#307 | When Labor Stalls: Recognizing and Resolving Dystocia with Midwife Molly O'Brien @biomechanics_for_birth

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

So I'm Molly. Molly O'Brien. I'm a midwife, and I teach midwives and obstetricians and anyone who will listen about making birth safer using the under better understanding of the pelvis and the biomechanics for birth so how the baby is passing through that that beautiful structure of the pelvis been at it for quite a long time.

Well, considering that one of the biggest reasons that women have C sections today, and the increasing number of C sections that women are having today, is related to labor taking too long, labor stalling, labor stopping, which is almost always related to the baby's position. Sometimes, of course, it's, you know, a maternal issue, dehydration, fatigue, exhaustion. But this is a very, very important topic, and women are constantly asking us and talking to us about, you know, what do I do to help my baby get in the best position for birth. So we are very excited to be talking to you about this today. Oh, thank you, Trisha. And you've hit the nail on the head. You're absolutely right. It is one of the leading reasons behind cesarean section, primary cesarean section, first time mums and high intervention rate is this issue, interestingly, and you did you, I think you explained that quite well there. You know, it is often a prolonged labor and is a difficult labor. In fact, labor dystocia, translated directly from the Greek, means difficult labor. But we have a problems immediately with that, because we don't have a consensus on the definition, we don't have a very good understanding about what is actually going on. And so the medical, the obstetrics, want to do something, understandably, they want to do something, but without a clear picture of the the causes of the labor, dystocia, then we're flailing around trying to push this baby through the pelvis using quite dangerous drugs. Actually, synthetic oxytocin comes, comes with high risk. And I'm actually not getting very far with that, because it isn't actually that effective, because it's not addressing the root cause.

Molly, before we get into the root cause, can you please talk about some of the most common definitions for labor, dystocia, or as many say, failure to progress? Oh, well, there you are. You could have made a month. Now. I don't love that term at all. We don't use it where I'm teaching. I don't. I don't use that term. I don't, I don't appreciate the word failure in anything related to birth. But you know that? I want women to know that's the same thing that that that's referring to. Yes, talk about some of the most common definitions that are circulating. I've heard labor over 24 hours. My own obstetrician, who I fired in my first pregnancy, had said anything under 10 hours you were saying there's no consensus. But I'd like to hear some of the definitions that you've heard, and I'd also like to hear what you consider labor dystocia to be, before we get into some of the resolutions.

Absolutely, I did. What did I read recently, I forgot I've reading. I love research, and I'm always reading up about this subject. And I think there's, oh gosh, there's more than 50 synonyms that is associated with this condition and and a failure to progress is the, I think, probably the most common prolonged labor, inefficient contractions, one that really gets me is insufficient maternal effort. You just didn't try hard enough, the inadequate pelvis. Do you hear the theme going on here? Is this really derogatory towards women and their bodies and what they can do. These definitions are not helpful, because they blame the mother and and it's really our misunderstanding of what's going on. So so we have great difficulty with that a prolonged labor is a certainly does seem, seem to be associated with it. But what does that actually mean? And like you just said, there, Cynthia, your obstetrician was saying 10 hours, or somebody else might say 14 or 24 what does that actually mean? And that's a problem that we have no definition. However, I do understand that's difficult because we're all different, and we all our births unfold in different ways. So it is hard to put a number on it.

