How Important is walking around during labor?

[EchoSoul]

So we just came back from my Prenatal appointment a few hours ago, and I asked my doctor a bunch of questions I thought up to know what to prepare myself for when the time comes. When I asked if laboring women are free to move about, he said no, because it endangers the mother. Now I love my doctor, and my fiance and I were pertty satisfied - considering the fact that it will be a hospital birth - of what wasn't routine. I have very few complaints, and even then, the things that are routine I can't really complain about! I know "having it your way"(golly I'm hungry...) is a lot to ask for in a hospital setting, so I really feel like we've struck it lucky. Besides, the stuff I really care about isn't even routine, and done only if the mother wants it. So really, not being able to move around (except for going to the bathroom) during labor isn't a huge deal to me. ...But SHOULD it be?

I can understand perhaps the Birthing Staff fears if laboring mom walks around that a particularly hard contraction might make her keel over and wind up hurting herself and/or the baby. At least, I'm assuming that's their reasoning. So how important, truly, is walking around during labor? Can shifting positions accomplish the same task by helping it move along?

[GoBecGo]

It can be the difference between a c-section for a malpositioned non-descending baby and a normal vaginal delivery.  You should care about it.

They probably think you'll hurt yourself because they assume you'll have had an epidural and are likely to fall over (sometimes you can feel your legs, but often if you can you've still got patchy control of them) and hurt yourself.  I would check their csection and epidural statistics, it's possible they almost never see a woman who is CAPABLE of walking safely in labour due to everyone being given an epidural.

[Tumble Bumbles]

Wow, I would be incredibly suspect of anyone who restricted movement in labor citing the danger to the mother. Additionally disturbing, is someone telling a grown woman what they are or aren't "allowed" to do in labor.  Oh Lordie, let me take a deep breath...

Given you've chosen a hospital birth, you will have to choose your battles. I think being able to freely choose position whilst laboring is one of those battles I would choose. The feeling of being restricted to change positions in labor or to choose positions you are most comfortable with is extremely detrimental to a laboring woman. I'm not trying to scare you at all, I'm just trying to impress upon you the importance of being able to freely move about to positions you instinctively and intuitively feel would be helpful to bring about the most successful and easy birth -- an inborn gift that has been given to women is the ability (when left to peacefully do so) to instinctively get into positions most favorable to them or the baby. That's why things like epidurals and hospital policy and (imo) ridiculous statements like your doctor made (no offense) can lead to a cascade of other interventions that often lead to unnecessary c-sections.

For example, sometimes walking about really helps to engage the baby in your pelvis in the most favorable position. Mama senses the need to walk about. She is restricted to the bed. Baby is in an unfavorable position and not engaged properly. Mama feels increasing stress that she can't walk about. Baby begins to feel the stress. Baby's heart rate reflects mama's stress. Staff freaks over heart rate change, BAM mama sectioned. Mama walks away saying the c-section was 'necessary' because baby wasn't in the 'right' position -- but had mama been able to walk about like she first felt the instinct too, baby could have very well changed position. This is a very simplified example of why being free to move is so important but I can't stress just how important it is.

 Are you saying they are not comfortable with you walking up and down the halls? Pacing the room? Getting out of bed? I don't exactly understand. A woman should be free to move about in labor however she feels comfortable. I will say that predicting whether walking or not walking in labor is important is directly tied to how important the mama believes it is at the time. Something you will not be able to judge until you are in the moment. In the moment, you may not want to walk. It may not benefit your process. OR, you may not want to do ANYTHING BUT walk and being restricted to a bed will not be helpful and WILL hinder your laboring process, even if you are able to change positions.

I would exercise your RIGHT (yes, it is your legal right to move about in labor no matter what anyone may tell you) to move freely during labor.

Just my opinion. Blessings mama.

