Side-lying Release

This is not just lying on one's side and leaning your leg over! Do weekly in pregnancy and once in early labor to potentially reduce labor length. Add to the activities to help a breech flip in pregnancy. Stall in labor? Annoying hip pain? Contractions with no progress?  Asynclitic or posterior baby? This technique is a star in the universe of maternal positioning for labor comfort and progress.

I could call this the side-lying Leg-hanging release to remind you that I don't mean just laying on the one's side with the top leg forward. There is more to it, so read the instructions below C. A. R. E. F. U. L. L. Y. to get the benefit. 

I could call this the pelvic floor release, and often I do. There are more muscles releasing and so, relaxing, than the pelvic floor group, though.

What is the Pelvic Floor?

Within the bony pelvis is a supportive "floor" of muscles, much like the respiratory diaphragm, that lifts the womb and other abdominal organs . There are two openings (holes) in the pelvic floor, one for the anus and one for the urethra and vagina. The baby comes through this opening during childbirth.

The pelvic floor opening is a front-to-back opening through which the baby turns like a button going through a button hole. The sides of the opening are strong and springy and direct the head to turn. 

What's the problem?

If one side of the opening is tighter than the other, or higher than the other, the baby can be tipped and/or rotated into an unfavorable position. The asymetrical tension can pull the pelvis out of balance.

Even if the pelvic floor is evenly tight fetal rotation or descent (coming down) can take a lot longer than usual.

Common habits of modern life can make the pelvic floor tight or twisted, simple things like driving a car or crossing our legs. Sports accidents or falls on either the head or the bum are suspect, too. 

Tension or torsion in the pelvic floor lengthens labor. Uneven tightness in the pelvic floor may make the baby's head tip causing an asynclitism (tipped head) that makes labor longer and increases the chance of cesarean or vacuum (ventouse). The strong pelvic floor of a dancer or horseback rider may lengthen labor considerably; this technique may help.

What's the solution?

Tania and Alice's story, told through the emails of doula, Amy Peterson, shows how Side-lying prevents 3rd Cesarean.
 

Photo: Gail Tully presenting The SIdelying Release at the Midwifery Today Conference in Harrisburg, PA, April 2012 with Jan Tritten (right) and Carol Gautschi (left). Gail learned The Sidelying Release from Dr. Carol Phillips, DC.

Many more babies and mothers can enjoy immediate skin-to-skin contact when cesareans are avoided with this technique!

Who benefits from a side-lying release?

• First time mothers benefit from releasing spasm in the pelvic floor once or twice in late pregnancy.
• Ballet dancing, horse back riding and daily running strengthen the pelvic floor so much that fetal descent can be slow and birth can be much longer. This technique may shorten labor for these women.
• Women who have had previous cesarean(s) for "failure to progress" or transverse arrest may benefit from a pelvic floor release in late pregnancy.
• Women who have had posterior, breech or other less than favorable fetal positions in previous births or has a baby in an unfavorable position in their current pregnancy.
• Women with a head down baby who kicks in her right side may benefit from the Pelvic Floor Release once a week, but there isn't harm from doing a pelvic floor more often, even daily. Women with breech, transverse, or posterior babies could do the pelvic floor release once a day.
• Women whose joints are very loose may not need it daily and shouldn't do this activity daily. Since very few women are hypermobile, this would be a rare restriction. 
• Women on bedrest may do this technique as part of a gentle stretching routine.

Anyone can do this technique, its not just for pregnant or birthing women. If intercourse or elimination is painful due to a tight or twisted pelvic floor give this technique a try.

When to do a sidelying release in labor?

What signs show that a side-lying release could be useful?

Discomfort in pregnancy from tight, tender areas (front or back), achy hips, or achy lower back may be symptoms that a pelvic floor release could offer comfort.
If the baby hasn’t engaged by 38 weeks gestation, a pelvic floor release may be helpful.

Left: Pelvic floor muscles (pink) have an opening for the baby to pass through. The tone of the pelvic floor (as baby comes down on the opening) is significant in fetal rotation.

In labor,

The benefits of a side-lying release help to over come a stall or plateau of dilation in the presence of strong contractions. In other words, the uterus is trying, its contracting. But the labor can't bring the baby down through the pelvic floor or can't bring baby down evenly.

• Labor just can't seem to get started. Contractions start and stop.
• Labor stalls at 5, 6, 7 cm or later. 
• Baby's head is tipped or asynclitic.
• Baby's head is stuck sideways, halfway down the pelvis at 0 station (Transverse Arrest) In this case, follow up with the lunge or the Open Knee-Chest position through several contractions.

A nurse-midwife tried the sidelying release during a stall in a long hospital labor she was at and later said, "Now I KNOW we have too many cesareans!" (Meaning the USA)

 Why are we doing a pelvic floor release?

The sidelying, pelvic floor release helps balance the pelvic floor muscles.

An imbalance in the pelvic floor like this can make the baby rotate to posterior, or make a posterior baby become a brow presentation. If one side of the pelvic floor is higher or tighter the baby’s head can tip into an asynclitic presentation (tipped). This makes the baby’s head seem much bigger and molding takes longer. The baby can’t help with the birth process very easily. The mom has much more work to do. 

I’ve been at births of asynclitic babies where pushing lasted a minimum of 3 hours, with 5 being common, all the way up to one birth in which infrequent contractions that were not strong made the 2nd stage take 18 hours.

