DrPH Dissertation and Experiential Project
Movement Restrictions, Pushing Position
and Adverse Birth Outcomes
JILL D. CHASSE, PHD, MS, MPA
Hypothesis:
utilizing movement during labor and allowing a mother to choose her birthing position will reduce length of labor and decrease adverse birth outcomes.
Moving During Labor and Actively choosing an upright birthing position:
Reduces physical pain
Reduces psychological stress/anxiety
Increase emotional veracity of control
Decreases subservient, submissive ideations
Allows gravity to help baby descend and cervix open
Moves uterus forward and increases size of pelvic outlet
MEASURE
length of labor
and
adverse outcomes ( PSI 17 – neonatal trauma, and ICD-9 complications occurring mainly in the course of labor and delivery (660–669)
in relation to
movement restriction and required lithotomy position
vs
no restriction of movement and elective pushing position
(x) Restricted movement (x) Unrestricted movement (x) Lithotomy position (no choice) (x) elective birthing position
Length of labor
A) Restricted movement and required lithotomy
Restricted movement and elective birthing position
C) Unrestricted movement and elective birthing position
D) Unrestricted movement and required lithotomy
Maternal Trauma
Complications Occurring Mainly In The Course Of Labor And Delivery
ICD -9 Code Description A B C D
660
Obstructed labor
(660.01) Obstruction, malposition, delivered
(660.11) Obstruction, bony pelvis, delivered
(660.41) Shoulder dystocia, delivered
(660.61) Trial of labor, failed, delivered
661
Abnormality of forces of labor
(661.0) Uterine inertia, primary, unspec.
(661.1) Uterine inertia, secondary, unspec.
(661.3) Labor, precipitate, unspec.
662
Long labor
(662.1) Labor, prolonged, unspec.
663
Umbilical cord complications during labor and delivery
663.1) Cord around neck, unspec.
(663.3) Cord entanglement, other and unspec.
664
Trauma to perineum and vulva during delivery
664.04) Laceration, perineal, 1st deg., postpartum
(664.14) Laceration, perineal, 2nd deg., postpartum
(664.24) Laceration, perineal, 3rd deg., postpartum
(664.34) Laceration, perineal, 4th deg., postpartum
665
Other obstetrical trauma
(665.3) Laceration of cervix, unspec.
666
Postpartum hemorrhage
(666.04) Hemorrhage, 3rd stage, postpartum
(666.14) Hemorrhage, other immediate postpartum
667
Retained placenta or membranes without hemorrhage
(667) Retained placenta or membranes, without hemorrhage
668
Complications of the administration of anesthetic or other sedation in labor and delivery
669
Other complications of labor and delivery not elsewhere classified
(669.51) Forceps/vacuum extractor delivery, delivered
(669.70) Cesarean delivery without indication unspecified as to episode of care
(669.70) Cesarean delivery without indication delivered with or without antepartum condition
(669.9) Complicated delivery/labor, unspec.
Neonatal Trauma PSI-17
ICD -9 Code
7670
SUBDURAL AND CEREBRAL
HEMORRHAGE (DUE TO TRAUMA OR TO
INTRAPARTUM ANOXIA OR HYPOXIA)
7674 INJURY TO SPINE AND SPINAL CORD
76711
EPICRANIAL SUBAPONEUROTIC
HEMORRHAGE (MASSIVE)
7673
INJURIES TO SKELETON (EXCLUDES
CLAVICLE)
7675
FACIAL NERVE INJ-BIRTH
7677
OTHER CRANIAL AND PERIPHERAL
NERVE INJURIES
7678
OTHER SPECIFIED BIRTH TRAUMA
Elective birthing position is defined as a non obligatory, personal decision made by the mother regarding which childbirth position she decides. Typically these include squatting, standing kneeling, all-fours, side lying, or sitting, which could be on a birth stool, in a tub, or elsewhere. Position may change throughout the delivery process and recommendations or suggestions may be given, but the ultimate position is elected by the mother.
The lithotomy position when no choice is given is defined as a required procedure where the mother is lying on her back with her legs in stirrups and buttocks close to the edge of the birthing table or bed. A mother in this situation is not permitted to choose another position. If a woman chooses to birth lying on her back it will be considered elective birthing position, as long as it was her decision.
Most hospitals now allow walking during labor, but there are very few that allow and support a mother’s choice
Why- movement makes a mother more comfortable physically feeling less pain and restriction and less stressed emotionally and psychologically, allowing for a shorter labor, reducing failure to progress and encouraging cervical dilation, effacement, and baby’s positioning into the correct station for birth.
Freedom of Movement Initiative 