Jude Polack, the original founder of Genesis Maternity Clinic, seen here with her third baby, born at Genesis Maternity Clinic.
“Keeping active during labour and adopting natural, upright or crouching birth positions is the safest, most enjoyable, most economical and sensible way for the majority of women to give birth.” ~ Janet Balaskas
What is an Active Birth?
During an active birth, women are encouraged to move around freely and choose positions that feel comfortable to them. Mothers who choose an active birth are unlikely to lie on their backs to birth their babies which are the standard approach in traditional hospital birth wards.
Historically, women have given birth in an upright position where they are free to move around. The traditional supine (on your back) position is a relatively recent development which is falling out of favour because this painful, physiologically dysfunctional way of giving birth, can result in the pelvis losing up to 30% of its capacity to be utilised for birth. This discovery has led to the active birth movement.
In a world where labour was controlled by medical professionals, the active birth movement encourages women to take back control of giving birth. Instead of being told what position to adopt during labour, women are encouraged to do whatever feels the most comfortable for them.
The term active birth was created by antenatal teacher and author, Janet Balaskas in the 1980’s. World-renowned and respected, Janet was born in South Africa is currently is the Director of the Active Birth Centre in London, UK.
Through intensive research, Janet discovered that women in other cultures didn’t lie on their backs to give birth. In fact they squatted, knelt or stood, surrounded by supportive women. The active birth movement is now gaining in popularity, and many healthcare professionals are now aware of the benefits of giving birth in upright positions.
Genesis Maternity Clinic advocates active birth and women can use birthing stools, balls and cushions to allow comfortable sitting, kneeling and squatting positions during the birth, We also provide birth tubs which allow women to go through labour and give birth in water. The water provides support and buoyancy which allows the mother to change position easily in the pool.
How can you benefit from an active birth?
- A shorter, more efficient labour: During labour your baby’s head moves slowly into the pelvic canal as it emerges from the dilating cervix. By adopting an active birth position your pelvis is at the best possible angle for gravity to help the birthing process. Numerous studies have shown that this is likely to make labour shorter and more efficient.
- Less pain: Being free to move and choose your own position has other advantages as well. It’s easier for your uterus to do its work naturally and the contractions tend to be less painful than if you were lying on your back. Freedom of movement, free expression of sound and the natural forward tilting of the uterus helps modify the pain and this is likely to reduce the need for medical pain relief.
- Less risk of foetal distress: Active birth also allows a better blood flow to the placenta since the mother is upright and breathing deeply. The baby receives plenty of oxygen and there is less risk of ‘foetal distress’ developing. Foetal distress is a common cause for a caesarean section or the use of forceps or vantoux to deliver the baby quickly. Another benefit is that there is no compression of the internal blood vessels which is not the case if the mother lies on her back for an extended period or in the semi-reclining position.
- A more powerful, easier way to push: During the second stage, when you are ready to give birth, choosing a kneeling, supported squatting or standing position will help you use your energy in the best way while you are pushing. It is much more effective and powerful to push with the help of gravity and the rotation and descent of the baby’s head is easier. There is no ideal position for giving birth and this varies from woman to woman. You may use several upright positions during this phase of the birth and can give birth in any one of them. The supine or reclining position is by far the least advantageous – working against gravity and reducing the space within the pelvis. When you are upright the pelvic joints are not constricted and this allows a greater degree of movement and expansion of the pelvic diameters so that the internal shape of your pelvis has more space to accommodate the baby’s head as it descends. During the final stages of the birthing process, the back wall of the pelvis (sacrum and coccyx) are free to move back to increase the diameters of the pelvic outlet to make plenty of space for your baby to be born.
- Skin to skin and breast contact: After your baby is born and you are enjoying the pleasure of holding him or her in your arms for the first time, it’s a good idea to sit upright so that you can hold your baby ‘skin-to-skin’ and position your baby well for the first contact with the breast. Then, while you are welcoming your baby and the first breastfeed begins, gravity will be helping your placenta to separate and your uterus to contract efficiently to prevent excessive blood loss.
- Partners can get more involved: In an active birth partners are often actively involved in giving both emotional and physical support. This active sharing of the birth experience can be very fulfilling and memorable, providing a good start to a new relationship as parents.
- Less trauma: An active birth usually results in minimal trauma for the baby during the birth process. Generally the baby is likely to be born in optimal condition, bonding after birth and the first breast feeding are facilitated and the mother generally feels good and recovers well from the birth. This makes caring for the new born baby easier.
- Birth hormones: From beginning to end, the entire birth process is stimulated by hormones that are produced by the hypothalamus. We share this trait with all other mammals, and like them, we need to feel safe and protected to release birth hormones effectively. Two important elements in an active birth are the quiet, reassuring presence of a supportive midwife and the right ambience in the labour room. The labour room should be comfortable, warm, calm and peaceful so that you have enough privacy and security to let yourself go, to be noisy if you need to be and to relax and rest in between the contractions without distractions. When the lights are turned down, the curtains are drawn and it is quiet, your body produces high levels of a hormone called oxytocin which stimulates good strong contractions. Your body also produces hormones called endorphins which are natural painkillers and relaxants. Combined with the benefits of being upright, these hormones help you shut out everything else, to immerse yourself in your labour and concentrate on the contractions. Once you relax, labour usually progresses well leading to an efficient second stage and a successful birth. It’s important to understand that labour and birth are involuntary. The uterus contracts spontaneously, firstly to open the womb and then to give birth to the baby. All of this happens without your conscious control. You do not need to do anything other than relax and let it all happen naturally.
- With the help of water: An important innovation in creating the ideal birthing environment for an active birth is the introduction of water birth pools. In addition to gravity, water is another natural element which has enormous power to support your instinctive resources during labour.
- After the birth: There is no denying that going through an active birth and experiencing labour is a challenge that may stretch you to your limits. The moment you are holding your baby in your arms for the first time you are likely to forget what you have been through almost instantly. Instead it is likely to be replaced by a feeling of enormous exhilaration. Giving birth is an achievement you can be very proud of. Having an Active Birth is an empowering and life transforming experience for many women. Starting from the basic wisdom that it’s best to keep upright and with a few simple modifications to the environment, I have seen over the years that most women can have a much better experience of birth than they might otherwise have done.
Content adapted from an article by Janet Balaskas, founder of the Active Birth Movement ~ “Active Birth and Why It Can Make a Difference for Your Birth.” 
Research Based Evidence for Active Birth
- US National Library of Medicine National Institutes of Health, May, 2012.
- US National Library of Medicine National Institutes of Health, Maternal positions and mobility during first stage labour. [Cochrane Database Syst Rev. 2013].
- American College of Midwives and Nurses, ACNM Releases Research Showing Significant Midwifery Care Benefits, Press Release, May 15, 2012.
- Sci Flo, Brazil, The vertical position during labour, December, 2009.
- Active Birth Manifesto Janet Balaskas, 1982. Revised, 2001.