Sarah Lavonne: Hi, I'm Sarah Lavonne, and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life, both in and outside of work, but don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life, trying to add some happy to your hour as we all grow together. By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses.
If you listened to the season finale of Happy Hour with Bundle Birth Nurses, Season 6, I went out with a bang talking about the one where Sarah messes up. I got on one of my many rants about specifically positions and how frustrating it is that it's so much more than positions when we're talking about physiologic birth, and we're trying to change outcomes, and we're trying to promote vaginal birth. It is so much more than positions.
Here I am today to actually talk about positions and give you a little mini class on positions because while that is true, the truth also exists that positions are a very powerful nursing tool that we have at our fingertips, and we love them because they're within our control, and they're very tangible versus all the intangibles that we also teach of the psyche and all the other stuff. We love them. They work. They are recommended by all of our major organizations, and they are encouraged to do every 30 minutes based on CMQCC, but don't have a heart attack because I'm going to give you a little more on that. The recommendation is those regular position changes because we know that motion is lotion, hence why we created our Motion app, hence why we say that left and right. That's a part of our bundle birthisms, and the point being that turn your patience because it helps labor progress, it helps prevent a C-section, and it's beneficial to the patient experience.
When we're thinking about our positions, how do our positions actually help? What's going on in there? The first thing I want to say is that the environment of your positions matters more than the positions themselves because if you are strategically positioning your patient based on the anatomy, based on the baby rules, and you're doing everything right, if the environment is tense and restricted, those positions don't really do much. The baby cannot move, and the entire goal is that the baby is able to tuck and turn and go through their cardinal movements and rotate down through the pelvis and navigate all of those 43 angles to be able to come down and out vaginally.
If we are trying to prevent a C-section, the number one reason for our NTSV C-sections in the US, based on ACOG's safe prevention of the primary cesarean, is labor arrest. The antidote to labor arresting is our ability to help keep labor progressing. Now, what does this mean? This means we are activating the physiology of the body, meaning that environment. There are not things that we can control or there are things that we cannot control, and there are things that we can control, and we can set the body up to work well.
Now, when we look at CMQCCs, which is nationally recognized, it's from California, but it's nationally recognized, it's a resource in all of the decreasing your C-section rate resources, they give us five steps in order to decrease the C-section rate. I have to call this out. If you've been to our Physiologic Birth class, hello. Hopefully, this will be a review for you. If you have not been to our Physiologic Birth class, that is your foundational class, that if you have not taken it is time. In my opinion, we should be taking that every year. If you've taken it before and you want to take it again, email us and we'll give you a code to come for $99 and just keep coming and refreshing your knowledge. Every time I teach it live, it gets a little bit different. I update the research every single time.
When we look at those guidelines, number three, this is a proven, evidence-based thing that helps to decrease the C-section rate is to bridge the provider knowledge and skills gaps specific to techniques of physiology. That really is, again, what our Physiologic Birth class does. Throughout the course of my years of research and reading every resource that I can get my hands on, the reality is that there's always new research.
There's always random research I'm still finding specific to positions, but really specific to physiologic birth. As a lifelong learner, I'm going to recap some of that evidence for you here today because one of the biggest pushbacks that I hear specific to any of our resources, we have position guides, pocket position guides, our motion app, is like, well, what's the evidence?
If we really look at that, I have to read you this definition of evidence-based care before we go any further because I've started to integrate this definition into everything that we teach because I feel like this is potentially what is missing when we talk about the "evidence." Often, what do we hear? Well, what's the evidence? Is the way of saying, I'm skeptical, prove it to me.
Especially when we are talking about our positions or any low-risk intervention, keep this definition in mind as a back pocket tool for your toolbox because the definition of evidence-based care, "It uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and facilitate optimal outcomes in mothers and newborns." Here's the kicker. "Evidence-based maternity care gives priority to care paths and practices that are effective and least invasive with limited or no known harms whenever possible." This comes from Sakala and Corry.
When we think about it through that lens, think about all of the practices and the way that we approach medicine, the idea is that you start with the least invasive, least risky intervention first. That is the premise of our entire Physiologic Birth Now catalog, which is Physiologic Birth, then you take Pushing. I did just launch Speedy Inductions, which comes from an episode here that actually we had where I was using physiologic birth techniques to be like, how do you adapt for an induction? Which is, by the way, an entire class now. It is coming in November. Sign up for it. It's there. It's this catalog, including Physiologic Coping, which is on demand on the site, of starting with the least invasive possible.
