There comes a point in every woman’s pregnancy where she starts to really think about what labor will be like. That moment might come right after a positive pregnancy test or in the final days of her third trimester. Movies and TV shows may lead you to believe you’ll be rushing into the hospital after your water unexpectedly and dramatically breaks, screaming the whole way and barely making it in time to deliver your baby. But this is not the reality for most women, especially for first-timers. In fact, active labor can last between four to eight hours for first time moms! And this is after early labor, which can stretch well into the 24-hour range. Is there anything you can do to help speed up your labor? Here’s a guide on one of the best tools to help you meet your baby faster: maternal positioning and movement to facilitate the cardinal movements of labor.
Cardinal movements: The journey your baby makes during labor
Before discussing how to speed up labor, it’s important to understand the specific movements your baby must make from the beginning of the birthing process to the end. These are known as the baby’s cardinal movements (if you’re a visual learner, check this out). Your baby doesn’t actively make these movements. Instead, she’s a passive passenger moved along by the anatomy of your pelvis, your positioning, the size of her head, and the strength of your contractions. She has to go through each of these cardinal movements before birth, but her journey is a guided (by you) tour rather than a self-paced (by her) one.
In the delivery room, you might have a nurse or doctor tell you your baby is “engaged” in your pelvis. This is also referred to as 0 station. It is the point of labor where the widest part of the baby’s head is in your pelvic inlet. Engagement is the first cardinal movement of labor.
After your baby completes her first cardinal movement, she begins on the second, which is the descent and flexion stage. In this stage, your baby descends until her head is on your pelvic floor. Her head becomes flexed downward towards her chest, which will help ease her entry into the world.
Your baby will then internally rotate, turning her head so that she faces your spine. Babies are sometimes born facing upward rather than downward, in a position called occiput posterior, or OP presentation. These ‘sunny side up’ babies are usually more difficult to birth due to their positioning. Most of the time, though, babies will internally rotate prior to delivery.
All together now…the last few cardinal movements usually happen rapidly
Good news! The final few cardinal movements typically happen quite quickly and are in the pushing stage of delivery. But first, a brief explanation of a common birthing term is in order.
What is crowning?
You might have heard of baby’s head ‘crowning,’ but what is that exactly? Crowning is actually when the baby’s head is stationary in the birth canal after a contraction- it doesn’t drop back inside. At this point you can see the top of baby’s head (but not her face yet if she’s in OA presentation).
Extension is when your baby has fully descended and her head is now passing out of your vaginal introitus (the opening of your vagina). Then there is external rotation, when your baby is externally rotated from the outside. She is now turned from face down to face either the right or left. This eases strain on her neck. It also allows the widest part of her body, her shoulders, to pass through your birth canal. Finally, there is expulsion, when her shoulders are expelled out of your vagina and she can now be completely delivered.
How to encourage the cardinal movements to speed up labor
Helping baby engage in your pelvic inlet
Before her journey into the outside world can begin, your baby must first “drop” into your pelvis. The process of pelvic engagement often takes place in the final days of pregnancy. Are there maternal positions to encourage your baby to descend? Yep!
Your baby will start out in your pelvic inlet, which is also referred to as -4 and -3 station. At this point, your provider might say that the baby is “still high” in your pelvis. This is a great time to use a birth ball and practice movements like pelvic tilts and figure eights to help move the bones of your pelvic inlet to allow your baby to engage in this upper portion of the pelvis.
Note: for a visual of many of the movements and positions I describe, check out this YouTube video by doula and birth educator Bridget Teyler.
Photo: Adobe
During this inlet stage, try to keep your knees apart and feet together as much as possible. A stationary way to do this is to let your chest and head rest on the edge of a couch or birth ball. Let your knees spread wide on the floor. This forward leaning will also help to align your baby properly in the occiput anterior (OA presentation), where she is facing your spine.
Photo: Adobe
Another way to perform this is by resting in “child’s pose”. Keep your knees as wide as possible as you breathe deeply. Especially if you are in the final hours of laboring at home before heading to your hospital or birthing center, it’s important to rest as much as possible to conserve energy for the marathon you’re about to undertake. Resting in a forward-leaning, knees-splayed position is a wonderful way to encourage your baby’s descent while also saving your energy.
Coaxing baby through the trickiest part of your pelvis
Next, recall that your baby will descend into your midpelvis, which is the most narrow portion. Stairwalking or slow lunges are great because they create more space in this very small section of your pelvis. If you have a partner or doula to help you, a position like the side-lying release is a great stretch which will help enlarge your pelvis.
