Slide 1

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 2

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 3

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 4

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 5

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 6

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 7

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 8

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 9

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 10

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 11

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 12

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 13

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 14

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 15

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 16

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 17

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 18

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 19

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 20

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 21

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 22

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 23

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 24

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 25

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 26

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 27

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 28

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 29

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 30

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 31

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 32

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 33

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 34

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 35

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 36

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 37

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 38

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 39

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 40

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 41

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42


Slide 42

this training is a
supplement to your
complete childbirth
education class

Promoting unrestricted movement
during labor and birth for
better birth outcomes

“Freedom of Movement” ©
The “Freedom of Movement” initiative
(FMI) promotes the unrestricted
movement in labor and birthing for low
risk mothers; this includes walking
freely during laboring and mother’s
choice of birthing position.

The Freedom of Movement Initiative
supports physiologic birth.

This means the promotion of practices
during labor and childbirth that:
* Are evidence-based
* Improve the health outcomes for mother
or baby
* Shift power from provider to woman
* Discourage technology or interventions
without proven benefit

Unrestricted movement and
freedom to choose a comfortable
position, especially when in pain,
allows a woman to feel
empowered and
in control of her own body.
POWERFUL AND STRONG

This reduces stress and tension,
as well as feelings of
fear, demoralization,
being submissive and dominated
so….

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

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

FEAR

Dr. Grantly Dick-Read’s
Restriction leads to fear.
Fear leads to pain
PAIN

TENSION

FREEDOM &
RESPECT

EASIER
BIRTHING

Freedom of
Respect leads to
calmness and
relaxation which
in turn leads to
easier birthing

RELAXATION

The feelings, attitude emotion of a mother
induces anxiety in labor, leading to fear,
which in turn causes muscular and
psychological tension resulting in pain.
Dr Dick-Read began the “Natural
Childbirth” movement by advocating for
education, support and understanding.
Adrenaline produced with fear can also
inhibit the first stage of labor and increase
pain.
Dick-Read G. (2004) Childbirth without fear: the
principles and practice of natural childbirth. Pinter &
Martin: London.

Walk,
kneel,
squat,
sit

An updated Cochrane Review of evidence on the topic
provides the strongest evidence yet in favor of women
staying upright during this stage of labor. Women are
29 percent less likely to have a caesarean birth.
“Because of the shape of the vagina, the passage of
the baby is more 'down' than 'up' when women give
birth on all fours.”
Professor Hannah Dahlen of the School of Nursing and Midwifery
at the University of Western Sydney

Being on all fours frees the woman
to rock her hips to maneuver the
baby down the birth canal. It may
Also make pushing easier.

Annemarie Lawrence1,*, Lucy Lewis2, G Justus
Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour.
Cochrane Pregnancy and Childbirth Group.

Dance and movement therapy (DMT)
The psychotherapeutic use of movement
The main principle of DMT is that mind and body are
inseparable. So allowing the body to relax and be at ease
through dance also allows the mind to be at ease and vice
versa (Levy, 1992).
Movement is like a moderator, between psychological,
emotional and physical issues occurring during labor and
birth, assisting in calming and integration for wellbeing.
Berrol CF. (1992). The neurophysiologic basis of the mind-body
connection in dance/movement therapy. American J of Dance
Therapy ; 14: 19-30.
Levy F. (1992). Dance Movement Therapy- A Healing Art. American
Alliance for Health. Physical Education, Recreation, and Dance. Reston
Virginia.

movement decreases
physical and emotional pain
Dance is an expressive therapy that has been used
for thousands of years and is currently used with
rehabilitation, physical therapy and cancer
treatments as well as for emotional and behavioral
therapy with children and adults.

Kolb B. (1985). Fundamentals of Human Neuropsychology. W. H. Freeman and Company. (2 nd ed.) New York
Strassel, Juliane; Daniel Cherkin, Lotte Steuten, Karen Sherman, Hubertus Vrijhoef (2011). "A Systematic Review of the Evidence for
the Effectiveness of Dance Therapy". Alternative Therapies 17 (3): 50.