What if we believed in the body? What if we were able to activate the body to do what it knows how to do? All of us love those births where we don't have to titrate pitocin. We don't have to go to the back. We don't have to induce. They're here. They're in. They're out. They push for 30 minutes, and they're done. That's what every patient wants too, right? That really is the premise of what we're trying to teach and learn through a physiologic birth perspective.
When we are bridging that knowledge and skills gap, that that actually holds evidence, thanks to this CMQCC toolkit, which I will also link down below for you to grab for yourself. It's a long document, but if you are not using it on your unit, please bring it to your unit because it is an enormous resource to us. What it's doing is we are starting with the physiology in following the premise of first, do no harm. That if something has known adverse effects, avoid it if possible. If you can't, then those medical interventions are there for you.
The other piece of this evidence-based care thing is that when we know that there is a practice that has possible adverse effects, that it has possible things that could go wrong, we are to avoid that when the best available research shows no clear anticipated benefit to justify its use. We're avoiding medical interventions until they're necessary. That's the premise of physiologic birth. We also need to ask the question of why are we doing these interventions? Are we just doing them because that's our routine or are we doing it because there's an actual expected benefit that is greater than the potential of the risk involved?
Now, we think about C-sections. I think that's a perfect example. There are C-sections that happen where you're like, mm, okay. Then there's other C-sections where you're like, clearly the scale tipped and there was no chance for a vaginal birth. Think of like a bleeding previa. We're not going to try a vaginal birth because the expected harm is so much greater. That is evidence-based practice.
When we're talking about our positions, I need you to remember that the risk of positions is little to nothing. Even if I'm thinking about all the like, well, but, well, but, even if there was a cord prolapse, that cord existed at the top of the vagina, at the bottom of the uterus. When the rupture happened, they could have been at home standing. Then is it the standing problem or is it the cord's problem, right? I think it's all about how you see it and how you approach it in that.
If we know that positions help, how do they help? I already talked about that, environment. That they help when the environment is soft, when we know that it's not just a knock-knock on wood pelvis in there. There's ligaments, there's fascia, there's the pelvic floor. All of those contribute to creating an environment where either the baby can go through the cardinal movements or it can't.
First and foremost, before you position them, do you know how to soften the tissues? Heat, movement, mobility, gravity we'll talk about in a second, but massage, vibration, all of those things, that's why we love our side-lying releases so much, creates an environment of soft and open so that when you position them strategically, the position works. By works I define that as like it actually allows the baby to come down, engage in the pelvis, go through the cardinal movements, rotate down and out.
That, I don't want us to forget, but when we're looking at the environment, what is that environment? It is softening all of those tissues, but what about the pelvis? In the pelvis, we know that the SI joints, which is backed by the sacrum, connecting the sacrum to the pelvis, and then the pubic symphysis, which is at the front of the pelvis, those both have cartilage. That cartilage is softened by a hormone called relaxin, which, especially towards the end of pregnancy, makes the pelvis a lot more mobile.
What do we know is that the baby starts from inside the uterus, and it needs to logically engage in the pelvis, come down, rotate down and out. That alignment of the baby to the pelvis matters. That pelvis is basically like a puzzle piece that the baby has to align to. The head is not perfectly round. The more tucked and flexed it is, the more perfectly rounded it is and the easier that it can rotate down and out. In general, we're talking about an oval.
In the pelvis there's these imaginary barriers on the pelvis at the top of the pelvis coming from the pubic symphysis all the way back to the sacrum where the sacral promontory is. At the rim of the top of the pelvis is called the inlet. It's important to know what's going on at the inlet. If the inlet is opening, the outlet is closing. Along there, there's the inlet, the mid pelvis is right at the ischial spine, and then the outlet is the invisible border on the bottom part of the pelvis that borders where the coccyx to the ischial tuberosities, which is your sit bones, to the pubic symphysis, and that's obviously like when the baby comes out, it comes out the outlet, and it comes into the inlet.
Now what we know about the baby's head is also it's important to visualize that the baby's head is kind of like a huge weight, and there's actually a weight. There's literally a weight. Don't take me literally, but imagine that the occiput of the baby's head has a weight in it. That's also why we think the baby goes vertex, but also as it begins to become vertex, gravity works to our and their advantage. When we talk about and you see and you read about positions, when you see that you can use gravity, gravity is a benefit. That's because gravity helps bring the baby down alongside those contractions.
