Promoting unrestricted movement during labor and birth for better birth outcomes

© 2012 APPPAH Congress WHAT IS IT? The “Freedom of Movement” initiative (FMI) promotes the unrestricted movement in labor and birthing for low risk mothers; this includes moving freely during laboring and mother’s choice of birthing position.

How will these women be recruited? Data will be gathered from women in their 3 rd trimesters planning to deliver at XXXXXX by completion of questionnaires. There will be questions regarding their plans for labor and birthing. If they would like more information about the research intervention, they will be given training and support on techniques for movement in labor Those women will receive suggestions on non pharmacologic pain reduction via movement and positioning in labor (FMI). The facilities will also be offered a training presentation to use for their staff. learn about the Freedom of Movement Initiative from provider attend prenatal visits after learning about FMI, attend training that teaches how to use movement in labor attend childbirth classes with Freedom of Movement training Utilize the movement techniques taught when at birth place through 1st and 2nd stages of labor Use techniques at place of birth

WHY PROMOTE MOVEMENT? Because movement RESTRICTION during labor and birth leads to MORE ADVERSE MATERNAL OUTCOMES Including: Caesarean sections Emotional trauma Perineal tearing Labor dystocia Deep vein thrombosis and more Russo, C. and Andrews, R. (2009). Potentially Avoidable Injuries to Mothers and Newborns During Childbirth, HCUP Statistical Brief #74. Agency for Healthcare Research and Quality, Rockville, MD.

Adverse maternal outcomes are HIGH Nearly 157,700 potentially avoidable injuries to mothers and newborns occurred during childbirth in % of live births were caesarean in Maryland ⁴ ( 36% in Montgomery County) ⁴ HIGHER than the average US rate of 33% ⁴ 25-34% of women report that their births were traumatic ¹² ⁵ Risk Factors are HIGH 42% of first time mothers are induced ³ 47% of mothers have labor accelerated with Pitocin ³ NOT evidence-based 1. Czarnocka J, Slade P Br J Clin Psychol 39 (Pt 1):35-51.Prevalence and predictors of post-traumatic stress symptoms following childbirth. 2. Declercq E, Sakala C, Corry M, Applebaum S New Mothers Speak Out: National Survey Results Highlight Women’s Postpartum Experiences. Childbirth Connection: New York 3. Dekker, Rebecca. (2013) Evidence Based Birth. Maternity Practices in the United States. Available: 4. National Vital Statistics Reports,(2013) Vol.62,No Soet JE, Brack GA, DiIorio C Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 30(1): Russo, C.A., Wier, L., and Steiner, C. Hospitalizations Related to Childbirth, HCUP Statistical Brief #71. April U.S. Agency for Healthcare Research and Quality, Rockville, MD © 2013 Evidence Based Birth

Restriction to bed and to a back lying (supine/lithotomy) positions are NOT BASED ON EVIDENCE They narrow the pelvic outlet Place pressure on the tailbone Place pressure on the perineum and work against gravity, leading to adverse outcomes increasing discomfort and pain, lengthening the pushing stage, and increasing the risk of a fetal malpresentation 76% of women are not allowed out of bed 92% of women are restricted to back-lying positions 1 Dekker, Rebecca. (2013) Evidence Based Birth. Maternity Practices in the United States. Available:

What has been successful in other communities? “An ideal birth position allows the mother's sacrum and coccyx the freedom to rotate backward, the rest of the pelvis room to open to optimal dimensions to allow for birth, and contractions to remain strong and close together. She (the mother) should choose the position that best enhances the quality of her contractions and her ability to push.” - “Holistic Midwifery,” midwifery textbook by Anne Frye © 2012 ALLterNATIVEliving (ANL)

Method of Intervention: *Introduce movement techniques *Provide movement tools *Have trained staff to encourage women unrestricted self- initiated comfort-seeking movements *Provide intermittent auscultation, only use IVs, pharmacologic augmentation or induction if medically necessary Method of Intervention: *Introduce movement techniques *Provide movement tools *Have trained staff to encourage women unrestricted self- initiated comfort-seeking movements *Provide intermittent auscultation, only use IVs, pharmacologic augmentation or induction if medically necessary © 2013 Memorial Hospital of South Bend © 2013 Regents of the University of Minnesota and Charlson Meadows. IT CAN BE TAUGHT to women by their providers at prenatal visits and at childbirth education classes. IT CAN BE INTEGRATED into a birth center or hospital FMI will provide a training seminar on suggestions, benefits, methods and tools. Birth assisting devices should be provided in the hospital to make movement possible.

HOW DO WE IMPLEMENT IT? With help from our collaborators, training in Labor Movement and these tools will be provided to local birthing facilities. What types of activities? Use of body movement (dancing, swaying, etc) Use of birthing support tools (stools, tubs, rebozos, cushions, bars, balls, etc) Use of nonpharmocologic movement oriented a approaches to pain relief (massage, counter pressure, stair step, hip squeeze, etc) HOW DO WE IMPLEMENT IT? With help from our collaborators, training in Labor Movement and these tools will be provided to local birthing facilities. What types of activities? Use of body movement (dancing, swaying, etc) Use of birthing support tools (stools, tubs, rebozos, cushions, bars, balls, etc) Use of nonpharmocologic movement oriented a approaches to pain relief (massage, counter pressure, stair step, hip squeeze, etc) ©

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 and reduces negative or reduces negative or traumatic experiences, that traumatic experiences, that could lead to longer could lead to longer recovery and/or recovery and/or postpartum depression postpartum depression © 2013 Dionna

For more information, contact: Jill Diana Chasse, PhD, MS,MPA c. ~ w. © 2013 Chasse