Molly, can I jump in with something? Yeah, go ahead. Regarding my obstetrician, who said 10 hours, I just want to point out something unbelievable that stood out to me, even as an initially uninformed, newly pregnant woman, my. Sense, was totally onto something very quickly when she said, I want to see you get to 10 centimeters within 10 hours or less. I said to her, what if I labor at home for eight hours and then come in and she said, you get 10 hours? I said. I said, What if I'm out to dinner in a restaurant with my husband and come right in? She said, you get 10 hours. I said, What if I labor at home for one and a half days and come in and she said, you get 10 hours. So I put together pretty quickly. She wasn't all that concerned with how long my labor would last, but she was very concerned with how long I would be in that hospital room you've again, that's, this is what I talk about in my course by mechanics for birth. In fact, I have a scenario that we start off with, and it's, it's actually about a woman who's actually suffering a long latent phase. And that is difficult because there's no definition for that. We don't where we're working in the dark here. But what happens is that we invalidate anything that went on before she entered the building. And that is really difficult for women because they're experiencing this. They might actually have had a really tough time at home and been told, Well, you're not you don't sound like you're in labor. Or they may have come in, been assessed and found to be two centimeters, sent home again. You're not in labor, invalidating everything that went on before and her experience. And I think that is a very traumatic thing for for women to experience. What we need to be doing, I believe, is moving away from the quantitative measurements, which is obstetrics has a place. I do understand that, but to measure it by how many hours, how many centimeters, how many contractions, is not the whole picture at all. What would be much better. And as midwives, and I'm really, as a midwife, I'm really, really supporting the midwifery profession here, because our work is qualitative. It's about the quality of experience. How are you doing? Because this woman in the scenario I was talking about, and I would use this in my course, is on her knees. She's actually suffering, and she needs help, even if she's considered not an established labor, she actually requires assistance here because she's really in a lot of pain. It doesn't correlate with this situation in late and early phase. And her neighbor may have gone into labor at the same time as her, and she's baked a cake for those home birth medals coming round. She's got on her ball. She's gone for a walk, she's had the snack. She is getting tired, of course, because it's going on for a while, but she's okay, and now the other woman isn't okay, and there's a difference. Can we tell when someone is starting to suffer when she's compromised? Now, instead of focusing only on the quantitative measurements of where you're only two centimeters, and that's exactly why nobody is able to put a time frame on birth, because it is a not an objective experience. It is a subjective experience. And one woman's 12 hour labor might be prolonged versus one woman's 36 hour labor might not be at all Exactly, exactly, and that's that's where the shift needs to happen. So we start to look at, how is she doing and, and this is a, this is what midwives are about, as you you know Trisha. It's holistic. We look at the whole person, how is she doing? How's her mental state, How's her emotional state? Because all of that has an interaction with the physical and and, and I know that some midwives might think, Oh, you biomechanics, that's very medical, because it's about the mechanical element of birth. Well, yes, it is about the mechanical element of birth, but it's coming from a midwifery perspective that does not actually ignore the rest of this human being who has a mind, who has emotions, who has experiences, who has fear, perhaps, or whatever, she's a whole person away as midwives, that's our work.

It's not very different from when a child has a fever and parents are taught to observe the child and not only go by the fever. So 103 degree fever may sound terrifying, but if the child is playing and acting normally, it's less concerning than a child with a 101 degree fever, who's listless and can sleep and fussy. It's similar, isn't it? I mean, there's so similar.

Cynthia, absolutely, and that's a really good example. Why don't we apply that? Why don't we apply that? And it's partly because obstetrics has is dominant in maternity services. Yes, and they want to fix things, and they pathologize the pelvis, and then in doing so, they've pathologized Midwifery, because that's not how we work. But if we work in the technocratic model of care, which actually most of us do, because that's where most women give birth, we are dominated by that narrative, and it is really quite challenging for us to do our work in that model of care, because it's not our model of care. And I would like to see, and I'm working towards this a collaboration, because we do need obstetricians. We do need the technocratic model. It saves lives. I'm not anti intervention, because we sometimes need that. But for the majority of women, no, this is wrong and this is causing harm.

Well, we have the percentages mixed up, with 10 to 15% of women choosing midwifery care, and 85 to 90% of women choosing care in obstetrics or medicine. Democratic. It's backwards, because really only a few percentage of women need the obstetrical model of care, and the rest really need the midwifery model of care, absolutely Trisha and as partly because of the, well, it's complex, actually. I mean, there's not a lot to unravel. There, isn't there? What we have, the media we have, birth is a dangerous thing. It's risky. The stories that go around, because there are a lot of damage, a lot of damage done. There's a lot of trauma. We have the birth trauma Association. We have lots of stories, and women are scared, and they are also pathologized as high risk no matter what they do. That's easy because of that dominant model. It's kind of run away with itself a bit, and is actually pathologizing most women. So you those women who are deemed to be low risk, and I, again, I'm not keen on these terms, because it, it narrows it down so so slightly, so that we only have, like 10, 15% of women who are allocated to that model of care, that midwifery model of care, and that that risk of who is high risk, that list of who is high risk, keeps increasing. It's absolutely it's gone from, you know, you were only high risk if you were borderline pre eclamptic or pre eclamptic, to, you know, anything too low fluid, too high fluid, your age and your size, your weight, it's, it's, just keeps getting added on. So you're right, absolutely. Who is low risk now, yeah, exactly.

