answers by Cathy Daub - President of BirthWorks International
Question - The World Health Organisation (WHO) now advises medical staff and midwives to stop speeding up birth unless there are real risks of complication. This contradicts their previous advice stating that labour progressing at a slower rate than one centimetre of cervical dilation per hour in the first stage is considered risky. Can you explain why certain cervical dilations take longer and why is it considered risky in the first place?
It is essential that the baby’s head is positioned on the cervix so it presses in all directions to dilate equally. Malposition may occur with babies in an occiput posterior position where they can’t tuck their chins well and the head may present forward on the cervix. Or, if the baby is in an asynclitic position with the head tilted to either side, the cervix will take longer to dilate. There may also be tight ligaments holding the baby back. The good news is that with movement and relaxation exercises for the pelvic floor, many of these situations can be alleviated and the baby can have a normal birth. Unless the cervix is fully dilated to allow the baby’s head to pass through, the baby will need surgical delivery.
Question -Do you believe their current advice is the correct thing to do and why?
Absolutely! This is a good and wise change of advice by WHO. We sometimes say that babies are like cakes- some need 25 minutes to bake and some 45minutes. Women labor in many different ways and can dilate slowly or quickly. This new advice gives women freedom to feel safe to labor without the pressure of restrictive timeframes. Women give birth in their own special way. But giving birth in upright positions or left sidelying with the pelvis tipped forward will most always result in a quicker birth.
The key word here is MOVE! There are ways that women can shorten their labors and dilate more quickly. Currently most women in the USA give birth lying on their backs with epidurals in place. Rather, they need to be up moving around and changing positions frequently. This helps them to use gravity and allows their babies to move into optimal pelvic positions for birth. The more space the baby has in which to move, the more optimally he/she will enter the inlet of the pelvis and make the two rotations necessary for birth. Movement of the sacrum is essential as this helps to open the inlet and outlet of the pelvis for birth whereas lying on the back with an epidural does not allow this movement and slows labor.