You do need strong, regular, painful contractions in order to help the baby navigate the pelvis. If we didn't have contractions, it's like they're walking around and they're doing all sorts of positions throughout their pregnancy, and then they're not in labor and the baby's not out. We need the combination of the contractions, the hormonal changes, and then also gravity and those positions to help rotate that baby.
As the baby is aligning, that occiput is going to follow gravity as one of our rules. If they're lying on their left side, which way is the occiput going to naturally begin to rotate when the hips are stacked? Towards the left. Okay, it's going to follow that gravity. That's also why we love hands and knees, which, by the way, has the best cardiac output. You're going to get the best perfusion in that way. That's why it also helps fix your D cells. We throw them on hands and knees. Now where's gravity? Gravity is anterior to the patient. That occiput can help rotate anterior when you get them on hands and knees. We need to remember gravity is one of our rules, and when we're positioning them, especially left and right, not only do we have gravity to our advantage, but gravity on a left side with a stacked hip would cause the head to move by gravity.
Now, you can also open the pelvis, so you can stabilize the pelvis. Anytime you're on a certain side, and this is what gets confusing with our position changes because you're charting the side that they are lying on, but that side that they are lying on is the stable side, that if the hips are stacked, the head will move in that direction. If the hips are open, meaning you have them twisted, a leg is up over around a peanut ball, they're not directly on top of each other, you are opening up the opposite side, encouraging the baby to go in that direction.
When you're on your left side, you may chart it as left runners or something, and you're not opening the left side by being on the left side because you're opening the side that is on the top or exposed or able to be mobile. Anytime you are in an open position, then the side you mobilize is the direction the baby will go because the baby will go the path of least resistance. As you're opening up by keeping your knees wide to open up the inlet, wouldn't it make sense that if the baby needs to come down, you open up the top part of the pelvis? Again, when you open the top part of the pelvis, the bottom part closes.
Does it matter? No, because the baby's not coming out. It's important to know the position of the baby, which is the orientation of the occiput within the patient. It's like stage left. Like whenever we're charting, it's on the patient's left side. It's always the patient's left side, not the one that we're looking at. If the baby is LOT and you are in the left stack position, that's going to keep the head in the LOT, but the moment you go right and you open the left side, then all of a sudden that allows for that extra mobility on the top part of the pelvis for the baby to be able to rotate down and out.
Now, the baby naturally aligns with the pelvis in a transverse position, and then as it rotates, in an ideal way, it's going to make an eighth turn anterior to avoid the ischial spines, and then it'll rotate fully anterior in an ideal scenario. Again, babies can come out however, but then they rotate in a full anterior position because the highest chance of a vaginal birth is when the outlet anterior-posterior diameter is widest and then the inlet transverse diameter is widest, which makes sense because the babies enter transverse, and then they rotate anterior-posterior with the head being longest from front to back.
Now, front to back, keep in mind, especially on outlet, meaning when they're pushing what is in the way? It is that sacrum. Often we forget about the sacrum. The sacrum needs to be able to nutate or counternutate in the case of pushing to be able to nutate, meaning to move out of the way. When we get down these rabbit holes of types of positions and how do you label them and all of that, and what does the evidence say, which I'll give you in a second? One of the categories of ways that you can take a look at the evidence is through a flexible or inflexible sacrum.
There's a lot of evidence on that. Actually, in the pushing class, I give you a handout that gives you the risk benefits, alternatives of all positions, including in the categories of flexible inflexible pelvis and for epidural and non-epidural patients. When you look at that evidence, it is extremely clear that the recommended positioning, especially for second stage, but in general, is to allow for a flexible sacrum. I think a lot of times too, we talk about open and closed knee and how that widens the inlet, yes, from side to side, but what about the sacrum? The sacrum's going to be that back part of the other side of the pelvis, the back part of the pelvis.
Some examples of a flexible sacrum would be like kneeling or standing squatting, sitting, side-lying, hands and knees, any kind of upright position, anything where the sacrum isn't pressing against something and unable to move, which leads me to then your inflexible sacrum positions are going to be your supine, semi recumbent. They're on their back, they're sitting even, without a donut under their booty or lowering the bottom part of the bed when they have that half moon in the med, or even a lithotomy position. Those are not recommended unless they're considered clinically necessary, which is not in the eye of the beholder.