But we do need to have those conversations, and we need to dig away at that and try and unravel it. And luckily, we have got great midwifery researchers coming on the scene, or are already on the scene that are really helping us, because we're getting the data from the midwifery perspective, given that actually the first professors of midwifery are, I think, still alive today, that's how new our academic area in midwifery is. So we are starting to get a handle on this using our own research data. But Meantime, and this is the joy, I think this is the the the magic you could say of biomechanics for birth is that when you start to use some of the techniques that makes more space for the baby, because ultimately, that's what the baby needs bit more space to come through this pelvis. Once you start to transform the labor from being difficult to this baby being born, it's a bit of a wow factor, and that opens the door for discussion. So that's why people say to me, Well, why can't? Can we just learn the techniques? Well, yeah, you could, but we're missing a chance here to have a big conversation, because it's like those, those women are maybe getting ready for theater. They've had this synthetic oxtoson, they're really struggling or whatever, and they're advised to have a cesarean. I go in there to help, and you think, maybe, you know, ask her if she would like to use some positions, and the baby's born. You walk out of there and you say, cancel this section. This baby's out. Everybody goes, what? How did what the heck. What did you do in there? And then you have the conversation.

So how do you assess labor dystocia? What exactly is the process like for you? And then how do you approach resolving it? And can you explain what biomechanics really is? It's, let me just go to biomechanics. What is biomechanics? Biomechanics is the study of human movement. Ultimately, it. There's a lot more technical than that, but in essence, it's about human movement. Quite frankly, can't think of a greater expression of human movement than a baby exiting another human being's body. I mean, that's pretty awesome. So I like the word biomechanics because I want everybody to engage. I want obstetricians to engage as well. I wanted to take it seriously. Because if we just use the word movement, which you could do, it hasn't got the emphasis behind it. Hasn't got the the the gravity you could say behind it to say, this is much more complex than just movement, having said that, movement is very much key to the solution, but what we got is we understand so going into biomechanics and understanding it better. You need to understand A and P better. We don't understand that. We have only come from it from a medicalized viewpoint, a pathology viewpoint, rather than a solitogenic viewpoint. So this degenesis is the basis of Midwifery, where we maintain and sustain health. That's our work as midwives. Pathology is the that's the doctor, that's obstetrics now that our training is often rooted in pathology, and that's not helpful to us, we need to understand, how do we keep this woman healthy, maintain her health, so understanding the soft tissues, the fascia and how the bones open, The pelvis opens, how this baby works its way through and so forth, that's going to be integral and changing the way we think about it and the way we see it. Once we understand that, we'll be able to put into place ideas about why this baby is struggling. Because at the minute, we do not know this is all the data, all the scientific research from the technocratic model, also, as we don't really understand it, we'll see it's inefficient contractions. But what does that mean? That's just a sign sometimes the contractions are affected prolonged labor maybe is long for some, but again, we've talked about that, what's long for some and not long for others? It's a bit vague, and it's not really saying, Why is this baby struggling to come through this pelvis? And I'm going to put it to you that the baby is struggling to come through this this pelvis because of a soft tissue or even bony issue.

Isn't it? Isn't it interesting that the solution that the technocratic or obstetrical model, has for that is more power, more power harder. Push harder.

Push harder. Brute force. Quite a male thing, a masculine kind of male solution. We'll batter it through rather than actually, maybe we can just make a little bit more space by movement, and that movement can come from the woman herself, and that is one of them will come straight to the solutions. Now, how? One more thing just I want to shift the whole narrative of that's a baby. Baby's in a male position. Sometimes the baby's not actually sometimes the baby's in an optimal position. It still can't come through. But sometimes the baby is in a sub optimal position, or mal position, you could say we have to that isn't the root cause what the babies don't go into a malposition, just for the sheer hell of it is because it's not enough space for it to tuck its wee head in and get into the optimal position.