Evidence in Scientific Literature
“There is clear and important evidence
that walking and upright positions in the
first stage of labour …

reduces
* the duration of labour,
* the risk of caesarean birth,
* the need for epidural”

“Women who
ambulated
during the first
stage of labor
were less likely
to have C-S,
forceps or
vacuum
extraction.”
(Albers, 1997)

Annemarie Lawrence1,*, Lucy Lewis2, G Justus Hofmeyr3, Cathy Styles4 (2013). Maternal
positions and mobility during first stage labour. Cochrane Pregnancy and Childbirth Group.

a sample of the qualitative responses received from
mothers who birthed in the past 5 years:
“I wasn't allowed to move around. It added stress to the process because I felt
like I needed to be up walking, needed to be upright for delivery...but I wasn't
allowed to do those things and was never given a good reason why. I fought to
be able to walk the halls, but the nurses fought to ensure i had a portable
monitor attached…. Overall, I feel I could've had the peaceful birth I wanted if
they had've left me alone. They seemed frantic, untrusting and determined to
have their hands in every aspect of my experience for "safety reasons".
“Yes! It is why I had a positive birth experience! Walked, showered & danced
with my husband!”
“I have labored six times. I realized during my first one that it was my
labor...and when they didn't want me to move, I told them I needed to pee. ,
when she was born they had me push for two hours on my back....lots of
tearing and they cut me. my second baby I walked, labored in a tub, but then
they had me leaning back to give birth...and cut me (this was a German
hospital), third baby we were in Italy. I had a midwife, and she left and baby
came. I needed to push, David said try, I hung on him and pushed. Then I sort
of squatted, and on second push her head was out! I learned that letting my
body get in to position made labor so much easier.”

“I was forced to be on my back for checks and the both itself, and was
harassed to stay on my back while laboring. It felt like a physiologically
impossible prison. I feel the position compromised my daughters health
as she was LOW and small and had the cord wrapped around her neck. I
was in a great deal more pain on my back. It was awful.”
“… there was nothing I could do but lie there and be in pain. I would
have been MUCH happier and (I believe) had an easier time doing the
work of delivery if I could have swayed, squatted, and paced the way my
body was telling me to.”

“I was forced to monitor and have iv hook up all night. By 9:30 am I said
enough. If you dont let me out of this bed I'm unhooking myself. They
insisted on another hour of fetal monitoring then let me walk with the iv
drip. Once I could move things sped along nicely. I firmly believe it was
walking that made it so!”

(replies received from “Freedom of Movement” data collection, October 2013, emphasis added)

Words used to describe movement restricted birth:
Powerless
Disregarded
Demoralizing
Angry
Mortified
Stressed
Awful
Prison
Words used to describe non restricted labor/birth movement:
Free
Ease
Safe
Instinctual
Great
Beautiful
Pleased
“I can't imagine how much pain I would have been in
if I had been restricted to a bed during my labor!” -Janelle P.

“I always suggest my moms get up and move around. It’s only
natural! I couldn’t imagine catching a baby with a woman forced
on her back. Not only would she be uncomfortable but it would
take so much longer.”
“When I support women in the hospital, I always find ways for
them to get up and move around, even if it’s just walking to the
bathroom. In my experience these moms are a lot happier, freer
and have better births.
“Yes- I teach moms to use whatever position they want. This is
easier when there’s a birth tub. They aren’t even able to lie
lithotomy.”

IV or intravenous catheter that is routinely
inserted in the lower arm or hand of a
laboring women is generally
NOT necessary.
It is mainly a precaution to prevent
dehydration, which is not an issue
if a woman is just allowed to drink.
There is no medical reason to
prevent eating and drinking in labor.

No need for an IV to stay hydrated…
“Allowing self-regulated intake of oral
hydration and nutrition has been shown to
help prevent ketosis and dehydration.”
“Cochrane review (3,130 women) found no
justification for restricting oral fluid or food
during labor.”

