LETS GET A MOVE

ON
SELINA WALLIS 18TH NOVEMBER 2023
WEAVERS DANCE

• Bara Hoy Mama, Bara Hoy Mama, 2 steps L

• Wey Wey Wey Wey Wey Wey Wey. 2 steps R
• Bara Hoy Mama, Bara Hoy Mama, 2 steps L
• Wey Wey Wey Wey Wey Wey Wey. 2 steps R
• Wey Wey Wey Wey Wey Wey Wey. 2 steps L
• [One silent step to the left]
 BIO

• Public Involvement Manager for ARC NWC

• 15+ years experience in public health
• Author of several papers including a Cochrane review
on breastfeeding
• Doula
• Grandmother
TASK

• Please turn to your neighbour- tell them what you want to get out of todays workshop and
why
RESEARCH ON MALPOSITION AND MATERNAL MOVEMENT

Effect of PA in Pregnancy
<GDM
<Large Gestational Age
>Flexion
<Prolonged Pregnancy
>MH
Exercise in pregnancy, including moderate to
vigorous is safe for all mothers and babies
throughout pregnancy and improves multiple
outcomes inc longterm health
RESEARCH ON MALPOSITION AND MATERNAL MOVEMENT

Effect of PA in Labour

>Quality of uterine contractions

>Increased pelvic dimensions
<Dystocia
<Length Labour
<POP
<Pain
<Assisted birth
<episiotomies
<CS
>locus of control
>satisfaction birth partners
 Women who did not use
stirrups when their baby was
born reported better than
average experiences for
questions on information
provision in hospital and
involvement during labour.
Conversely, women who gave
birth lying with their legs in
stirrups when their baby was
born reported worse than
average experiences for the
same questions.
POLITICS: MATERNAL MOVEMENT AS A
DISRUPTOR TO INTERVENTION
• Maternity care is increasingly polarised. There is a huge backlash
against promoting ’Normal’, ‘Natural’ or ‘Physiological birth’ as
unsafe, anti feminist and direct causal in baby deaths
• Increasing maternal physical activity in pregnancy and labour is a
modifiable factor that can improve everyone's outcomes in all types of
planned births and is currently not highly contested by risk averse
discourse
 BARRIERS AND FACILITATORS TO MATERNAL MOVEMENT IN
LABOUR

Environment Women were more likely to

: (a) lack of space, (b) inadequate support, (c) use of unwarranted debilitating assume upright birth
technology, and (d) movement restricting pain relief[1] positions in the birth center
Cultural influences and provider influences also effect choice of maternal setting (81.84%) than in the
position. [2, 3] delivery ward setting
Use of a pool in labour has been suggested to increase maternal ability to (24.47%). They also
change position instinctively wanted to lean
The advice given by midwives was the most important forward during labor and
factor birth [4]

1.Hollins Martin CJ, Martin CR. A narrative review of maternal physical activity during labour and its effects upon length of first stage. Complementary therapies in clinical practice 2013;19(1):44-49
2.Martin CJH, Kenney L, Pratt T, et al. The Development and Validation of An Activity Monitoring System for Use in Measurement of Posture of Childbearing Women During First Stage of Labor. Journal of
Midwifery & Women’s Health 2015;60(2):182-86
3.Nieuwenhuijze MJ, Low LK, Korstjens I, et al. The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labor. Journal of Midwifery &
Women’s Health 2014;59(3):277-85
4. Juggling Instinct and Fear: An Ethnographic Study of Facilitators and Inhibitors of Physiological Birth Positioning in Two Different Birth Settings
WHAT EFFECTS MIDWIVES FACILITATION OF
PHYSICAL ACTIVITY IN PREGNANCY?
Midwives’ (Community midwives (N = 10) from ten randomly selected antenatal clinics in
England) perceived barriers in providing effective physical activity advice and guidance:
Theme 1: lack of training, knowledge, and confidence
Theme 2: time constraints and ensuing compromises
Theme 3: unawareness of suitable resources and opportunities
Theme 4: reliance on common sense and own experience as opposed to evidence-based
practice
Theme 5: perceptions of vulnerability relating to inherent fears and exposure to risk
 ARE YOU A MOVER AND SHAKER?
WHAT STOPS/STARTS PEOPLE MOVING?

