Preparing for a Gentle Birth: The Pelvis in Pregnancy

Preparing for a Gentle Birth: The Pelvis in Pregnancy

by Blandine Calais-Germain, Nuria Vives Pares


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Product Details

ISBN-13: 9781594773884
Publisher: Inner Traditions/Bear & Company
Publication date: 08/24/2012
Edition description: Original
Pages: 192
Sales rank: 752,175
Product dimensions: 9.80(w) x 7.90(h) x 0.50(d)

About the Author

Blandine Calais-Germain is a dancer, dance instructor, and physical therapist. Renowned for her movement-based classes on anatomy, she is the author of several books, including No-Risk Abs, No-Risk Pilates, and the bestselling Anatomy of Movement. She lives in Limoux, France. Núria Vives Parés is a psychomotor therapist who teaches anatomy and movement to hospital and maternity ward staff throughout Europe. She lives in Palafrugell, Spain.

Read an Excerpt

Chapter 6
The Principal Positions of Childbirth

- Introduction
- Parameters of observation of positions

Childbirth positions . . . Positions lying on the back
- Presentation of the positions lying on the back
- Reclining position

Positions lying on the side
- Presentation of the positions lying on the side
- With slight flexion of the femurs

Seated positions
- On a low seat
- On a large ball

Kneeling positions (with the weight forward)
- With legs parallel and symmetrical
- With internal/external rotation of the femurs

Standing positions
- With the hips slightly flexed

Squatting positions
- With external rotation of the femurs
- With internal rotation of the femurs


In this chapter we take stock of the positions that are typically used today in childbirth. While there are definitely other possible positions, what we present here are those most frequently used.

In the first positions presented, the pelvis is mobilized by the hips or the spine in a sagittal plane, that is to say, toward the front or back. The movements of the sacrum in the sagittal plane are those that are best known and most often described. The movements are viewed in profile, and they are easiest to understand because everything happens on a single plane (forward and back).

The sagittal plane is the one in which the amplitude of movement is the greatest and where we can make the greatest progress in labor.

But, in fact, childbirth is an asymmetrical event when we are talking about the pelvis: positions are rarely organized in a purely sagittal plane.

In practice they are most often combined with other positions in other planes, thereby giving rise to many variations.

This chapter, therefore, proposes different positions, where we start first with the sagittal and symmetric and then bring in the frontal and transverse planes, that is to say: hip rotation and the asymmetries of the legs.

This expands the possibilities of birthing positions and helps us to understand why a woman in labor—when she is not restricted in the way she can move—may choose atypical or “bizarre” positions and movements.

The following tools offer the woman in labor other position possibilities, especially when she understands why and how they are used.

Parameters of Observation of Positions

1. Description of the position
This is a global description pointing out characteristic components.

2. How are the hips?

Description of their position (see chapter 4).

3. How are the knees (and the feet)?

Description of their position.

4. Are the lower limbs symmetrical?
This is an important aspect to observe to see if the position corresponds to a possible asymmetry of the pelvis.

5. Is the pelvis under pressure?
This section describes which parts of the pelvis are under pressure and what exterior elements might be causing it.

6. Are the two iliac bones free?

Can they move, or are they in a fixed position or being pulled in a certain direction?

7. Is the sacrum free?

Can it move or is it in a fixed position or being pulled in a certain direction?

8. Are the openings modified by the position?

Are they enlarged or reduced in size, front to back and/or laterally?

9. Remarks

Lying on the Back

These positions are addressed first because they are the most common positions used in hospitals, particularly for monitoring, vaginal examinations, and epidurals.

Numerous women also ask to lie down to rest when they arrive at the hospital. If the fetus is already engaged (often the case), gravity pulls the fetus toward the back of the abdominal cavity rather than toward the pelvis.

Uterine contractions are fighting an uphill battle against two forces: gravitational pull that does not favor engagement with the birth canal and a lack of mobility of the sacrum.

In the event that lying on the back has to be sustained, for instance during a gynecological exam, place a soft material—a packet of gel or water—under the sacrum so it is able to stay mobile.

In case the woman wants to stay on her back to rest, raise the bed so that the position of the uterus favors engagement with the birth canal.

Lying on the Back
With Slight Flexion of the Femurs

1. Description of the position
The trunk is flat, the knees bent, feet flat on the bed, the table, or in the foot supports

2. What is the position of the hips?

The hips are in approximately 45° of flexion

3. What is the position of the knees (and the feet)?
The knees and feet are in about 90° of flexion.

4. Are the lower limbs symmetrical?


5. Is the pelvis under pressure?
There is pressure on the entire posterior pelvis.

6. Are the two iliac bones free?
Yes, because hip flexion does not exceed 90°.

7. Is the sacrum free?
The sacrum is blocked by the bed or birthing table.

8. Are the openings modified by the position?


9. Remarks

- Often women complain of “kidney pain.” The posterior sacroiliac ligaments are compressed. The fetus has to engage, but the position inhibits it and this causes the pain.
- This position does not facilitate pelvic mobility. All of the posterior structures are restricted and compressed, and this can cause pain.
- This position is more practical for the obstetrics personnel and is currently used during the engagement, especially in the case of epidurals and frequent monitoring.
- For the woman, this position does not require the work of any postural muscles, and it allows her to rest if she is tired.
- However, the contraction of the uterus is fighting against two forces: gravitational pull that does not favor engagement, and restriction of pelvic mobility.

Table of Contents

Foreword by Carmen Barona Vilar

A Note to Doctors, Midwives, and Mothers

How to Use This Book

Introduction: The Pelvis in Motion

1 What Is the Pelvis and What Does It Do?
2 The Parts of the Pelvis
3 How Does the Pelvis Move?
4 How Does the Area around the Pelvis Move?
5 The Pelvis Changes Shape during Childbirth
6 The Principal Positions of Childbirth
7 The Movements and Transformations of the Pelvis
8 The Three Star Positions: Standing, Sitting, Kneeling

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