Fetal monitoring
Do babies have better outcomes with fetal monitoring?
NO!
Get off the strap.
“There were no differences between women who received
intermittent auscultation and those who received continuous
EFM in perinatal mortality, cerebral palsy, Apgar scores, cord
blood gasses, admission to the neonatal intensive care unit, or
low-oxygen brain damage.” Dekker, 2012.
Readings are often inaccurate due to maternal/fetal
movements.
No only does fetal monitoring NOT HELP BETTER OUTCOMES,
it actually may cause damage.

Increase rate of Cesarean Section delivery
Increase use of Vacuum and Forceps
Additionally, “70% of obstetrical litigation
related to fetal brain damage is related to
purported abnormalities on the EFM tracing.”
Symonds

And incidence of neonatal seizures
significantly decreased when fetal monitoring
was not used.
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.

ACOG Practice Bulletin 70 (2005) states:
“Those with high-risk conditions (eg, suspected fetal

growth restriction, preeclampsia, and type 1 diabetes
should be monitored continuously).”
NOT LOW RISK moms

http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm

CHILDBIRTH
Don’t Take it Lying Down!
Stand up and lean against the wall
Stand up and lean against your partner
Sit on a birth ball
Sit on a birth stool
Kneel on a pillow and lean into your partner
Squat on a mat or on the bed
Get on all 4’s and sway
Rock your hips

~

walk around

© 2013 Birth-Matters

~ Shift often!

Practice different positions and
have your birth partner be
prepared to help you with them
Changing position can reduce the length of
labor. Mendez-Bauer and Newton (1986)
state: “duration of labor from 3 to 10 cm
cervical dilation was about 50% shorter in
patients who alternated supine and
standing, standing and sitting positions.”

WHAT CAN YOU DO?
Ask to keep fetal monitoring to
to a minimum, utilizing
intermittent auscultation.
If the hospital refuses, ask them to
pull the electronic monitor on you
intermittently (not strapped to you)
Ask that an IVs be only used in the
case of a medically necessity and if
you can have mobile attachments for
freedom of movement in a wide area.

Learn the tools available
to help with birth such as

water tubs

© 2009 Chasse, J
© 2013 http://www.kayabirth.com/

Water is soothing and helps promote relaxation, with
ease of movement and greater comfort. Some women
are also more uninhibited in water, allowing their body
to relax and easier release the baby.

birthing bars
and
birthing balls

© 2013 Memorial Hospital of South Bend

© 2013 Regents of the University of
Minnesota and Charlson Meadows.

Squatting with a birth bar and
sitting on a ball gives much
needed support. Upright
posture works with gravity.
Also increases blood flow to
the uterus and provides
counter pressure when
sitting.

Sitting upright on a birth ball or squatting on a birth bar
allows you to find the correct posture and position for
the baby to come down and allowing the contractions
to be more effective. Your pelvis outlet increases by up
to 30% allowing easier decent for baby.
Rocking on a ball can relieve back tension and pain

rebozo
This is a traditional mexican scarf that can
be placed around the mother's body with
ends held by a doula, friend or partner to
help support mom and baby’s weight.
Rhythmic moving with slight lifting relaxes
the mother. Upon relaxation, the partner
tugs strongly on one end that encourages
positive movement in the desired
direction. For this type of massage, jerk
the end of the rebozo on the side you want
the baby rotate toward.

SUMMARY:
Use unrestricted self-initiated
comfort-seeking movements
during labor and birth
2013 ©
Prenataldancefitness.com

Change position and use
different ways to move such as
squatting, stretching,
swaying and dancing.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour.
Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934.

Remember that you can
make a difference in having a
POSTIVE BIRTH EXPERIENCE
with evidence based tools,
care and education,
lower adverse maternal
outcomes is possible

Thank you for
participating
in this training
For more information, please write to
Dr. Jill Diana Chasse
[email protected]

Additional References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review. Obstet
Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000.Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J NurseMidwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial. Birth
26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.World
Health Organization partograph in management of labour. Lancet 343 (8910):1399–1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.

42