Is that right? Is that? Is that? Can we take that to the bank? Does that mean for sure, if a baby is mal positioned, it is certainly because of not having enough space, or is there any randomness to it? Does a baby just sometimes for whatever reason, not going to just throw it right?

Well, we cannot say for absolute sure, because the work hasn't been done on that. But if you look at the anatomy and physiology, if you actually look at everything together, and the fact that women are immobilized on the bed during a dynamic physiological process where there is a baby and mother dance going on here, the baby has reflexes. You if you look at anatomy and physiology, you will it will be very hard to deny a very strong possibility that this baby is struggling to come through because of lack of space. And when we provide more space, and I'm talking about the mother providing it herself, or shifting the balance of power to the mother, when that is provided, that baby comes out that is very empowering information, very isn't it? No, we've got a long way to go still to work out, because we're written about in the dark a wee bit. And sometimes it won't work, and sometimes those women will require some help, and I'm grateful that that is available. And sometimes the. The baby doesn't come because we don't have enough information, because it's a relatively new topic, and we don't have enough information about it. So we might be trying, where's the baby? If we're if the baby is very high up in the pelvis and struggling to come down through the brim, that might be that there's a an imbalance up there. But if we actually try and use positions to open the bottom of the pelvis, the pelvic outlet, then we're not going to be helping that baby. So we need to use the correct types of movement to make space where the baby is, and that matters as well.

Can I just add to it that we're also talking about how the baby is positioned in late pregnancy. And if we're saying, and I do believe is true, that the baby's position is determined by the mother's physical Well, her anatomy and physiology, as you said, so her her posture, her Yeah, any variations in her body, any tension on her right side versus her left side, how her pelvis is shaped, how her uterus is tilted, where she has, you know, tension in the fascia, all of these things. And it isn't just in labor, and it isn't just being in the bed and labor. It is also what she's doing in the last three or four weeks in the last trimester of pregnant it's even how her body is aligned prior to conceiving that all Yes, agree that all plays into it.

I think there is an aspect of that. Certainly it makes sense that if you have imbalance there that's creating tension in the pelvis and in the uterus then, then that that could have an impact on how the baby is going to come through during labor. We don't know enough yet, so we're we are sort of just putting feelers out thinking about this. It makes sense, but we don't believe that we have enough information yet to say that we absolutely impact more than anything that will impact what's going on in the labor room. What I feel is, if you come in with a baby who is struggling to come through a little bit in an awkward position, if you and I feel quite strongly about this, having had a first baby who was for me back to back in that wasn't right for me, had I been able to get up and follow my instincts and move, I could have released that baby myself. No, we need that kind of information. We need that data. We need that research to be done to show that that's the case, I will say that this research coming through. There's a Irish midwife, or sheen Lennon, advanced midwifery practitioner, I think there's almost the equivalent of consultant midwife, and she's in Sligo in Ireland, and she did a retrospective review of her caseload, where she had attended my course, and she was giving them information from the course, but she put she said it was biomechanics for birth toolkit. Now that toolkit, the information that she was giving included wearing the right size bra so you weren't restricting the thoracic area, because the diaphragm mirrors the pelvic floor and works together. So that was there, walking, doing yoga, what other other elements related to what you were just saying? Trisha about those and not being too sedentary. So moving more in pregnancy and what she found was that there were less inductions when they were doing that there were more spontaneous, more spontaneous onsets of labor, compared to the women who did not have that that information. So I think that's quite powerful. Saying, Yeah, you know, if you're because we are not our ancestors, we always, oh, but we've got all the equipment. Yes, we do, but we sit a lot. We've got a sedentary lifestyle. A sedentary lifestyle means that you will have more and this is true coming from other disciplines, you will more likely have a shortened calf muscle. Well, how does that impact on the pelvis? Because of the fascia and the connections.

