological tension resulting in pain. Dr Dick-Read began the “Natural Childbirth” movement by advocating for education, support and understanding. Adrenaline produced with fear can also inhibit the first stage of labor and increase pain. Dick-Read G. (2004) Childbirth without fear: the principles and practice of natural childbirth. Pinter & Martin: London.

Walk, kneel, squat, sit

29 percent less likely An updated Cochrane Review of evidence on the topic provides the strongest evidence yet in favor of women staying upright during this stage of labor. Women are 29 percent less likely to have a caesarean birth. “Because of the shape of the vagina, the passage of the baby is more 'down' than 'up' when women give birth on all fours.” Professor Hannah Dahlen of the School of Nursing and Midwifery at the University of Western Sydney Being on all fours frees the woman to rock her hips to maneuver the baby down the birth canal. It may Also make pushing easier. Annemarie Lawrence 1,*, Lucy Lewis 2, G Justus Hofmeyr 3, Cathy Styles 4 (2013). Maternal positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT) The psychotherapeutic use of movement The main principle of DMT is that mind and body are inseparable. So allowing the body to relax and be at ease through dance also allows the mind to be at ease and vice versa (Levy, 1992). Movement is like a moderator, between psychological, emotional and physical issues occurring during labor and birth, assisting in calming and integration for wellbeing. Dance and movement therapy (DMT) The psychotherapeutic use of movement The main principle of DMT is that mind and body are inseparable. So allowing the body to relax and be at ease through dance also allows the mind to be at ease and vice versa (Levy, 1992). Movement is like a moderator, between psychological, emotional and physical issues occurring during labor and birth, assisting in calming and integration for wellbeing. Levy F. (1992). Dance Movement Therapy- A Healing Art. American Alliance for Health. Physical Education, Recreation, and Dance. Reston Virginia. Berrol CF. (1992). The neurophysiologic basis of the mind-body connection in dance/movement therapy. American J of Dance Therapy ; 14:

movement decreases physical and emotional pain Dance is an expressive therapy that has been used for thousands of years and is currently used with rehabilitation, physical therapy and cancer treatments as well as for emotional and behavioral therapy with children and adults. movement decreases physical and emotional pain Dance is an expressive therapy that has been used for thousands of years and is currently used with rehabilitation, physical therapy and cancer treatments as well as for emotional and behavioral therapy with children and adults. Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50."A Systematic Review of the Evidence for the Effectiveness of Dance Therapy"

Evidence in Scientific Literature “There is clear and important evidence that walking and upright positions in the first stage of labour … reduces * the duration of labour, * the risk of caesarean birth, * the need for epidural” Annemarie Lawrence 1,*, Lucy Lewis 2, G Justus Hofmeyr 3, Cathy Styles 4 (2013). Maternal positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group. “Women who ambulated during the first stage of labor were less likely to have C-S, forceps or vacuum extraction.” (Albers, 1997)

a sample of the qualitative responses received from mothers who birthed in the past 5 years: a sample of the qualitative responses received from mothers who birthed in the past 5 years: “I wasn't allowed to move around. It added stress to the process because I felt like I needed to be up walking, needed to be upright for delivery...but I wasn't allowed to do those things and was never given a good reason why. I fought to be able to walk the halls, but the nurses fought to ensure i had a portable monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if they had've left me alone. They seemed frantic, untrusting and determined to have their hands in every aspect of my experience for "safety reasons". “Yes! It is why I had a positive birth experience! Walked, showered & danced with my husband!” “I have labored six times. I realized during my first one that it was my labor...and when they didn't want me to move, I told them I needed to pee., when she was born they had me push for two hours on my back....lots of tearing and they cut me. my second baby I walked, labored in a tub, but then they had me leaning back to give birth...and cut me (this was a German hospital), third baby we were in Italy. I had a midwife, and she left and baby came. I needed to push, David said try, I hung on him and pushed. Then I sort of squatted, and on second push her head was out! I learned that letting my body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was harassed to stay on my back while laboring. It felt like a physiologically impossible prison. I feel the position compromised my daughters health as she was LOW and small and had the cord wrapped around her neck. I was in a great deal more pain on my back. It was awful.” “… there was nothing I could do but lie there and be in pain. I would have been MUCH happier and (I believe) had an easier time doing the work of delivery if I could have swayed, squatted, and paced the way my body was telling me to.” “I was forced to monitor and have iv hook up all night. By 9:30 am I said enough. If you dont let me out of this bed I'm unhooking myself. They insisted on another hour of fetal monitoring then let me walk with the iv drip. Once I could move things sped along nicely. I firmly believe it was walking that made it so!” (replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth: Powerless Disregarded Demoralizing Angry Mortified Stressed Awful Prison Words used to describe non restricted labor/birth movement: Free Ease Safe Instinctual Great Beautiful Pleased Words used to describe movement restricted birth: Powerless Disregarded Demoralizing Angry Mortified Stressed Awful Prison Words used to describe non restricted labor/birth movement: Free Ease Safe Instinctual Great Beautiful Pleased “I can't imagine how much pain I would have been in if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only natural! I couldn’t imagine catching a baby with a woman forced on her back. Not only would she be uncomfortable but it would take so much longer.” “When I support women in the hospital, I always find ways for them to get up and move around, even if it’s just walking to the bathroom. In my experience these moms are a lot happier, freer and have better births. “Yes- I teach moms to use whatever position they want. This is easier when there’s a birth tub. They aren’t even able to lie lithotomy.”

IV or intravenous catheter that is routinely inserted in the lower arm or hand of a laboring women is generally NOT necessary. It is mainly a precaution to prevent It is mainly a precaution to prevent dehydration, which is not an issue dehydration, which is not an issue if a woman is just allowed to drink. if a woman is just allowed to drink. There is no medical reason to There is no medical reason to prevent eating and drinking in labor. prevent eating and drinking in labor.