When you need to visualize, especially on delivery, you visualize for an appease, for a shoulder dystocia, or for some sort of emergency. Most of the time that's not the case. Ultimately the evidence shows they should be avoided in that way. You can look at it through flexible, inflexible sacrum. If we look at the benefits of a flexible sacrum, I'll list them out really quickly. Optimal expansion of the pelvic outlet, lower rates of cesarean and instrumental delivery, shorter second stage of labor by 26 minutes, increased perineal integrity, and fewer severe tears, improved fetal rotation and descent, enhanced maternal comfort, respect, and autonomy, and less intense pain.
Now, the risks of the flexible pelvis positions are they have a slightly higher chance of mild perineal trauma. It might be difficult for them to maintain for long periods of time, which is true. You think about a hands and knees, like I can't be in a hands and knees forever, my wrists are hurting. You want to change positions out of that occasionally. Then monitoring might be more challenging, which is a nurse problem in my opinion. I know that's a challenge, and that's one of the big ones that people ask me about all the time. What about the monitoring and, I'm so over the monitoring, and I have two patients. You do the best you can with what you've got. Ultimately it is our responsibility to allow for that mobility and help set the patient up for success. Do the best you can.
There is a potential for increased blood loss, over 500 milliliters in some studies, even though we know that neonatal outcomes, they're unaffected. Babies are still okay. Then it's challenging for patients with an epidural. If we think about it in that lens, there's that component that like, are we thinking about the sacrum when we're helping encourage positions and we're giving autonomy to our patients over those choices?
Now the other fun fact, we know that mobility in general helps with uteral placental blood flow, which increases our uterine contractility. If anyone's arguing about a position change, which I don't hear, to be honest, if they are, they should go to our resource list for our class and read every study that talks about. All of our major practice guidelines, AWHONN's Perinatal Nursing, ACOG says it, ACNM, they're all in support. I'll read you those in a second. In general, we know that when you move the patient, it betters the blood flow to the baby, which for perfusion purposes is awesome and also for the uterine contractility is awesome. Let's move them. Motion is lotion.
We can open the anatomy where it is. We need to be able to move the sacrum and flex or unflex the sacrum, nutate, counternutate. The baby aligns to the pelvis using gravity to its advantage in an environment that needs to be soft. That is your ideal for your positioning.
Now, when we look at the evidence on positions, to be honest, we have a lot more on second stage, which is one of the reasons why I put together the pushing class. I would teach Physiologic Birth, and I always felt like I was skimping on the pushing component of what does physiologic pushing look like, and what does the evidence say on the recommendations for all the different components of pushing; open-closed glottis, spontaneous versus not, delayed versus immediate, should you labor down or not, how do you talk to a provider about all that? We do all of that in our pushing class. You're welcome to come. It's online. It's available to you.
At the same time, when you categorize positions that are recommended for epidural patients versus not epidural patients, there is a different recommendation. For our epiduralized patients, the recommended positions are lateral, so side-lying, semi-recumbent, supported upright, and hands and knees. We're turning them a lot with our epidurals. They say even in ACOG guidelines for especially second stage, but in general for positions, they don't recommend upright, and that's because an upright position is impossible for an epidural. In general, those side-lying positions are recommended, which helps the baby rotate. It has less chance of an operative vaginal birth or a cesarean, especially in those lateral positions, and then patients love it. They love that autonomy.
Now, what is the official recommendation, especially for pushing, is to encourage safe mobility and regular position changes, avoiding routine, lithotomy, and supine. Lateral is preferred for epiduralized patients if upright is not feasible. Now, upright with an epidural, here's my caveat to this, and this is like fun fact, heavy tip, is that when a patient has an epidural, they do not have the sensation that something's falling asleep. When they're upright and they have contractions and they have a baby on a cervix and they are not changing that position that frequently, what, in my opinion, again, I'm expressing my opinion, but this is based on all of the physiologic birth research that I have done as an expert in this, is that you have that pressure on the cervix for a long time is less perfusion to the cervix, so you end up with traumatizing the cervix, leading to a swollen cervix.
Can you use upright positions with an epidural? Absolutely, you should, but do not leave them there forever. Because, just like you and I, we're going to eventually shift our weight when our butt falls asleep, but epiduralized patients aren't going to necessarily know that. They're not going to have those cues. That's my little caveat for that.