Wow, are you saying we have shorter calf muscles because we're not moving and walking as much? Yeah, I once heard an anthropologist speak, and he said that they think early humans walked around 19 kilometers a day. There you go. If that's correct, then the absence of sufficient walking, by those metrics, means we have shorter calf muscles. And you're saying because of the fascia, it actually connects all the way up to the pelvis on the bird. That is unbelievable. Absolutely unbelievable. It's the last I never think, yeah.

Now, when I say you're not born with shorter calf muscles, right? But they are created. They shorten because you're not using them. You're sitting in a sitting position. That means that your calf muscles are more likely to shorten, as well as that you have your psoas muscle that comes from your respiratory diaphragm all the way through your pelvis, such a fight and flight muscles there. There's a pair running down the spine and that that's believed to be integral in the babies passing through the pelvis. It helps the baby pass through the pelvis. Now that is affected if you sit too long. Wow, tone of that muscle. So that's why, yes, as Trisha was saying, those activities, or inactivities in the pregnancy can affect your body and and how balanced it is for your baby to start coming through that pelvis. It doesn't mean all is lost. I would like to make sure everybody understands that if you have had a sedentary lifestyle. Don't worry. You what? I think? Yes, try and, you know, try and get up and move around, even if you've got a desk job, get a ball. Sit on a ball. Move your pelvis, you know, at your desk or have, you know, there's all sorts of little things that you can sit on that will help you move. If you can't have a ball in your office, get up. You can get you can download little apps that will remind you to get up every 2030, minutes or so. And even if you just go up and walk around for a few minutes and sit down again, you will be, you know, developing good habits there. I think an important distinction when we think about our ancestors and then we think about modern society is it hasn't been that many years that we have had soft, cushy things to rest our hands on all day. You know, we sit on our bums in the car, our bums in a chair. We sit on our bums on a couch. Yeah, all of these positions tilt the pelvis in a way that's unfavorable for a baby's position. And think of how many hours, if you look at how many hours in your day, you're actually sitting on a soft surface with your pelvis not in the proper position. Versus our ancestors, who, if they sat down, they were sitting cross legged, cross legged on the ground, or squat, or they were laying down on their side, or they were squatting, or they were sitting on a rock and they were forward leaning a little bit. You're never sitting on a soft, comfy surface that makes pelvis tilt back. So that's what we need to avoid, even if you're a little bit sedentary in pregnancy, especially in late pregnancy, you're exhausted and you want to rest. Rest on your side. Don't sit on a couch in a recliner position, just on a birth ball. Yeah, and don't beat yourself up if you want to sit on the couch for a week while. Just don't make it a habit of just being there for the evening, watching Netflix or whatever and not moving. You know, it's about balance, about everything, but do you're absolutely right? Get up and move, sit on a ball or be aware. And again, it's about awareness of our posture. Sit on your sit bones. Have your feet flat on the floor, bring yourself we slump. And you know what, Trisha and Cynthia as a modern society, our posture is really pretty poor, and we have a lot of fear and anxiety as well, and that affects our posture and affects our whole bodies. Kids are on their phones as our young people, young women, young men, and they're looking at their phones constantly and has created spurs on the back of their skull. I mean, this is changing our bodies, this lifestyle that we have. So yes, we do have to pay attention, and let's do that, and that's not even going into Ultra processed foods, and what that's doing to our bodies as well. So this is all we are, not our ancestors. So unfortunately, you know, we have a lot of work to do to maintain health.

