As many women have learned to their advantage, labor is not something to take lying down. Jenn Riedy of Allentown, Pennsylvania, would agree. After many hours of slowly progressing labor, Jenn's doula (a woman trained and experienced in labor-support techniques) persuaded her to get on her hands and knees. Soon Jenn's cervix was fully dilated, and she was feeling the urge to push.

Jenn eventually became a doula herself and returned the favor to her very first client. The woman had been laboring for many hours. Pitocin, a medication used to stimulate stronger contractions, hadn't helped much. But once Jenn talked her into trying hands-and-knees, her client rapidly completed dilation.

Speeding up labor. A variety of positions and related activities promote labor progress. According to The Labor Progress Handbook by Penny Simkin and Ruth Ancheta, positions and activities can correct a poorly positioned baby--almost certainly Jenn's and her client's problem--as well as line up the baby, the cervix, and the pelvic outlet so that the forces of labor work more effectively, make more room in the pelvis, and improve contraction quality. In most cases, they also ease pain. What's more, adds Saraswathi Vedam, CNM, an assistant professor of nurse-midwifery at Yale's School of Nursing, free mobility helps women feel in control and increases confidence. Finally, positioning and activity can avert the need for riskier interventions such as Pitocin, vaginal instrument delivery, or cesarean section.

So, if you're not going to lie down on the job, what should you do? Here are some guidelines:

Take advantage of gravity. Forward-leaning positions or positions like hands-and-knees that put your back parallel to the floor can swing a posterior baby (the back of the baby's head lies toward the back of the mother's pelvis) into the more favorable anterior position (the baby's face lies toward the back of the mother's pelvis). An upright torso can bring the baby's head down to help open the cervix during the dilation phase and help the baby move down and out during the pushing phase. (To see why you want gravity working for you, heft a gallon of milk or water--about the weight of the average newborn--to see how much force this exerts.) A vertical torso can be achieved standing, sitting, kneeling, or squatting. Sometimes you might need to get gravity out of the way as, for example, when pressure on the cervix causes a premature urge to push. Hands-and-knees, side-lying, and knee-chest (rump in the air) positions are all good for this.

Rock and roll. To get a cork out of a bottle, you wiggle it. The same principle applies to babies. On hands and knees, you can rock your pelvis by tucking your tail under like a bad dog or rock your body forward and back. Standing, you can slow-dance with your partner, sway from foot to foot, circle your hips, or climb stairs. Ancheta adds that repetitive movement also soothes pain.

Use your legs as leverage. Vedam notes that open-leg positions open the pelvic outlet by as much as an additional 30%. Vedam studied squatting to push and found that the combination of upright torso and wider pelvic outlet shortened the pushing phase by more than 20 minutes for first-time mothers compared with the conventional semisitting posture. Other open-leg options include lunging to one side, sitting with one leg over the arm of a chair, or kneeling with one leg up, one down.

Avoid lying flat or nearly flat on your back. In this position, the weight of your body and baby compresses the major blood vessels serving the baby, diminishing oxygen supply. On your back, gravity holds the baby in the unfavorable posterior position, and the weight of your body against the bed prevents your sacrum, the flat plate at the base of your spine, from flexing open. Pushing while on your back means you're pushing your baby uphill.

Use variety. Shifting from position to position might be the best method. What feels best almost always is best. Exception: if the labor isn't progressing, it might be necessary to stir things up--and occasionally, what is effective might be uncomfortable. If so, try it for a limited time-say, five contractions. If it hasn't helped by then, move to something else.

With long labors, alternate activity with rest. Vedam likens long labors to a marathon--pace yourself. Rest positions include lying on your left side in bed, sitting in a comfy chair, or reclining into your partner's arms. In a long labor, remember that most problems with progress will resolve. Time is your friend.

When factors limit mobility, be creative. The need for electronic fetal monitoring needn't keep you in bed. You can sit or stand. An IV can be hung on poles with wheels. If you must be in bed, you might be able to sit, kneel, get on hands and knees, or squat. At least lie on your left side, not on your back. With an epidural, sit up or lie on your side. Few women walk with the so-called walking epidural, but a light epidural can permit you to sit in a chair, get on hands and knees, or even squat with safeguards against falling.

Do what comes naturally. As Vedam observes: "The most important thing is to listen to your body. When you're uncomfortable or the labor is not progressing well, the first thing to try is a position change. The evidence is clear that activity and upright position promote both comfort and progress."

* taken from "Moving Through Labor," by Henci Goer, Every Baby magazine, Issue Four.

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