[EchoSoul]

That's the funny thing though, I also asked him if they routinely use pain medication, and they don't, it's only if the mother requests it. Obviously on my birth plan I can request certain things, do you think I should request mobility, so long as perhaps my husband is there at my side? I know positions can turn ill-positioned babies(which I ALSO asked - if laboring women were allowed to use their own positions to turn an ill-positioned baby, and he said yes), but is that not enough when you're bed-ridden during labor?

[midnightmommy]

Something else to consider...your doctor will only be there for a very small portion of your labor. Ask the hospital too what their policy is. In all honesty what happens during labor is more up to your nurse. If they are ok with you walking, and your doctor walks in and says you need to lie down. You have the right to either tell him that this is what you want (or have someone else do it for you), and if he doesn't like it then the hospital will gladly call you another doctor or midwife. You can also tell bossy nurses to take a walk if hospital policy says one thing and they say another.

[EchoSoul]

Next time I can ask for clarification. In specific, I asked, "Are laboring women free to move about?" And he shook his head, and said, "No, because it can endanger the mother." But to my other questions I am free to chose the position I feel I need to turn an ill-positioned baby, and the hospital is familiar with women giving birth in gravity-enhanced positions and have available Birthing Stools, Birthing Balls, wedge supports and Squat Bars.

Come to think of it...the answer is kind of shady, isn't it? This is my first time, so I didn't think the question would need any clarifications or second parts attached to it, :(

But since I am free to chose positions, it seems like he's saying as long as I do it on the bed or besides it in the case of using a Birthing Stool, Birthing Ball, or Squat Bar.

[Tumble Bumbles]

You presume you have to request mobility. You can demand it. I mean, in a respectful way, but demand nonetheless. It's important to remember, and always remember, you're not asking permission for anything. I would really remove "are women allowed" questions from your vocabulary.  Yes, you are allowed. You are always allowed. It is your body, your baby, and you are hiring and paying these people to perform a service for you. Of course, remain respectful and professional but never forget that you need not ask permission!

 So rather than,"I would like to move around during labor" in your birth plan... I would write:

"I will be moving around during labor as needed so I will require intermittent monitoring only"

The reason they don't routinely give pain medication unless the mama asks is because they cannot legally just administer pain medication without a mother's specific consent. Things such as moving about are trickier because they can just say it's not 'policy' or whatever and unless a mama knows it is indeed her legal right to do so and not be restricted to the bed, most people will just assume they don't have that right.

Blessings for a peaceful and easy birth!

[EchoSoul]

Originally Posted by midnightmommy 

Something else to consider...your doctor will only be there for a very small portion of your labor. Ask the hospital too what their policy is. In all honesty what happens during labor is more up to your nurse. If they are ok with you walking, and your doctor walks in and says you need to lie down. You have the right to either tell him that this is what you want (or have someone else do it for you), and if he doesn't like it then the hospital will gladly call you another doctor or midwife. You can also tell bossy nurses to take a walk if hospital policy says one thing and they say another.

There were questions he admitted to not knowing, since they applied to things that would happen past his responsibility for the delivery. I asked him in the beginning if he could answer them, or direct me to someone in the hospital that could, but he said he could so we went with it. Where would I ask? The Maternal-Fetal Department? This whole entire process can be utterly confusing. I didn't realize not being able to walk around was so important! It is kind of a pinch to the heart because we like him so much, but I've read and heard hospital births doesn't appeal to every person. I'd do at-home, goodness knows I would, but no midwives close enough by take Medicaid, and we do not have the funds to pay under the table for one, :(

[midnightmommy]

Have you taken a hospital tour? They usually can answer questions then. If they can't you are already there...ask a nurse at the desk.

[EchoSoul]

Originally Posted by Tumble Bumbles 

You presume you have to request mobility. You can demand it. I mean, in a respectful way, but demand nonetheless. It's important to remember, and always remember, you're not asking permission for anything. I would really remove "are women allowed" questions from your vocabulary.  Yes, you are allowed. You are always allowed. It is your body, your baby, and you are hiring and paying these people to perform a service for you. Of course, remain respectful and professional but never forget that you need not ask permission!