Now, what's the recommendation for patients without an epidural? It is called dynamic positioning. All that means is that they are listening to their body, they are moving around, they are frequently positioning, repositioning themselves and positioning themselves. You think about the last patient you had. I just had one that delivered without an epidural, and she was on all fours on the bed, over the bed, laying on her side. Then she'd get off the bed. At one point, she went to go get on all fours on the ground, and I was like, no. Slow-mo, I can see the germs. I grabbed a sheet and threw it down in front of her, and she landed on the sheet. Thank God, or I would have had a massive heart attack of the germs on the floor. While you're in labor land, do you care? Not at all.
She was on the floor on all fours, and then she was squatting, and then she was up and around. That is a dynamic positioning, that we're not fighting their instinct. We're not telling them they can or can't do things, that they're listening to their body. Now, the benefit of that is they're frequently changing positions, usually at least every 30 minutes up to an hour. They have gravity to their advantage. That mobility is going to help propel the fetus to get in an optimal position. It gives them agency, which contributes to their experience. Then as they go throughout labor, you have this adaptation to the labor stages.
We don't know when they're 4 versus 5, versus now it's active labor. We can look at it and we can definitely hypothesize, but how often are we wrong where I'm like, oh, yes, they're definitely in active labor, and you're like, you're 1. I'm sorry, what? As labor changes and as the baby comes down and the body needs different things to help with that process, they have all of that instinct. They have that mobility. They have the ability to adapt to not only the labor stage, but their pain and the position of the baby as well. It's going to help promote that vaginal birth by that dynamic positioning. The recommendation for our non-epiduralized patients is let them labor, let them position. Don't tell them what to do.
Now, occasionally you have a patient where they're like, what do I do? What should I do? How do I help? How do I speed this up? In that case, you want to know the position of the baby, where it needs to go to get to ideally anterior, are the tissues soft, and if they're not, do all of your softening techniques, and then make that suggestion. Now, here's the other trick here is that if something feels better for somebody without an epidural, encourage them to do that. There's this common misnomer in the world of like, oh, stronger contraction equals cervical change, but when I lay on my side, my contractions go away.
Or you're walking, this is that uterine placental blood flow, that they're walking and they have more frequent contractions. What do we do when we want to try to get rid of the contractions? We lay them on their side, and if they're in a true labor, they're going to lay on their side and the contractions will continue rather than go away. We want to encourage them to listen to their bodies because the body's instinct gives cues as to what the body needs by coping, not causing more pain. Our natural physiology is refusing the pain. We want to run away from the pain, and so something that feels better encourages us that direction naturally encourages the baby in the right direction.
Now, what do our major organizations say as their little, let me give you a little snippet from each one related to our position changes? AWHONN's Perinatal Nursing, which if you don't have that book, I'll link it down below. It's time. You should have this book. This is our textbook to our profession. It is your go-to. I was at a hospital that didn't have policies and procedures, but we just use AWHONN's Perinatal Nursing, so know it. I read it three times in my career and once before I took my RNC and passed, so very important.
It says that, "Women who are encouraged to be mobile during labor report greater comfort, decreased use of analgesia and anesthesia, and a 50% reduction in operative births. Upright positioning during labor is safe and effective measure that can be encouraged by the perinatal nurse supporting women in assuming positions of comfort per their choice." Even if they have an epidural, give them choice. Grab the position guide and hand it to them and say, knowing that the baby's at the inlet and that you're trying to get them into the inlet or they're in a mid-pelvis position based on vaginal exams, say, does any of these positions feel good? They can go, ooh, that one looks good. You're giving them agency while also guiding them to help the pelvis align to the baby.
Now, ACOG says from their First and Second Stage Labor Management from 2024, which you should also know, says that, "Frequent position changes during labor to enhance maternal comfort and promote optimal fetal positioning should be supported by adopting positions to allow appropriate maternal and fetal monitoring and treatments." When I teach the pushing class, I talk a lot about ACOG because I think a lot of times when we're pushing, part of the struggle is the team dynamics. Up until then, you've been very independent. The doctor hasn't been at the bedside, but now they arrive and now they're coming in with their ACOG lens. It's important to know what is their lens so that we can collaborate better.
