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Teach the Concept of Available Space
Passage and passenger remain the same size, but by manoeuviring and changing their inter-relationship, one may pass through the other.
Below a floating ball in a bottle of liquid represents the baby and the pelvis. Notice how the available space (seen by the horizontal line) can be altered to give the baby more room to manoeuvre.
How Tilting the Pelvis Changes the Available Space
(i) Lean left – raise right leg – for baby R.O.L -P not engaged by 38 weeks. Also for failure to descend in 2nd stage ( right shoulder on brim)
(ii) Upright – Minimal moving room
(iii) Lean right – raise left leg – for L.O.A trying to rotate at the brim. Also if shoulders are not transverse at 2nd stage.
Effects of a Change of Posture on the Available Space
(i) (ii) (iii)
Bad Okay Good
(i) Back rounded, weight behind tuberosities – result – Flat brim and closed outlet.
(ii) Back straight, well balanced – result – Inlet open
(iii) Back arched – result – Inlet and outlet wide open. Plenty of space.
If midwives believe in normal birth and women’s ability to achieve it, they will see that becoming seriously involved in antenatal education is a priority. It provides access to pregnant women and equally as important their support people. The times optimal foetal positioning fails are almost always where the partner laughs at the idea. Pregnant women are very sensitive to words and attitudes. Small classes mean that we have to keep on repeating ourselves, but much of what is in current classes could be left out, or reduced to a minimum. If most mothers are going to achieve the normal O A, there is no need for in-depth talk of epidurals and interventions. Once they are relegated to their proper place as emergency procedures, we will be able to practise as midwives, rather than obstetric nurses.