No need for an IV to stay hydrated… “Allowing self-regulated intake of oral hydration and nutrition has been shown to help prevent ketosis and dehydration.” “Cochrane review (3,130 women) found no justification for restricting oral fluid or food during labor.”

Fetal monitoring Do babies have better outcomes with fetal monitoring? NO! Get off the strap. “There were no differences between women who received intermittent auscultation and those who received continuous EFM in perinatal mortality, cerebral palsy, Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage.” Dekker, Readings are often inaccurate due to maternal/fetal movements. No only does fetal monitoring NOT HELP BETTER OUTCOMES, it actually may cause damage.

Increase rate of Cesarean Section delivery Increase use of Vacuum and Forceps Additionally, “70% of obstetrical litigation related to fetal brain damage is related to purported abnormalities on the EFM tracing.” Symonds And incidence of neonatal seizures significantly decreased when fetal monitoring was not used. ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states: “ Those with high-risk conditions (eg, suspected fetal growth restriction, preeclampsia, and type 1 diabetes should be monitored continuously).” NOT LOW RISK moms

© 2013 Birth-Matters CHILDBIRTH Don’t Take it Lying Down! Stand up and lean against the wall Stand up and lean against your partner Sit on a birth ball Sit on a birth stool Kneel on a pillow and lean into your partner Squat on a mat or on the bed Get on all 4’s and sway Rock your hips ~ walk around ~ Shift often!

Practice different positions and have your birth partner be prepared to help you with them Practice different positions and have your birth partner be prepared to help you with them Changing position can reduce the length of labor. Mendez-Bauer and Newton (1986) state: “duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in patients who alternated supine and standing, standing and sitting positions.”

WHAT CAN YOU DO? Ask to keep fetal monitoring to to a minimum, utilizing intermittent auscultation. If the hospital refuses, ask them to pull the electronic monitor on you intermittently (not strapped to you) Ask that an IVs be only used in the case of a medically necessity and if you can have mobile attachments for freedom of movement in a wide area. WHAT CAN YOU DO? Ask to keep fetal monitoring to to a minimum, utilizing intermittent auscultation. If the hospital refuses, ask them to pull the electronic monitor on you intermittently (not strapped to you) Ask that an IVs be only used in the case of a medically necessity and if you can have mobile attachments for freedom of movement in a wide area.

Learn the tools available to help with birth such as water tubs Learn the tools available to help with birth such as water tubs © © 2009 Chasse, J Water is soothing and helps promote relaxation, with ease of movement and greater comfort. Some women are also more uninhibited in water, allowing their body to relax and easier release the baby.

birthing bars and birthing balls birthing bars and birthing balls © 2013 Memorial Hospital of South Bend © 2013 Regents of the University of Minnesota and Charlson Meadows. Sitting upright on a birth ball or squatting on a birth bar allows you to find the correct posture and position for the baby to come down and allowing the contractions to be more effective. Your pelvis outlet increases by up to 30% allowing easier decent for baby. Rocking on a ball can relieve back tension and pain Squatting with a birth bar and sitting on a ball gives much needed support. Upright posture works with gravity. Also increases blood flow to the uterus and provides counter pressure when sitting.

rebozo This is a traditional mexican scarf that can be placed around the mother's body with ends held by a doula, friend or partner to help support mom and baby’s weight. Rhythmic moving with slight lifting relaxes the mother. Upon relaxation, the partner tugs strongly on one end that encourages positive movement in the desired direction. For this type of massage, jerk the end of the rebozo on the side you want the baby rotate toward. rebozo This is a traditional mexican scarf that can be placed around the mother's body with ends held by a doula, friend or partner to help support mom and baby’s weight. Rhythmic moving with slight lifting relaxes the mother. Upon relaxation, the partner tugs strongly on one end that encourages positive movement in the desired direction. For this type of massage, jerk the end of the rebozo on the side you want the baby rotate toward.

SUMMARY: Use unrestricted self-initiated comfort-seeking movements during labor and birth Change position and use different ways to move such as squatting, stretching, swaying and dancing © Prenataldancefitness.com Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD

Remember that you can make a difference in having a POSTIVE BIRTH EXPERIENCE with evidence based tools, care and education, lower adverse maternal outcomes is possible Remember that you can make a difference in having a POSTIVE BIRTH EXPERIENCE with evidence based tools, care and education, lower adverse maternal outcomes is possible

Thank you for participating in this training For more information, please write to Dr. Jill Diana Chasse

42 Additional References Carroli G and J Belizan Episiotomy for vaginal birth (Cochrane Review), in The Cochrane Library. Issue 2. Update Software: Oxford. Eason E et al Preventing perineal trauma during childbirth: A systematic review. Obstet Gynecol 95: 464 –4 71. Gupta JK and VC Nikodem Woman’s position during second stage of labour (Cochrane Review), in The Cochrane Library. Issue 4. Update Software: Oxford. Lauzon L and E Hodnett Caregivers' use of strict criteria for diagnosing active labour in term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford. Ludka LM and CC Roberts Eating and drinking in labor: A literature review. J Nurse- Midwifery 38(4): 199 – 207. Madi BC et al Effects of female relative support in labor: A randomized control trial. Birth 26:4 – 10. Neilson JP Evidence-based intrapartum care: evidence from the Cochrane Library. Int J Gynecol Obstet 63 (Suppl 1): S97 –S 102. World Health Organization Safe Maternal Health and Safe Motherhood Programme World Health Organization partograph in management of labour. Lancet 343 (8910):1399 – World Health Organization (WHO) Care in Normal Birth: A Practical Guide. Report of a Technical Working Group. WHO: Geneva.