Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push.

Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities. There is discussion about current research and suggestions on how to improve the quality of the birth experience. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions," published in The Journal of Perinatal Education, 16(3), 2007.

Care practice #2: freedom of movement throughout labor.

This updated edition of Care Practice Paper #2 presents the evidence for the benefits of allowing freedom of movement in labor. Physiologic and anatomical principles that support the benefits of movement are explained. The authors review common obstacles to movement in labor, including the routine use of interventions that inhibit women's ability to walk or change position. Women are encouraged to plan to be active in labor and to select care providers and birth settings that provide the full range of options for using movement in labor.

Care practice #5: spontaneous pushing in upright or gravity-neutral positions.

This updated edition of Care Practice Paper #5 presents the evidence for the benefits of spontaneous pushing in upright or gravity-neutral positions during labor. Various pushing positions and techniques are described, and the advantages and disadvantages are reviewed. Women are encouraged to push when and how their bodies tell them to and to choose the positions for birth that are the most comfortable.

#2: Freedom of Movement throughout Labor.

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of allowing freedom of movement throughout labor is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. The accompanying commentary-written by a well-known author of numerous articles and books on childbirth-compares the activities of women in two birthing environments: the conventional medicalized setting and the unconventional naturalistic setting. Reasons why women may not move in labor are presented. Lamaze International encourages women to use movement in labor in order to make labor more comfortable and more efficient.

#5: Non-Supine (e.g., Upright or Side-Lying) Positions for Birth.

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of non-supine positions for birth is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. Upright and gravity-neutral positions facilitate rotation and descent of the baby and result in reduced duration of second stage, a reduction in episiotomies, and fewer abnormal fetal heart rate patterns. The accompanying commentary-written by a leading proponent of maternity care-supports these benefits. Lamaze International recommends that laboring women not push until they feel an urge to do so, and that they choose positions for birth that are most comfortable for them.