Which position would the nurse teach the client to avoid when she experiences back pain during labor

Anemia: Abnormally low levels of red blood cells in the bloodstream. Most cases are caused by iron deficiency (lack of iron).

Cerclage: A procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth.

Cesarean Delivery: Delivery of a fetus from the uterus through an incision made in the woman’s abdomen.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.

Dehydration: A condition that happens when the body does not have as much water as it needs.

Gestational Diabetes: Diabetes that starts during pregnancy.

Hormones: Substances made in the body that control the function of cells or organs.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Oxygen: An element that we breathe in to sustain life.

Placenta Previa: A condition in which the placenta covers the opening of the uterus.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Preterm: Less than 37 weeks of pregnancy.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

There's no rule to say you must give birth flat on your back in a hospital bed. You can choose to move around and into different positions throughout your baby's birth. It's your prerogative. Birthing positions can help you to feel in control, reduce pain and open your pelvis to help the baby come out.

Which position is best?

In the past 100 years, women in Western countries have usually given birth lying down, mostly on their backs. However, in previous centuries they gave birth in an upright position, as women in many other cultures have traditionally done.

Today, you can choose the position that makes you most comfortable, unless there is a medical reason not to. Many women find positions instinctively during labour and birth. You may also choose to practise some of them before you have your baby.

It is recommended that you walk, move and change positions frequently during the various stages of labour.

Positions for stage 1 labour

Early labour

During the first stage, your cervix gets thinner and dilates (opens up) to about 3cm. You may still be at home and choose to stand in the shower, sit in the bath, walk around or find another position that's comfortable for you.

Unless there is a medical reason to do it, lying on your back is not recommended in the first stage of labour because it can reduce blood supply to your baby and potentially lead to a longer labour. You can, however, rest during this early phase to conserve energy, which you'll need later. Choose a comfy position lying on your side or sitting with your feet up.

Keep moving and changing positions to prevent fatigue and ensure your muscles don't get too sore. You may find yourself standing upright or bent over while rocking and swaying, sometimes called the 'dance of labour'. This can help both you and the baby by easing pressure on the pelvic area and encouraging the baby to move into the correct position in the pelvis.

Active labour

As you move into established, also known as 'active' labour, your cervix dilates from 3 to 10 cm and contractions become more frequent and stronger.

Your maternity team will encourage you to choose your own positions during this phase and may make suggestions to help you. Try to choose an upright position since it has many benefits, including:

• allowing for the baby to move down and into the right position
• bringing on stronger contractions and potentially a shorter labour
• decreasing the chance of needing an epidural
• giving you less severe pain or backache
• reducing the likelihood of a forceps or vacuum-assisted birth
• decreasing the chance of problems with the baby's heart rate
• helping to open your pelvis for the next stage

Here are some positions you could choose:

• kneeling, using a chair or birthing ball (yoga, or 'fit' ball) for support
• swaying or walking and holding a support person during contractions
• standing and moving in the shower to help reduce pain
• sitting or kneeling in a bath, to reduce pain and make you buoyant, making it easier to change positions
• squatting, using a birthing stool, ball or squatting bar; this can help the flow of oxygen to your baby, reduce back pain and move the baby correctly into position
• sitting and rocking on a chair or edge of the bed
• sitting backwards on a chair, with arms resting on the chair-back
• leaning forward over the bed
• sitting on a chair leaning forward
• lunging with one foot up on a chair or footstool
• kneeling on hands and knees to help reduce back pain

If you want, your birth partner can massage you, help guide your breathing, and support you while you are in these positions.

Positions for stage 2 labour

The second stage is when your cervix is fully dilated and as your contractions happen, you'll push so your baby can move through and out of your vagina.

Maintaining an upright position can open your pelvis and make it more comfortable for you to push. It can also help angle or tilt the pelvis to help the baby come down and lead to a faster birth.

If you are in bed, you can still kneel or go on all fours. You can also sit, semi-recumbent, on the bed, or lie on your side with your top leg bent.

If your baby is positioned facing your back (posterior) or halfway between your back or front (lateral), being on your hands and knees can help, particularly with back pain.

What could stop me moving or choosing my own positions?

• An epidural usually makes your legs feel heavy and numb so you will need to lie on the bed. However, new mobile, or 'walking', epidurals are now available to allow you to get up and move. You will need to check whether your hospital provides this.
• An electronic monitor may be placed around your abdomen to check the baby's heartbeat and this may restrict your movement. Ask if your birthing facility has a mobile monitor, which will let you move around.
• If forceps or a ventouse (vacuum) is used to help your baby out of your vagina, you will need to lie on your back. The same applies for a vaginal examination or episiotomy.

How to practise using positions for labour and birth

• Join an antenatal class.
• Search for images and videos on the internet and practise at home.

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