How to do a side-lying release

You need a surface that is as long as the mother. Though yesterday, we did this with a couch that was not quite as long as the mother was tall and it worked anyway. The surface is usually a firm couch or bed, but can be a heavy, strong table or counter. A hospital bed works wonderfully when raised a bit, during labor in the hospital. Some doulas and childbirth educators are experimenting with doing the sidelying release while the mother lays on the floor.

A woman can do this alone, but a helper is very useful. If done alone, she braces herself with her arm, holding a heavy table, for instance. She has to consciously keep her hips stacked one above the other.

The mother lays on her side. She can choose which ever side she feels more comfortable or natural in first. She MUST do this on BOTH sides no matter which side she starts with, however, or she may make her pelvic floor more uneven.

How to do the Sidelying Release

1.)  The woman lies on her side on a firm surface. Her hip is close to the edge of a couch. She lays her head on her lower arm or a pillow.

2.)  Her helper stands in front of her. The helpers forward hip is against the surface. This prevents the mother from falling forward!

3.)  The mother scoots her hip right up to the very edge of the couch. The pregnant woman’s pregnant belly is either between the helper’s thighs or they are belly to belly, depending on the height of the surface.

4.)  The helper curves both her palms around the edge of the mother’s anterior hip (front and top; ASIS).  The helper must prevent the mother’s hip from leaning forward when the mother does the next step. So she gets ready to hold it back. Meanwhile, the helper presses down firmly (but not as strongly as for counter pressure or the hip press, rather about 2-3 pounds of pressure or push down to create the weight of a 2-3 pound bag of beans or sugar).

5.)  The mother straightens her lower leg. Her lower foot is flexed up. She doesn't "point" her toes forward, but brings them up (flexed).

6.)  Keep her top shoulder over her lower shoulder. (A second helper is useful to hold her top shoulder and give comforting words and eye contact, but isn't necessary if one isn't available.) The top hip stays over the lower hip, this is important.

Photo: Nickie Kerrigan, CPM, supports the woman's upper shoulder, but just because we have the extra hands at a workshop. Shoulder stabilzing is nice but not necessary. It is necessary, however, to keep the hip and shoulders one above the other so the torso doesn't twist.

7.)  When the helper is ready, but not before!, the mother slightly lifts her leg up and forward and then lets it slowly hang down in front of her. Helper: Don’t let her hip tip forward! Here’s the point of the Side-lying Release:  Her top leg hangs forward and into the air. Let the full weight of the top leg hang. Keep the lower leg straight. The helper has to avoid the mother’s thigh so the thigh can hang freely.

She breathes deeply and slowly. Her belly is relaxed. Her leg relaxes more.

Photos: Penny Simkin experiences The Pelvic Floor Release / Sidelying Release on a massage table at the ICEA-Lamaze Mega Conference in 2010. She relaxes her upper leg completely (the lower leg is straight with toes up). Photo by Nickie Kerrigan, CPM.

8. )  How long? In pregnancy:  Her leg hangs like this for 1-2 minutes. It’s ok to try it longer, but its vital that its done on both sides. A few people have reported holding each side for up to 20 minutes to flip a breech! In labor: Let the leg hang like this through 3 contractions and switch sides for another 3 contractions. Stay like this between contractions, too!

9.)  Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.  It’s vitally important to do both sides so that you don't create more of an imbalance!

 "After we finished the left side, she got up to use the restroom. Contractions were more regular, not so close together and VERY productive. Suddenly she had to poop! Her water broke, she began to push and we scrambled to get things together for the hospital....I learned that I will reserve these spectacular techniques from Spinning Babies for when we're close to the delivery locale!" - doula, who'll remain anonymous for now.

What should one be feeling when doing the sidelying (or pelvic floor) release?

A subtle stretch of some muscles. This technique stretches any of three muscle or muscle groups.

1. The pelvic floor
2. The piriformis 
3. The rotators

This woman points out where she feels a slight stretch from letting her leg hang freely while her hip is held back. 

Doing the side-lying release by yourself without a helper

1. Lay on your side close to the edge of the couch. Have a coffee table in front of you.
2. Lay your head on your lower arm. Hold the table with your other hand.
3. Make sure your hip is right on the edge of the couch! Right on the edge so that you feel that tipping forward would make you fall off. Don’t tip forward!
4. Straighten your lower leg. Keep your top shoulder over your lower shoulder as best you can while you hold the table (move the table first to make this easier). Keep your top hip over your other hip, this is important.
5. Let your top leg hang forward into the air. Let the full weight of your top leg hang. Keep your lower leg straight. Breath deeply and slowly. Let your belly relax.
6. Let your leg hang like this for 1-2 minutes in late pregnancy. Let your leg hang like this through 3 contractions if you are doing this in labor.
7. Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.

How to do a diaphragmatic release from an article in Midwifery Today.

Gail's first experience with the Pelvic Floor/ Sidelying Release

I was taught the Side-lying Release by Carol Phillips, DC at a long birth. This first-time mother got to 4-5 cm on her 3rd day of on and off again labor. Carol arrived and showed me how to do this release. The mom went right into transition and her second stage was so smooth that the baby was crowning before anyone in the room realized she was even in the pushing stage! Her baby was in an anterior position and was not asynclitic. She simply had a really tight pelvic floor. Not everyone gets that great of pain relief from this technique, but it almost always enhances labor progress in a happy and noticeable way when done to help a stall (contractions without progress). 

Dr. Carol Phillips has a video of her class learning to do the side-lying release on her youtube channel. Be sure to watch the entire thing as Dr. Carol corrects mistakes of the students who are doing it. Here is the link: http://www.youtube.com/watch?v=y-07DqjNrS0&feature=plcp