Diaphragmatic Suspension During Labour and Delivery

Understanding Diaphragmatic Suspension
Diaphragmatic suspension refers to positions that lift the diaphragm, relax the pelvic floor, and align the organs properly. The pelvic floor naturally relaxes when not under pressure, but when pressure is applied, it resists or tenses up. During delivery, the pelvic floor needs to move upward to open freely, similar to a door that opens inward instead of outward.

The Purpose of Suspension
The use of suspension positions serves several purposes during labor and delivery:

1. Preventing prolapse by lifting the diaphragm and organs.

2. Promoting elongation, which facilitates diaphragmatic breathing.

3. Engaging the transversus abdominis muscles for effective pushing.

4. Maintaining a straight spine and avoiding compression at the vertebrae.

5. Preserving mobility in the thoraco-lumbar junction, reducing contraction pain.

6. Stretching the psoas muscles (hip flexor, back extensor) to alleviate compression on the lumbar spine and allow proper pelvic rotation.

7. Ensuring the psoas is at its optimal length for achieving an elongated posture and diaphragmatic breathing.

Suspension techniques are beneficial throughout labor, but particularly crucial during the pushing phase, especially for individuals with an epidural.

Achieving the Proper Position To achieve proper suspension during labor and delivery, follow these guidelines:

1. Raise your arms above shoulder height with internally rotated arms (elbows facing the ceiling).

2. Maintain an elongated spine.

3. Practice breathing through the diaphragm.

Breathing Technique The most efficient breathing method involves expanding the ribcage, enabling optimal air intake without adversely affecting other muscles. During labor, breathing through contractions can help manage their intensity. While pushing, it is crucial not to hold your breath, as this increases pressure on the pelvic floor, causing muscle tension and placing additional strain on internal organs.

To practice this breathing technique, place your hands just above your belly and below your bra strap. This position allows you to feel the movement of your ribs as you inhale and exhale. Avoid excessive movement in the upper chest and belly.

Suspension Positions during Labor and Delivery It is advisable to practice these positions in the weeks leading up to delivery to become familiar and comfortable with them:

1. Squatting with suspension:

   • Utilize the edge of a sink, bar, bed rail, or have someone assist you.

   • Ensure a secure grip.

   • Keep feet parallel, not turned out.

   • Squat down, lowering your buttocks toward the floor.

   • Allow the coccyx (tailbone) to untuck.

   • Maintain an elongated spine.

   • If arms and legs become tired, you can substitute with heel sitting or high kneeling.

2. Sitting on a birthing ball:

   • Keep your arms on the bed or hold onto another person for support.

   • Breathe using the diaphragm.

   • Maintain an elongated spine.

   • Avoid arching your back.

3. Sitting on a birthing stool, heel-sitting, or high kneeling:

   • Use any overhead support to rest your arms or head.

   • Find a comfortable position that supports suspension.

   • Keep your hands and knees on the floor.

4. Hands and knees:

   • This position helps decrease pressure on your back caused by the baby's weight.

   • It also allows you to rock or tilt your pelvis.

5. Lying down in a semi-recumbent position:

   • Utilize an overhead bar or hold onto a towel/sheet anchored above your head.

   • Extend your arms above your head while lying on your side.

6. Suspension on your back without assistance:

   • Lie on your back with your feet against the wall.

   • Place your hands on your knees and rotate them inward, bringing your elbows towards the ceiling.

   • Gently tuck your chin.

   • Feel your spine elongate and the diaphragm lift.