 So rather than,"I would like to move around during labor" in your birth plan... I would write:

"I will be moving around during labor as needed so I will require intermittent monitoring only"

The reason they don't routinely give pain medication unless the mama asks is because they cannot legally just administer pain medication without a mother's specific consent. Things such as moving about are trickier because they can just say it's not 'policy' or whatever and unless a mama knows it is indeed her legal right to do so and not be restricted to the bed, most people will just assume they don't have that right.

Blessings for a peaceful and easy birth!

That makes sense.. Because I cannot possibly imagine that I'm the ONLY woman there who doesn't want any epidural, and I can't possibly imagine that I'm the only woman there that would take this "laying down", ....literally.

Then I certainly will exercise my right in my birth plan to move around! And goodness knows my husband will back me up.

[EchoSoul]

Originally Posted by midnightmommy 

Have you taken a hospital tour? They usually can answer questions then. If they can't you are already there...ask a nurse at the desk.

A legitimate tour? No. But I've toured the hospital being sent place to place for this and that, although I don't think that counts. I'll certainly find someone to ask, :) Perhaps I should inquire about a CNM being there at the delivery? Does that seem like a good idea?

[EchoSoul]

Having food available for laboring women apparently also isn't routine(so I bring my own, right? Which I was going to do anyways regardless), Fetal Monitoring is routine, Internal Exams are routine, as are IVs(I've read IVs are typically routine in the case the mother wants the pain meds NOW and it's easier to inject them when she already is attached). And that's everything that's routine there that poses a problem if they put up a fight.

[tracymom1]

What the doctor may have meant is that you cannot roam the halls while in labor. Hospitals like to keep you in your room for a variety of safety reasons (like if a problem arises such as bleeding or syncope you will not be far away from the equipment they need to provide care). I can't see ehy you wouldn't be able to move about your room, that is if you are not getting pain meds.

[Tumble Bumbles]

You can decline all of that, completely. In fact, internal exams are way more harmful than they help -- ESPECIALLY after ROM (water breaking). I love this article by a midwife on the uselessness of cervical checks in labor: Cervical Exams: Who Needs Them . Internal exams can work to justify an unnecessary c-section if they feel you aren't "progressing" fast enough. "Failure to progress" is probably the #1 reason for unnecessary c-sections.

You can choose intermittent monitoring, in fact this is so much better because continuous has a high level of false fetal distress alerting (gosh I couldn't think of a better way to put that) in that it can say your baby is in distress when he/she is in fact fine -- leading to a potentially unnecessary section.

I think the best thing to do in your birth plan is to begin statements with "I do or do not consent"

I do not consent to routine internal exams

I do not consent to continuous fetal monitoring etc.

That terminology is far more assertive than "I would prefer" and far less open to interpretation. You can leave an area underneath in case you change your mind to write "consented to one at 11am" (or whatever) with your initials if you change your mind (which is always an option too).

Remembering the birth plan is only as good as the people who see it. It actually serves more as a visual aid for you or your husband to advocate for you. You can make sure everyone who enters the room gets a copy of it, or you can post it on your bed.

Blessings!

[womenswisdom]

Originally Posted by EchoSoul 

Having food available for laboring women apparently also isn't routine(so I bring my own, right? Which I was going to do anyways regardless), Fetal Monitoring is routine, Internal Exams are routine, as are IVs(I've read IVs are typically routine in the case the mother wants the pain meds NOW and it's easier to inject them when she already is attached). And that's everything that's routine there that poses a problem if they put up a fight.

Bring your own food, but try not to eat it in front of the nurses, since they will be obligated to inform you of the hospital policy that you are not allowed food during labor.  Intermittent monitoring is appropriate for a low-risk woman, but continuous monitoring is not.  Be sure to find out which they are talking about.  Internal exams might be helpful if they aid in decision-making about something, but they can also lead to a diagnosis of failure to progress when in fact your labor is normal.  I would ask at what point they would consider augmentation and how quickly they expect you progress.  What is the purpose of the internal exams?  IV access is typical policy, but that doesn't mean that you have to consent to a saline lock or that if you do consent to a saline lock that you need to consent to being hooked up to IV fluids, which mess with your blood chemistry, are usually not necessary if you are drinking freely and not vomiting.  Have you considered hiring a doula? Maybe finding one in training if money is an issue?