Stops Starts
ADVERSE CHILDHOOD EXPERIENCES EFFECT
LIFETIME PHYSICAL ACTIVITY LEVELS & MH
• ACEs are associated with childhood obesity
• the odds of engaging in a healthy weight behaviour decreased as the number of ACEs increased
• The severity of perinatal-PTSD symptoms for those with perinatal trauma in pregnancy was
significantly higher in those women exposed to at least one ACE related to abuse.
• Associations between ACEs and poor physical health outcomes (poor self-reported physical health,
inflammation, high resting heart rate, and obesity) were consistently weaker or attenuated among
those who were physically active. Physical activity may also moderate the associations between
ACEs and depressive symptoms, psychological functioning, and health-related quality of life.
 WHAT ABOUT MALPOSITION?
PASSENGER THROUGH THE PASSAGE…
•Prolonged How do we know?
pregnancy
•PROM
•Latent labour
OP= •Pain Palpation and
>2,000g •>Vaginal Exams
vaginal
•Dystocia
*Simpson et al 2015
•Augmentation examination
•Monitoring have 50%
•Fetal distress
•Forceps error rates
•EMCS
•3rd/4th degree tears
•PPH
•Infection

Simpson, C. N., Chambers, C. N., Sharshiner, R., & Caughey, A. B. (2015). Effects of Persistent Occiput Posterior
Position on Mode of Delivery [256]. Obstetrics & Gynecology, 125, 82S-83S.
 WHICH BABIES GET STUCK?

Unstuck Stuck Whether a malposition is a

problem will depend on many
80% of factors-
malposition's •Pelvis shape/size
resolve in Android or smaller •Uterine ligaments
labour pelvis •Baby size
Gynecoid pelvis •Baby position (this can also
Larger baby encompass flexion (chin tucking)
and compound limbs
Smaller baby
Malposition •Mothers health in pregnancy (diet
and exercise)
Mobile •Mothers mobility in labour
Immobile •Mothers pain relief in labour
 DYNAMIC MOVEMENT

• A computational simulation of squatting while pregnant on

pelvic dimensions found that maternal joint loading in an
upright birthing position, such as squatting, could open the
outlet of the birth canal and dynamic (moving) activities
may generate greater pelvic mobility than the
comparable static posture.[1]
• Spending more than 50% of labor time upright was
significantly associated with a lower chance of having a
cesarean birth, less pain and more vaginal births when
babies were OP in labour. [2] 1. Hemmerich, A., Bandrowska, T., & Dumas, G. A. (2019). The effects of squatting while pregnant on pelvic dimensions: A computational
simulation to understand childbirth. Journal of biomechanics, 87, 64-74.
2. Gizzo, S., Di Gangi, S., Noventa, M., Bacile, V., Zambon, A., & Nardelli, G. B. (2014). Women’s choice of positions during labour: return to the
past or a modern way to give birth? A cohort study in Italy. BioMed research international, 2014.
 MAKING SPACE WITH MOVEMENT

• This simple change to the position of legs will make a huge difference
to the outcomes for mothers and babies. (sit on hands and try it!)
• Kneeling squat position significantly increases the bony transverse and
anteroposterior dimension in the mid pelvic plane and the pelvic
outlet[1]
• In a study using MR obstetric pelvimetry an upright birthing position
significantly expands female pelvic bony dimensions, suggesting
facilitation of labor and delivery[2]

1.Reitter A, Daviss B-A, Bisits A, et al. Does pregnancy and/or shifting positions create more room in a woman’s pelvis?
American journal of obstetrics and gynecology 2014;211(6):662. e1-62. e9

2.Michel SC, Rake A, Treiber K, et al. MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions.
American Journal of Roentgenology 2002;179(4):1063-67
TOOLS
 REBOZO

• The use of a cloth (Rebozo/Manta/Chalina) is a technique

used both historically and in the present day by traditional
midwives in Mexico, central and south America and
increasingly being used globally to prevent and resolve
malposition
• The rebozo is also used in labour as a comfort measure and
as a birth aid (e.g. to pull on during second stage)
• The use of the rebozo to help correct fetal malposition has
been described in a large academic medical center
 WHY USE A REBOZO?

