Pelvic Movement For Labor and Delivery
When working with patients, I often discuss harnessing pelvic movement to facilitate comfort during labor and delivery.
I enjoy showing my patients how these movements can be emphasized during pregnancy and contribute to labor progress if the patient prefers a vaginal delivery. In the case of a cesarean delivery, knowing pelvic mobility may improve both your comfort and your baby's comfort.
For the sake of this blog, we are focusing on pelvic movement to promote a vaginal delivery, so what leads to a vaginal delivery?
What are the 3 P's?
If you are planning to deliver a baby vaginally we can think of the 3 P’s, Power, Passage, and Passenger. In a typical vaginal delivery, uterine contractions are strong and effective enough to dilate the cervix (power), the baby can pass through the maternal pelvis (passage), and the baby is labor-tolerant and in the best position for delivery (passenger). Pelvic mobility is regarded as part of the passage aspect of this concept, responding to the baby while passing through. Any problems with the size or movement of the pelvis may make it difficult for the baby to pass through it and be born vaginally. If a patient prefers a vaginal birth, there are treatments to improve pelvic movement and mobility.
So let's discuss the anatomy of the pelvis!
Anatomy and Alignment of the Pelvis/Pelvic Girdle
The human pelvis is made up of three distinct bones: one sacrum and two ilium. These three bones are linked by soft tissue and muscle, allowing the pelvis to be dynamic and movable. During pregnancy, the relaxin hormone softens the soft tissues that link these bones, allowing for greater movement and flexibility while also increasing discomfort/pain. According to studies, there is an increase in relaxin around the end of pregnancy or during labor, which aids in the expansion/movement of the pelvis during delivery as well as the dilation of the cervix.
Levels of the Pelvis
The pelvis can be divided into 3 levels: inlet, midpelvis, and outflow. During labor, the baby must pass through three levels. The pelvic station indicates where the baby's head is and corresponds to pelvic levels (-4 to -1 = inlet, 0 = midpelvis, +1-+4 = outlet). Typically, the baby is in a negative station until labor begins, then transitions to a positive number station as labor develops. Once we can see the babies' heads, we can assume they are at a positive station.
How do we create the space needed for labor?
During labor, I recommend changing positions every 30 minutes or every 3-4 contractions, whichever you are most comfortable with. You may find that your body tells you otherwise, and that's okay too. Peanut balls and birthing balls can be extremely beneficial at any time and are simple to use, even with an epidural or maternal exhaustion. Depending on the stage of labor you are in or where the baby is in your pelvis, there are various motions you can perform to encourage pelvic movement and, hopefully, labor progression.
In early or active labor (when you have regular, often painful, contractions)... we want to encourage your baby to engage in INLET of the pelvis. We can accomplish this in a variety of ways. Knees out, peanut ball between knees, counter pressure on the sacral apex, and pelvic circles/light bouncing on a birthing ball can all be beneficial. Remember that gravity is your friend, so stay as upright as possible, especially during early labor.
Once your cervix has fully dilated (and you have reached the pushing stage)... the baby is most likely engaged in MIDPELVIS, which is characterized by asymmetrical movements. You may also perform asymmetrical movements early in active labor to promote movement, listen to your body, you might intuitively move in certain directions or positions to help the baby navigate.
Pushing continues... Once the baby reaches a positive station and/or crowns, we want to open the pelvic OUTLET. Keep your knees in with counter-pressure on iliac crests, a peanut ball between ankles, and so on...
What are some things I can do during my pregnancy to prepare?
Adjustments: Getting adjusted by a Webster-certified chiropractor during pregnancy promotes pelvic mobility while also relieving pain and improving comfort. All of our chiropractors at ANH Wellness are certified in Webster technique and have years of experience treating women during pregnancy.
The Miles Circuit: I recommend this to almost all of my patients, you can read a bit more on the positions on the website, but the goal is to help your baby engage in the pelvic before labor begins. I recommend doing it if you're past 39 weeks and performing each position for 2-3 minutes a day, working up to eventually 30 minutes in each position.
Spinning Babies Three Balances: Our chiropractors at ANH Wellness are also trained in Spinning Babies and can help you and your partner learn the Three Balances which can be helpful in pregnancy and labor. For additional information, visit the Spinning Babies website or ask a chiropractor at your next consultation!
In Conclusion
As you can see, there are numerous methods to move when in labor. There is no incorrect way to move as long as it feels comfortable for you and your baby. Remember to modify your routine at least once every 30 minutes. We like to believe that "change brings change," so any time you try something new, your work is more likely to improve.
All of the information in this blog is not a substitute for medical advice and should not be used in its place. Please consult with your obstetric provider before performing any of the advice in this blog.
By: Dr. Megan Stavalone
Perinatal Certified Chiropractor at ANH Wellness
Disclaimer: "The information including but not limited to text, graphics, images, and other material contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment."
Sources: Management of Normal Delivery (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/labor-and-delivery/management-of-normal-labor) Relaxin for Cervical Ripening and Induction of Labor (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8693181/) The Miles Circuit (https://www.milescircuit.com) Spinning Babies - Three Balances (https://www.spinningbabies.com/pregnancy-birth/techniques/three-ways-to-body-balance/)