[EchoSoul]

Originally Posted by Tumble Bumbles 

You can decline all of that, completely. In fact, internal exams are way more harmful than they help -- ESPECIALLY after ROM (water breaking). I love this article by a midwife on the uselessness of cervical checks in labor: Cervical Exams: Who Needs Them . Internal exams can work to justify an unnecessary c-section if they feel you aren't "progressing" fast enough. "Failure to progress" is probably the #1 reason for unnecessary c-sections.

You can choose intermittent monitoring, in fact this is so much better because continuous has a high level of false fetal distress alerting (gosh I couldn't think of a better way to put that) in that it can say your baby is in distress when he/she is in fact fine -- leading to a potentially unnecessary section.

I think the best thing to do in your birth plan is to begin statements with "I do or do not consent"

I do not consent to routine internal exams

I do not consent to continuous fetal monitoring etc.

That terminology is far more assertive than "I would prefer" and far less open to interpretation. You can leave an area underneath in case you change your mind to write "consented to one at 11am" (or whatever) with your initials if you change your mind (which is always an option too).

Remembering the birth plan is only as good as the people who see it. It actually serves more as a visual aid for you or your husband to advocate for you. You can make sure everyone who enters the room gets a copy of it, or you can post it on your bed.

Blessings!

I began writing down "Consenting to" and "Not consenting to" the more times I revised and edited my birth plan. The original birth plan sample I was going off of had a lot of "We'd prefer" and such, but the more information I found out, such as a lot of interventions CAUSING the need for a C-section, the more times I began replacing "We'd prefer" with "Consent/Not consent to" and "by request". It makes me feel a ton better to write that, than it did to write "We'd prefer", because you're right, that does seem to leave too many open holes.

Also, I have a question; for things I find really important, even though the doctor confirmed them as not being routine, should I still write them down in my birth plan? Essentially as a back-up written by word instead of spoken and going on trust.

Originally Posted by tracymom1 

What the doctor may have meant is that you cannot roam the halls while in labor. Hospitals like to keep you in your room for a variety of safety reasons (like if a problem arises such as bleeding or syncope you will not be far away from the equipment they need to provide care). I can't see ehy you wouldn't be able to move about your room, that is if you are not getting pain meds.

I hope so! I can't imagine I'd be bed-ridden, but have the free use of a Birthing Ball, Birthing Stool, and a Squatting Bar on the bed. Talk about dangerous. Fine - I can deal with being able to pace and not roaming the halls, but to be completely bed-ridden, ...I don't want to think about it.

Originally Posted by womenswisdom 

Originally Posted by EchoSoul 

Having food available for laboring women apparently also isn't routine(so I bring my own, right? Which I was going to do anyways regardless), Fetal Monitoring is routine, Internal Exams are routine, as are IVs(I've read IVs are typically routine in the case the mother wants the pain meds NOW and it's easier to inject them when she already is attached). And that's everything that's routine there that poses a problem if they put up a fight.

Bring your own food, but try not to eat it in front of the nurses, since they will be obligated to inform you of the hospital policy that you are not allowed food during labor.  Intermittent monitoring is appropriate for a low-risk woman, but continuous monitoring is not.  Be sure to find out which they are talking about.  Internal exams might be helpful if they aid in decision-making about something, but they can also lead to a diagnosis of failure to progress when in fact your labor is normal.  I would ask at what point they would consider augmentation and how quickly they expect you progress.  What is the purpose of the internal exams?  IV access is typical policy, but that doesn't mean that you have to consent to a saline lock or that if you do consent to a saline lock that you need to consent to being hooked up to IV fluids, which mess with your blood chemistry, are usually not necessary if you are drinking freely and not vomiting.  Have you considered hiring a doula? Maybe finding one in training if money is an issue?