The goal is they just want to be able to monitor and treat the patient. They want to keep them safe. So long as they're able to be monitored and they can respond to emergencies, then let them move around. That's the recommendation. I love from Approaches to Limit Intervention, ACOG's Approaches to Limit Intervention, which again is such a helpful resource for us to know. They say that no one position needs to be mandated nor prescribed. If somebody is telling your patient that you have to be this way, that's not what ACOG says. Remember that as we're navigating these conversations.
Now, the other big question that I get is how do you chart the position names? My favorite resource for this, which is the best that I've found out there. If you want to partner on a research study to name all of the positions, please reach out. I would love to be a part of that one. Basically, my suggestion when people write in or they'll write an email of like, how do I chart this? Or we're trying to put it in our EMRs. If you have the position guide and you are using it unit-wide, there is a label on the position guide that each page has either A, B, C, or D, and then a number. We do have facilities that are using that as like we did A16 or A4 as your position. That's, I think, really helpful.
If you haven't adopted that as a unit-wide thing, typically, I would go towards the category of position more than the actual name because there's a lot of positions out there, aka Flying Cowgirl, that isn't necessarily in our textbooks, per se, as like a clinical name, but it's more like a street name. Typically, there are sort of categories, lithotomy being one of them, lateral, upright, semi-recumbent, supine, sitting, squatting, kneeling, hands and knees, lunging, open knee chest. Those are kind of like our categories, and so I would start there.
If they're on their left side, it's a left lateral, and then comment. With a peanut ball, if you're on your left, so your right leg elevated with a peanut ball, bottom arm behind the patient, tilted in an open position. I know that's a lot. You can choose, give or take, how you navigate that, and of course, always be talking to your managers, educators, on how they want you to chart those positions. We do the best we can, and if a position does have a name, then hands and knees it is. Kneeling over the back of the bed, knees together, feet wide, supported with a pillow, squatting with a squat bar, et cetera, et cetera, for charting your positions.
Now, when you evaluate your positions, you want to be thinking through the lens of what am I doing with the body? Is the sacrum flexible? Are we moving them? When in doubt, do both sides. When in doubt, motion is lotion. Often, it is not so much about the specific position, but it is about the mobility, the shifting of the angles of the pelvis that helps the baby rotate down and out. It is not just the positions. Those contractions help, the psyche helps, ligaments, fascia, all of that helps.
Now, the last thing I want to say as we're talking about positions is that, yes, we need to be doing them. How frequent? My recommendation, from a Bundle Birth perspective, is, make it the goal to be every 30 minutes, with a goal of no more than 59 minutes. At the 59-minute mark, you are in there at least turning them every hour. If the goal is 30, then the reality is that you'll get in there between 30 and 60 in order to keep your patients moving on the regular side.
Now, my fear with positions and position changes is that you get so excited and you feel like, I'm going to do all the positions all the time, and you'll learn this in Speedy Inductions, that if you don't have contractions, you need contractions to push the baby down to make the positions effective, that don't wear them out. I love this quote from The Understanding of Dynamic Birth Positions in Women in Labor and Childbirth. It was one of the midwives from that study that said this, "The concept of dynamic birth positions implies a harmony of both movement and stillness. Birth is a multifaceted process, and those assisting the woman must also adapt to their rhythm, not always in a state of constant activity. Rest can play a pivotal role in advancing labor, ushering the woman into the subsequent phase."
It's not all about wearing them out with all the positions, that there is this balance of rest and activity. I think when we get so prescriptive of, then we do this, and we do the Lavonne Circuit and the labor warm-up, and all these things, that we forget the art of labor, the movement of labor, the instinct that comes, the better you get at palpating those contractions and feeling where the baby is and watching the movements of the laboring person, and also feeling out their affect, like you're tired, let them sleep, and encourage them to sleep, that you're not going to walk your baby out. That can be helpful at times, but it's not always helpful. There's a beautiful balance of your rest and your activity as you're encouraging labor forward and encouraging using your position changes, yes, but all of your other tools to help encourage that vaginal birth.
Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram. If you were enticed by any of this information, please join us at our Physiologic Birth class. If you've been to Physiologic birth, come to our Pushing class, sign up for our Speedy Inductions class, and for our hospital partners, we cannot wait to do those in-person physiologic birth workshops. Stay tuned for the future of possibly doing that in-person. Now it's your turn to take what you learned today, apply it to your life, and go turn your patient, remembering that motion is lotion. We'll see you next time.