Molly, we were talking earlier about how you assess a woman, and we were getting to why this happens, which has been very interesting. And can we get into how you continue with that assessment? And yeah, I think again, I'm going to start from the most important, because there's a hierarchy of assessment tools, and I'm going to listen to the woman. Okay, listen to the woman, because they often say in the birthing room, they might say it doesn't feel right or something wrong. And if they say that, you have to pay attention, because they have inside information this baby is going through their body, and nobody listens to them. And that's what they say when they're surveyed, they say nobody listened to me. I knew there was something wrong, and that is so important that we need to start listening to women. The contractions are a little different to the usual contractions, and again, we have evidence for this. I. Um, they're a different shape. There are little more erratic. They might be double peaking coupling. So again, we don't need a monitor to show us that the women can be experiencing that. I can tell somebody has a mechanical issue on the phone by asking the right question, but more importantly, understanding the answer. If I said to her, how long are your contractions was a quite a reasonable question to ask. Are you expecting them to be around about a minute? And she says, no, there are a couple of minutes. Well, why are there a couple of minutes? She's have to think, and it might be that they're double peaking or coupling, and that's her experience. They will last that length of time. For her, she might have lingering pain actually, which also correlates strongly with a dystocia with an obstructed label, with a baby who's having difficulty, she'll have that lingering pain building up having contraction lingers afterwards, and so for her, she may describe that as two minutes. So that's quite a key feature. Now there's, there's not one feature that tells you definitely, this is it. It's a whole picture that we're building. But the the nature of the contractions is, is one of them? Has she had a long latent phase that can be an issue for her. Is she exhausted before she's even started? Is she chaotic before she's even started? Dehydrated? Has she a demeanor of helplessness and hopelessness? Because that often comes and again, there's a variety of patterns, because some will have some of those, and some will have other things, but I'm just giving you a rundown of some of the things that we would look for.

Can I ask you a question? Can I just interject for a second? I would be wondering if I were pregnant and trying to prepare for this. Given this conversation, is there any circuit? Is there ever a circumstance in which a woman's labor goes on for a very long time, but she feels fine. If she's 35 hours in. She's tired, but she feels well. Do you have any concern? Do you ever get to a point based on the quantitative where you do, in fact, start to feel like there might be labor decision if the mother and baby are well, I am not concerned. Okay. Okay, if a mother and baby are, well, that's, that's, then that's, that's, that's what we want, isn't it? A mother and baby are, well, I'm not concerned, because we have all sorts of reasons why we might take our time. Usually, if we're in the right environment with the right support person or people, we actually don't have much of a problem giving birth, but our problem is not having that we're in an environment that isn't actually designed for birth hospitals, and it might be that this woman just needs a bit more time. We don't know what women are bringing to the birth room. We don't know what's happened to her, we don't know what's what's in her mind. It might take a bit of a time for her to let go and unfold. And actually, this is why HypnoBirthing and biomechanics of birth are a brilliant marriage, because they look at the mind and the body together, but if the mother and baby are, well, what's wrong? So, no, I don't feel concerned with that. So what I'm getting from that is there's no inherent concern based on the duration of labor. But if that woman is presented with some something feels off, can you continue with what you would do? Then I would want to wonder what, what is it that she feels and if she says it feels like the baby's stuck, then I would offer her some assistance, if I mean, as I say, the top solution is one that the woman finds herself through instinctive movement that, in itself, is easy to say, but difficult to have, because who moves instinctively, who's connected to the body? We just had a conversation. We're not our ancestors, where we live in our head a lot. We're not really connected to our body. Are we listening to our body? Have we? Have we given up our power and think that all the medical professionals around us, they all know better than me, and we need to reverse that, not be through education. So women start to connect better with their bodies. We start to listen better as well, and making sure that birth can be dynamic and she can mobilize, and she can take up positions, and all she sometimes, all she needs to do is lift her leg, and that's all she needed to do. And she knew that, and she did it, and the babies come out.

