Yoga-Based Birth Skill #1- Movement (Asana) - Movement as an Evidence Based Birth Practice

Article Index

“Walking and position changes including upright positions improve the effectiveness of contractions and reduce the length of first stage labor by 1 to 1 1/2 hours without any other intervention usage or negative effects to mother or baby. It improves a mothers sense of satisfaction with their overall birth experience, it is harmless practice that also improves their comfort and sense of control.” The Labor Progress Handbook 4th ed Penny Simkin, et al.

Lamaze International, in 2007, was looking to define parameters for optimal maternity care according to the systematic evidence reviews conducted by the Cochrane Database Collaboration. They found that optimal maternity care can be distilled into six characteristics. Optimal Maternity Care Practice #2 states that women should have freedom of movement during labor.

In 2014, Pittsburgh’s own, Michele Ondek, published an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,”  that was originally published in The Journal of Perinatal Education, 16(3), 2007.

I really like the way she summarized her findings in this review:

“There is an optimal way to give birth and it is supporting the physiologic process (ACNM et al., 2012; Goer & Romano, 2012; Lothian, 2009). No study has ever shown that walking in labor is harmful in healthy women with normal labors, which is the evidence-based conclusion of the mother-friendly birth practice to provide the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor issued by the Coalition for Improving Maternity Services (Storton, 2007). “A woman’s position in labor, mobility, and fear and anxiety or, conversely, confidence may influence her experience of pain” (Jones et al., 2013, para. 1). Current practice, which is intervention intensive, has contributed to the high U.S. cesarean rate of almost one-third of women and has resulted in increased maternal morbidity and mortality (American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, 2014). Because dystocia is the most common indication for cesarean surgery, efforts to reduce the cesarean rate must include efforts to support the physiologic process in which the women’s ability to be mobile is key. Women need to feel that they can labor in a supportive environment that decreases their fear of pain by supporting their ability to cope with the pain of labor, including having the freedom to walk, move, and change position throughout labor.”

In US Midwives 2012, three midwife organizations issued the consensus that stated freedom of movement in labor and the woman’s choice of birth position are essential to the goal of healthy physiologic childbirth. American College of Nurse Midwives (ACNM) Midwives Alliance of North America (MANA) and National Association of Professional Midwives (NACPM).  In Great Britain, the Royal College of Midwives (RCM) also support active and upright positions.

In 2019, the World Health Organization’s Guideline Development Group issued recommendations designed to facilitate Intrapartum Care for a Positive Childbirth Experience. Recommendation #25 states “The adoption of mobility and an upright position during labor in low risk women is strongly recommended.” WHO further states that mobility represents a form of intervention that is beneficial, essentially harmless, cheap and easy to implement.

The benefits and effectiveness of mobility and upright positions during labor have also been proven to be evidence based. 

  • 2013 Cochrane Review of 25 randomized controlled trials (RCT) of more than 5,000 pregnant women that looked at the effects of mother’s positions and movements during 1st stage labor. Participants were either upright movers or remained on back or in bed. Participants in the upright moving group experienced shorter labors (by 11/2 hours), were less likely to request an epidural and less likely to have a Cesarean Section.
  • 2017 Cochrane Review of 32 RCT’s involving more than 9,000 pregnant women looked at the effects of mother’s positioning during 2nd stage labor in women without epidurals. Participants were either upright or supine during pushing and delivery. Women who gave birth in an upright position reported less pain and more overall satisfaction with their experience. There were two contraindications to giving birth in an upright position:
      • Women who gave birth (2nd stage labor) were 20% more likely to have a second degree tear than those who gave birth in a supine position.
      • Women who gave birth (2nd stage labor) were 48% more likely to have an “estimated” blood loss of greater than 500ml.
      • There is controversy surrounding both of these numbers. I feel both of these findings merit further discussion and perspective-this study will be addressed in the future articles about specific Yoga Based Birth Skills that are implemented during the Second Stage of Labor.
  • 2015 small study done regarding the use of a birthing ball during labor that found the utilization of such a ball significantly lowered the level of pain experienced by participants assigned to and trained to use a ball during labor.
  • 2012 A Systematic Review published in the journal: Evidence Based Complementary and Alternative Medicine. This review looked at 6 trials (3 RCT’s and 3 CT’s). The results for the RCT’s were published. This is a small amount of data and the review stated that more RCT’s were needed to obtain definitive results. The reviewers found that the participants that practiced Yoga while pregnant and during labor showed less stress, higher quality of experience, better Autonomic Nervous System functioning, more comfort, less pain, and a shorter duration of labor. No contraindications were discovered other than the fact that some women sometimes felt contractions during practice, but this was easily remedied by changing position and the intensity of the practice. [My Note: That yoga practice can bring on and perhaps intensify contractions can only be seen as a benefit during labor.]

The American College of Obstetricians and Gynecologists Committee on Obstetric Practice states in their 2019 Committee Opinion No. 766 that “frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning can be supported as long as adopted positions allow appropriate maternal and fetal monitoring and treatments are not contraindicated by maternal or obstetric complications.”