You can perform a similar stretch by yourself by utilizing the runner’s position. In this position, you are laying on your side, with one leg on the bed or floor and the other up on a peanut ball or stack of firm pillows. This midpelvis stage is typically when the cervix is dilated to a 5 cm or higher, and your contractions will be growing in intensity. Using these maternal positions to encourage the descent of your baby should correlate with speeding up and intensification of your contractions.
Time for the crown(ing): moving baby through your pelvic outlet
Finally, your baby will reach your pelvic outlet, or the +2 and +3 station. This means she is nearly crowning or beginning to crown. Stalling in this portion of labor could be due to your sitz bones being in the way. To keep these wide, it’s important to now have your feet apart and your knees closer together if you are side-lying. To do this, keep a peanut ball in between your ankles rather than your knees. You can also kneel with one knee up or squat using a birthing stool. Continue to lean forward if you are sitting, keeping your knees in and ankles apart. Let gravity help bring your baby down as you keep your sitz bones out of the way. Your sitz bones, like their name implies, are the bones in the bottom of your pelvis that you sit on.
What if I’m using an epidural?
Yes, you can position yourself to encourage the descent of your baby even with an epidural! Whether or not you have much feeling in your lower half, it is still crucial to be changing positions every 20-45 minutes, says labor and delivery nurse and YouTuber Nurse Zabe. Many of the above described positions (such as side-lying release and various positions utilizing a peanut ball) are perfect for moms who are using an epidural. Can’t move on your own? Ask your nurse or doula to help you change positions every half hour or so. Flip from side to side and use a peanut ball to help create space in your pelvis.
Another fantastic laboring position for women with an epidural is the throne position. This achieves similar results to using a birth ball. Ask your nurse to put the head of the hospital bed in an upright position and drop the foot of the bed all the way down so it becomes similar to a chair. Make sure you are properly supported with pillows. Oh, and lean forward as much as you can!
If you have an epidural, don’t do this
Oftentimes, your nurse or doula can help you move into the specific positions that are best for where your baby is currently sitting in your pelvis. It’s vital to make sure that you are not just laying flat on your back or in a reclined position with an epidural. These positions will not encourage the descent of your baby through your pelvis, no matter what stage she is in.
Quick tips to help you speed up labor
What if labor is taking forever and nothing seems to work? The following quick tips can help encourage your baby to descend and complete her cardinal movements, therefore speeding up your labor. Hopefully this allows you to meet her sooner!
- “Movement is magical”, says Nurse Zabe. If you are not using an epidural, try the gentle movements described above like pelvic tilts on a birthing ball or slow lunges. Even if you are bed-bound, move as much as possible with the help of your birthing support team.
- Birth is largely dependent on your pelvic floor, which needs to be as relaxed as possible. While it can be easy to tense up from the pain of contractions, try to keep your body loose. This includes unclenching your jaw and relaxing your face. Try letting your mouth gently hang open and letting out low sounds during contractions, leaning into the sensations rather than fighting them. Blowing slow raspberries or making ‘horse lips’ is another great way to relax your facial muscles. This will in turn relax your pelvic floor.
- Get on the toilet! Yes, really! Your pelvic floor automatically relaxes when you are sitting on the toilet. As an added bonus, it will help you keep your bladder empty. The toilet is a ‘dilation station’ that will oftentimes make your contractions way more intense and speed up the labor process.
- Speaking of relaxation, try to keep the lights dimmed and the environment as serene as possible. Although this can be difficult in a hospital setting, let your birth team know your preferences for creating a calm birthing environment.
Lo esencial
Although you cannot control every variable that might arise during your birthing experience, it is still your labor. You have the ability to make decisions to encourage your baby’s journey into the world and even help speed up labor! Practice different laboring positions ahead of time and enlist your spouse, partner, or doula to help you. When the big day comes, trust your body and its ability to birth. You were made to do this!
This article was last updated on November 7th, 2023, to clarify that your baby is a passive, not active, passenger in the birth process.
Lecturas complementarias:
Cervical checks during labor— are they necessary?
Los sorprendentes beneficios del embarazo para la salud
Placental problems—when and when not to worry
Tylenol use during pregnancy: to take or not to take?
Las 6 cosas que toda mujer que se plantee un parto natural debe saber
Three percent of women give birth outside of a hospital setting. If we are talking about Natural Womanhood here, then let’s include women who deliver their babies at home. It is likely home birthers and fertility awareness users overlap.
Even if someone is planning to deliver in a hospital or birthing center, prepare for a home birth anyway. How many families have been caught completely by surprise by a labor and delivery that progressed quicker than expected?