The pelvic floor is a "bowl"of muscles holding up the lower abdominal organs. The pelvic floor has an opening that allows the baby to descend (come down) through in labor. Innocent habits of modern life can make the pelvic floor tight or twisted, 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. An asymmetry (uneven) in the pelvic floor can 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 Side-lying Release (also called the pelvic floor release) can help labor progress in the presence of a posterior, brow or asynclitic fetal presentation.

Who benefits from a side-lying release?

First time mothers benefit from releasing spasm in the pelvic floor once or twice in late pregnancy. Women who have had previous cesarean(s) will 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. People can do this without pregnancy, too, if intercourse or elimination is painful due to the pelvic floor

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.

Where does one get a pelvic floor release?

A myofascial therapist can help guide you through a side-lying release. With a little trial and error you can probably figure out how to do one at home, before or in labor.  Women do a side-lying release in the hospital during labor.

Left, the pelvic floor muscles (pink) have an opening for the baby to pass through. The edges of the opening are significant in fetal rotation.

 Why are we doing a pelvic floor release?

The pelvic floor has a front-to-back opening through which the baby travels.  The sides of the opening are strong and springy. 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.

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, during labor in the hospital.
A woman can do this alone, but a helper is very useful.

The mother lays on the surface, lets call it a couch, 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 what, however, or she may make her pelvic floor more uneven.

1. The woman lies on her side close to the edge of a couch. She lays her head on her lower arm.
2. Her helper stands in front of her with her pregnant belly between the helper’s thighs.
   
3. The helper curves both her palms around the edge of the mother’s anterior (front and top) hip.  The helper presses down a bit, not much, but firmly. The helper is going to prevent the mother’s hip from leaning forward when the mother does the next step.
4. With the helper in place, the mother scoots her hip right up to the very edge of the couch. Right on the edge, so that tipping forward would make her fall off. Don’t let her tip forward!
5. The mother straightens her lower leg. Her lower foot is flexed up, not pointed toes.
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.) The top hip stays over the lower hip, this is important.
7. 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 shift her weight away from the mother’s thigh so the thigh can hang freely. She breathes deeply and slowly. Her belly is relaxed.
8. Her leg hangs like this for 1-2 minutes when the side-lying release is done in late pregnancy. Let the leg hang like this through 3 contractions when doing this in labor. This is what stretches the pelvic floor.
   

9. Repeat on the other side immediately. Repeat for just as long, 1-2 minutes in pregnancy and through 3 contractions during labor.

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.

Is there any time you shouldn’t do a side-lying release?

If there is a history of fast births the side-lying release is probably not necessary. In a labor that is progressing steadily there is no need for a pelvic floor release.
You can ask your care provider if there is any medical reason not to do the pelvic floor release. If you are seeing a myofascial worker, a craniosacral therapist or chiropractor, please talk to them about doing the pelvic floor release first.

If you do the pelvic floor release on both sides, I can’t see the danger of it. But if you have a bad lower back, not due to pregnancy, surgery or something you suspect is a contraindication, then please, by all means, don’t feel obliged to do the side-lying release.

I was taught the Side-lying Release by Carol Phillips, DC at a long birth. This first time mother took 3 days to get to 4-5 cm. Carol arrived and saw the need for the side-lying release. She showed me how to do it. The mom went right into transition and her second stage was so smooth that the baby was crowning before anyone had any idea that she was in the pushing stage. Her baby was in an anterior position and was not asynclitic. She simply had a really tight pelvic floor.

Our moms with posterior and asynclitic babies don’t have the ease of the first mother at whose birth I learned this technique. But we see improvement.  

A story of a birth that was helped by a side-lying release

Yesterday, we were at a home birth with a first time mother. Her baby was tilted to the mother’s right. The baby’s sutures showed a moderately flexed (his chin was lifted up a bit, not tucked) oblique posterior baby with the right parietal bone presenting. In easier words, the baby was facing up, chin up and head tilted a little bit as if listening with his right ear.  Her water had broken spontaneously at 3 am and started labor.

At 9 am her midwife (one of my partners, Clare) estimated from her behavior and contraction pattern that she was about 9 cm dilated. Emme (our other partner) and I headed over. We usually are there earlier in labor, but with two other moms warming up to imminent labor, Clare let us sleep in before calling.

Labor didn’t sound like it was progressing so Clare did the first vaginal exam at 10:30 am. The baby was asynclitic as shown by there being room to the left of the baby’s head and the head pressed to the right above the ishial spine. Cervix was swollen on the front and couldn’t be felt in the back (9 ½ cm).

We tried lunges and the lunge with the mother’s right leg up on a chair seemed to help as shown by stronger contractions during the lunge with the right leg up.
The cervix was complete (10 cm) at 2 pm.

We did the pelvic floor release about 3:30 pm when pushing in a variety of positions wasn’t progressing labor well  –there was no significant descent.

She chose to start the pelvic floor release on her right side. We didn’t hear a difference in her birthing sounds during the three contractions she went through while letting her left leg hang in the air.

Then she got on her right side. The first contraction on her right side with her left leg hanging forward was dramatic. It sounded like the strongest contraction of her whole labor. The next contraction was mild and the third contraction of the pelvic floor release was quite strong, almost like the first.

The mom got up from the pelvic floor release and stood through a couple contractions on her way to the kitchen counter where her husband helped her do The Dangle. This seemed to help progress a little.

The strange thing about asynclitic babies is that occasionally laying on the back and pushing with knees open and apart seems to give good progress. This position limits the sacrum, but it also flattens the sacrum some. For whatever reason, on her back was the position that helped the most. This mom was willing to do everything it took and a couple things that were thrown in as best guesses to give birth to her baby.

The baby was born alert at 7 pm and beginning to breath before the body was born. Apgars 8-9. He was over 8 pounds. His molding and caput were not extreme at all. The mother had taken homeopathic arnica about every 30 minutes throughout her 5 hours of pushing.

After a birth like this we can see why one nurse-midwife said, after a hospital birth much like this homebirth story, "Now I KNOW we have too many cesareans!" We meaning the US.