Let's just add to that that that instinctive ability to move is severely diminished when women are giving birth in the hospital because of how the room. Is set up because the bed is the focal point of the room, because there's nowhere else to go. There's nobody there, you know, and there's wires and there's corners and there's hard surfaces. That's when you when you go to a birth with a woman at home, she is generally following her instincts. She's in whatever room and moving the way that her body is intuitively speaking with her, and just walking into a hospital that interferes with that, and then you have to have more structured, yeah, positioning. That's it. That's it you do. But I think all midwives need to focus on providing an environment that enables movement and bring even I mean, because the bed is absolutely as you described there Trisha, and it denotes passivity when we have a bed in the middle. And what that women seen on the Turley, on the media, she's in her she's been instructed by that to get on the bed, because that's where you give birth. So we need education to encourage her to move around. Now, doula are lovely for this. They often will come in with their client and put the bag bag straight on the bed. And the beds are now taking up another function. Now it's about the bags are and if the midwife has provided a ball and a map that women's much more likely. And that's little it does. It is. It feels overwhelming at first, but when you break it down, if that woman's got that going on in this quite unfriendly, unwelcoming, medicalized room, she can at least think, well, I'm going to sit on that ball because that's there for me. And I think I'll just do that. Plus, if she's been using a ball throughout her pregnancy, she'll be very comfortable with using it, so she'll be more familiar. She can get her playlist on. She can dance. And dancing is something I promote in pregnancy. Move because that's going to help you connect with your body. So move your pelvis, do some sexy dancing, lift your arms up in the air, move around. And if you're doing that, and you start to get comfortable with that, you might well do it in the birth room too. Put your favorite music on and move one of the most memorable births that I have ever attended. It was when I was a student at Yale School of Nursing, and I was at Yale New Haven Hospital, which is a very medical birthing institution, was a woman who was literally on top of the bed. She had flattened the bed out, and she was just dancing. She had loud music on, and she was just going up and down the bed, dancing, moving freely. And the beautiful thing about it was not just that she was free to move her body the way she wanted to, but it made everybody else so sort of uncomfortable, they didn't know what to do with it, so they left her alone. Everybody just stayed out of the room. What's going on in here? And she just danced her baby out. And I was like, That's it. That's perfect. Oh, good, perfect. It's perfect. It's so, so good. And do yoga and swim and dance in your pregnancy. Get a birthing bowl and get in the bathroom. Make sure that you have space to move. Ask for a ball, ask for a mat because you would like to move around, or if you're choosing to have an epidural. And so a lot of women do you are on the bed, and sometimes that happens. Don't worry, you could still move on the bed. You can roll from side to side. If you can get on your knees, that's good. And again, keep moving around on the bed as much as you can every 20 to 30 minutes. Change your position. That's helpful if you're pushing your baby out and your baby isn't coming very easily, and this can happen if you have an epidural, especially because you don't get that sensation. But a top tip would be to rotate your thighs inwards, that opens the bottom part of your pelvis and makes a little bit more space. So if you're on your hands and knees or on your side, hands and knees, on your side, standing up, these are called flexible sacrum positions. That means that your sacrum, the back of your pelvis, can move, and it's supposed to move. So try to get into those positions. And if you're struggling to push your baby out, even if you haven't got an empty or whatever is going on, you can turn your thighs inwards so that your toes are pointing to each other. Now that movement opens up where the baby's coming out, but the baby does have to be in that part of the pelvis, that lower part, and that will give your baby a bit more space. The other thing you can do, which is really important, if you've got if you're on the bed. I understand lots of women I'm encouraging not to be on the bed, but I do understand reality is a lot of women are on there. Get a peanut ball. You. Make sure your providers have peanut balls available. And if they aren't, you should ask for them, because they will help you. So even as you lie there, having a peanut ball between your knees in various positions is really helpful for making a little bit more space for the baby. The other top tip is breathing. Long, slow abdominal breaths, and these help to relax your pelvic floor.

Sometimes we hear from others that they are told to assume a certain position because they may be experiencing a stall or, you know, slow down in labor, and then they find it very uncomfortable. They don't want to be in that position that doesn't feel good to them. And then, you know, their nurses telling them, yes, yes, you have to stay in this position. You have to work through this. This is the position you need to be in. Would you agree or disagree with that? I
would disagree with it very strongly, unless there was a specific reason. Most of the time, it's because the it's convenient for the midwife or the obstetrician. Obstetrician. Now, if the baby's heart rate was a bit erratic and causing some concern because she was in a certain position, then obviously we have to take that into consideration, because lying on the side the baby's heartbeat is not great. Maybe there's some compression of the chord, and moving to another position would be better. And that's what the midwife is saying. But I'm such I'm suspecting that a lot, and I know actually a lot of midwives are going to say, can you lie on your back? The majority of women are lying semi recumbent because it fits the narrative in the hospital, and that's because we want to see the perineum. We want to see the baby coming out. That's not good enough, because actually, that is not good for you. It is not good for you. Anatomically. That doesn't fit for you. And if you don't feel that, and that's most important, you should take up the position that is best for you, because it feels right for you. You are having the baby, nobody else, the babies inside your body, listen to your body, do what feels right for you.

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