Intermittent sure sounds better to me than Internal or External Continuous. For Internal Exams I've written "done only on consent". The only details he went into, as far as augmentation goes, is if it were a week past my due date, but didn't say anything beyond that. I was trying to rush it along because they keep the room real warm and I was getting overheated real quick. I'll certainly look into a doula - is it not too late? I'm 27 weeks.

[GoBecGo]

Originally Posted by EchoSoul 

That's the funny thing though, I also asked him if they routinely use pain medication, and they don't, it's only if the mother requests it. Obviously on my birth plan I can request certain things, do you think I should request mobility, so long as perhaps my husband is there at my side? I know positions can turn ill-positioned babies(which I ALSO asked - if laboring women were allowed to use their own positions to turn an ill-positioned baby, and he said yes), but is that not enough when you're bed-ridden during labor?

"Maternal request" epidurals run at 80% in the hospital i booked back-up care with for my DD's.  That is the mother says "this is getting painful" and the staff say "ooh, why not have the epidural" and then write it up as a maternally requested epidural.  Check their stats.  If 80% of the women who give birth there have an epidural the odds are heavily against you doing without one.  It doesn't mean you can't, but it does make it pretty unlikely.  Likewise csection rates.  If your Ob has a 60% c-section rate for first timers, you are statistically less likely to manage a vaginal birth than not.  Preparation can only do so much.

Changing positions MIGHT be enough to help reposition a baby, but it depends so much on the baby and the position.  If the baby is coming down a little "off" and needs to do a 90 degree rotation then you being on your knees might be enough.  If the baby is tangled in the cord and needs to do a 360+ rotation to untangle and descend then it's going to need more help.  The rocking motion of the walking pelvis is ideal for allowing shifts of position, as are lunges, squats and stair-climbing.  You can "do" lots of positions on the bed, but you cannot move between them as freely as if you are just able to get off the bed and move about.  Is it REALLY more dangerous to do lunges on the floor than on a bed!?

I'm not trying to scare you, but humans aren't really designed to give birth easily in a stressful place where they aren't allowed to move or eat normally and where they have to have needles stuck in them and straps around them/wires hanging out of their vaginas.  Interventions can save lives, be sure you use only the ones you NEED and WANT and not just those the hospital or Ob deem necessary simply to protect their routine.

[EchoSoul]

Originally Posted by GoBecGo 

Originally Posted by EchoSoul 

That's the funny thing though, I also asked him if they routinely use pain medication, and they don't, it's only if the mother requests it. Obviously on my birth plan I can request certain things, do you think I should request mobility, so long as perhaps my husband is there at my side? I know positions can turn ill-positioned babies(which I ALSO asked - if laboring women were allowed to use their own positions to turn an ill-positioned baby, and he said yes), but is that not enough when you're bed-ridden during labor?

"Maternal request" epidurals run at 80% in the hospital i booked back-up care with for my DD's.  That is the mother says "this is getting painful" and the staff say "ooh, why not have the epidural" and then write it up as a maternally requested epidural.  Check their stats.  If 80% of the women who give birth there have an epidural the odds are heavily against you doing without one.  It doesn't mean you can't, but it does make it pretty unlikely.  Likewise csection rates.  If your Ob has a 60% c-section rate for first timers, you are statistically less likely to manage a vaginal birth than not.  Preparation can only do so much.

Changing positions MIGHT be enough to help reposition a baby, but it depends so much on the baby and the position.  If the baby is coming down a little "off" and needs to do a 90 degree rotation then you being on your knees might be enough.  If the baby is tangled in the cord and needs to do a 360+ rotation to untangle and descend then it's going to need more help.  The rocking motion of the walking pelvis is ideal for allowing shifts of position, as are lunges, squats and stair-climbing.  You can "do" lots of positions on the bed, but you cannot move between them as freely as if you are just able to get off the bed and move about.  Is it REALLY more dangerous to do lunges on the floor than on a bed!?