• Relaxing: Rebozo sifting produces deep relaxation which

encourages rotation
• If you cant move the baby-move the mother!
• If mothers can’t move themselves rebozo helps you help them
move
• Helps support midwives/doulas/partners to provide care if
labour is long and woman needs intensive support
• Extension of the arms
MANTEADA

Relaxes the uterine

round and broad
ligaments
2 mins daily from 30
weeks- up to 3x3 a
day if needed
 Posterior, ROA or asynclitic

Can be used in pregnancy to rotate baby (esp useful in prolonged

pregnancy)
Also useful when a woman is immobile

https://www.facebook.com/selina.wallis1/videos/10156451033199120/
EARLY LABOUR

• Birth ball
• Abdominal lift
• Belly dancing
• Inversion
ABDOMINAL LIFT

Hold through 10 contractions in a row

Helps occiput posterior babies rotate.
It can be used when the baby is high in
the pelvis, at the brim down to the
midpelvis
Can also be done lying down if
mother is exhausted
MID LABOUR

• Shaking the apples

• Hip and buttock rebozo
• Knee Chest
• Cooks counter pressure
• Pelvic floor release
• Lunge
• Elephant walk
• Charley Chaplin walk
• Walchers- high head
• Bellydancing
SHAKING THE APPLES, COOKS COUNTER
PRESSURE, KETCHUP BOTTLE
BIRTH BALL

• Birth ball use in pregnancy and labour has

been found to lead to shorter first-stage
labour duration, less epidural analgesia,
and fewer caesarean deliveries, a review
concluded that clinical implementation of
the birth ball exercise programme could be
an effective adjunctive tool to improve
childbirth self-efficacy and reduce pain
among women in labour[3-7]
PEANUT BALL

Growing evidence for efficacy

LUNGE

The Lunge opens the

midpelvis.for:
• Helping an occiput
posterior baby rotate or
descend
• Helping an asynclitic
baby descend
• Overcome a stall
in active labor
DANCE

Figure 8 and circle

hips
Camel walk
Hip drops
Shimmy

• Movement as a Tool for Labor with with Stephanie

Larson, Founder, Dancing For Birth
• 10 mins
 SECOND STAGE

• Lunge (on both sides)

Women feel
• Walk to toilet more control
over their
pushing in the
• Walk up stairs (if at home) second stage
when they are
• Try Dangle or pulling down on in an upright
position
cloth
• Try pelvic release
• Try double hip squeeze sitting to push was
assoc
with >pain,
• Pancake flip prolonged second
stage, and increased
feelings of
• Belly dancing vulnerability
HIP PRESS

• Transition and pelvic pain in second stage

HIGH RISK BIRTH ON CLU

• Women labouring on CLU often have limited mobility due to EFM and/or drip placement
• Analgesic use can also limit mobility
• Many techniques can still be used in these situations, with modifications, for example
when an epidural is in place a peanut ball has been found to improve outcomes (Tussey
and Botsois 2011)
• A rebozo can be placed underneath a woman pelvis prior to epidural placement
 WHEN LABOUR NEEDS TO START

• Overdue? PROM?
• #Look at: baby position
Dates?
• 1 Massage- psoas release Breast
massage?
• 2 Rebozo (manteada) followed by inversion for 30 secs (x3) Birth ball
• 3 Rebozo lying down (plus hips/buttocks)
• 4 Bellydancing (use gravity, jiggling and rotation)
• 5 Massage and acupressure
 SUMMARY

• If it looks like Malposition it probably is!

• Whether babies get stuck is probably a mixture of pelvis shape, relaxation, baby size, baby position and mobility
• Movement in pregnancy improves outcomes
• Movement in labour improves outcomes- needs to be dynamic- changing
• Movement is facilitated by comfort, music and modelling
• There are a range of tools and strategies that can be used to encourage maternal movement -Rebozo is a tool which can be
used to facilitate movement even when women are relatively immobile-
• Midwives and health professionals are key players to facilitate movement but Culture, education environment and partners
are imp too- so are we!!!
• What will you do differently after todays workshop?
OVER TO YOU…

• What can you change today to support mothers mobility in pregnancy and labour?
• Share with the people sitting next to you what you will take away from todays workshop
and what you will do differently
 CONTACT

E mail selinawallis@hotmail.com

Mob: 07821147990

Facebook page: Unlocking birth

Website: Magical Birth blog

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