I tell my clients and students in my Confident Birthing Classes that my favorite position for progressing labor is almost always… the toilet.
I have no idea who said this originally: “Failure to progress is most usually failure to wait.” Folks have a hard time waiting. And normal, physiologic birth can take some time, especially in a first time motherbaby.
I say motherbaby because they are just that…one…motherbaby. And together, they have much to do get this baby out. It takes time.
Luckily, doulas (and midwives and childbirth educators) are not the only ones who get this now. We’ve been joined by obstetricians who are also beginning to get it.
This is no small feat, so it bears a little detour in this post to discuss the value of waiting in the context of some pretty game-changing events.
Here is a great summary of the (somewhat recent) joint statement from the American College of Obstetrics and Gynecologists and the Society for Maternal-Fetal Medicine
stating pretty darn clearly (and raising some hackles in the process) that women need time to give birth.
In their Obstetric Care Consensus Statement – Safe Prevention of the Primary Cesarean Section they make this remarkable statement:
“Slow but progressive labor in the first stage of labor should not be an indication for cesarean.”
So, you can be sure that nudging the labor forward is not because we are bored, in a hurry, have someplace else to be. It is because we are looking at the whole picture of this birth.
We are considering how tired this mama might be. We are thinking about whether her membranes are intact or her water broke many hours ago.
We are thinking about whether she is too nauseous to keep food down and her energy up. We are thinking about – if she has had any cervical exams –
and we know anything about her how her cervix is dilating (slowly, unevenly?) or how high baby may be in her pelvis at this moment.
And most important, we are thinking about how she is doing emotionally. With all that in consideration, as well as her desire to give birth without pain medication,
we gently, lovingly (and sometimes firmly) encourage her to try a position that may help her labor progress.
You’ll notice, however, that you are not facing out as you would if you were just going to make trip to the bathroom. We want you to stay here a while so we are going to help you get comfortable. Pillows on the top of the tank of the toilet to keep you from having to put your arms across the cold porcelain, and to give you a place to rest your head, make it the perfect spot for that forward bending most mamas do instinctively when the contraction starts.
And gravity, along with the nearly squat position of the toilet make it a perfect position to help baby move down.
To stay there though, we may need to help you get even more comfortable. For example, we might need to make that seat a little softer.
And we might need to add a little lift under your feet so you can keep them flat on the floor and under your knees. This helps you keep your pelvis open and takes a little load off your thighs.
We can do this with towels, books or yoga blocks depending on how much lift you need.
OK. So we have you on the toilet and now you’re pretty comfy. You can rest your upper body and head on the pillows. You can close your eyes and sleep (between contractions).
We’ll get your partner on a stool or the birth ball behind you ready with a back massage during your rests and double hip squeeze or direct pressure during the contraction.
And we’ll likely ask you to stay here 20-30 minutes. Maybe longer. Yep. Because it makes a difference.
It’s probably clear that the toilet is a similar shape, size and height to a birth stool. So it makes sense that this is good place to hang out.
But we’re here not because you are ready to push, we’re here to either get contractions longer, stronger, and closer together or baby to move down or both.
And it seems to work. Here’s why: in addition to harnessing gravity, and getting you into a position that opens your pelvis while supporting you to rest,
the open space in the toilet seat allows you freedom of movement to rock and sway your pelvis during your contractions.
This movement makes a huge difference and can be just what is needed between lovely spells of resting to bring your baby down and progress your labor.
And let’s talk (for just a second) about how psycho-somatically, this the perfect place for your body to remember how to let your lower sphincters open. ‘Nuff said? Thought so.
But what about if you are laboring in the hospital where they have no tanks behind the toilets?
Well, we’ve got that worked out for you! You sit facing out as you would if you were going to use the toilet normally.
Partner then sits on the birth ball getting as close to the toilet as possible – with your legs open on either side.
You’ll both need one or two pillows…. two for you to put on your partner’s back to lean forward and rest comfortably and one or two for your partner to wrap forward around for support.
This is sometimes partners’ favorite position. I wonder why? But maybe your partner really needs to go lie down for a bit… we have to watch tired dads on birth balls, you know.
So, we have another option for moms in hospitals too.
We’ll wrap those pipes with pillows and we can wrap the pipes with the rebozo too, for a hand-hold.
So, I am going to wrap up with this. Every once in a while (not that often, I am afraid) this position brings a baby down quickly and sometimes you can feel an urge to push. Well, nothing gets some care providers more worked up than a mom pushing on a toilet. If you are first time mom and your urge to push is not overwhelming, you may wish to stay here for a bit. If you choose to do that, it will likely get those same care providers VERY worked up… and while I have never (in my nearly 20 years as a doula) seen a mom push a baby out INTO the toilet, I suppose that could happen. After all, I always say, just when you think you know something about birth, it humbles you. So with that in mind…I think I have a solution.
If you are just beginning to feel pushy and you can’t imagine moving yet (I say yet, because changing positions often in pushing is a good thing),
you might negotiate with that nurse, doctor or midwife by placing a bath sheet across the toilet – UNDER the seat.
Of course, if you stand up to do that…you might just change positions.