I'm not trying to scare you, but humans aren't really designed to give birth easily in a stressful place where they aren't allowed to move or eat normally and where they have to have needles stuck in them and straps around them/wires hanging out of their vaginas.  Interventions can save lives, be sure you use only the ones you NEED and WANT and not just those the hospital or Ob deem necessary simply to protect their routine.

Please don't be concerned about scaring me. I value the amount of honesty coming from you and everyone else, it's much needed, especially during something as crucial as this! It will help me prepare in knowing what I may have to stand my ground in with a heavy foot. While I am trying to not let my apprehension get the better of me, I imagine everyone gathered, enforcing their levels of wisdom on me while I'm in labor trying to focus and stay relaxed, and I do not want it ruining my self-control. I had no idea that epidurals based on "maternal request" could be something so sleazy, so I made note of that to remember. I'll definitely check into the statistics. But, uh....how? Call them?

I'll make sure they know I'll be moving around, :)

[Tumble Bumbles]

I know everyone is throwing a lot of information your way but I just wanted to expand a bit on the suggestion the doc had to induce or augment labor at a week over your due date. Please, please keep in mind that the average gestation for a first time mama is 41 weeks + 1 day (I am making the assumption you're a first-time mama). My own first babe came at 42 weeks + 5 days and was completely fine, and only weighed 8lbs on the nose. Please don't allow anyone to scare you with "big babies" or any of that nonsense if you do happen to go 'over' (as most women actually do).

As far as checking statistics you can call human resources for that information I would imagine. Some hospital statistics are available online as well.

I couldn't agree more with GoBecGo's comments.

Also, 27 weeks isn't too late to find a doula. I went from an OB to a home birth midwife around that time lol It's important to remember that doulas cannot advocate for you, but can help you advocate for yourself. A good doula would say things such as:

"The doctor's just asked to do an internal exam to check dilation. Do you want a minute to think about that before making a decision? You can decline that if you choose" or, "The nurse is suggesting epidural for your pain but your birth plan says you wanted to avoid that. Do you need a moment to think about it before deciding?"  She would say that to you, but of course you have to make your own decisions. She is there to support you and help you find your voice to help you achieve the birth you want in situations where you may feel pressured -- as well as helping your partner be an active role in supporting you the way you need, in addition to providing labor support. A very supportive and assertive (but respectful) friend or family member who respects your wishes 100% can also fill this role if needed. The bolded is very important.

You still have plenty of time. Don't stress mama. Knowledge truly is power.

[Italiamom]

EchoSoul,

First, welcome to our big community here!

If you haven't already read it, I would highly recommend Ina May's Guide to Childbirth.  It will explain in detail a lot of the things that mamas here are trying to gently stress.  And if you've read it, then disregard my suggestion!

Also, if natural childbirth in a hospital setting is your goal, I would really, really suggest looking into getting a doula.  27 weeks is absolutely not too late to hire one!!  My sister-in-law used a doula at both of her (completely med free) hospital births, and I believe in her first pregnancy she didn't hire one until 36 weeks!  Your tribal area of MDC would be a great place to look, or to get suggestions from mamas who have used doulas in your neck of the woods.  A birth plan is great, but in most hospitals it means pretty much nothing.  A doula can help you to create a birth plan, and then advocate for your wishes when birth time actually comes.  Also, Doulas can be a great resource in working with doctors in a way that doesn't leave them feeling walked on, and doesn't leave you in a position where your ultimate wishes are being disrespected.  And they can help your partner to support you in ways they may not have thought of, which is nice too :)

Statistics can be hard to come by.  You would first try calling the hospital, yes, although most hospitals aren't pleased about giving them out, or simply don't have them.  You can also try posting in your tribal area about info for the hospital you are intending to birth in.  Or you could try looking at The Birth Survey and seeing what info they have.

Good luck!!