Déambulation, ballons et postures pendant le travail obstétrical: où en est-on ?

Abstract

Obstetrical mechanics is a continuous adaptation between the fœtal head and the maternal pelvis. The pelvis is going enlarged at the level of sacroiliac joins and the fœtal head is rotated and orientated in its best diameter, guided by perineal muscles. Moving during delivery facilitates this adaptation. Deambulation, sitting on a balloon, and suspension by shoulders, are possible and beneficial for the progress of labour and for pain relief. When labour has progressed, standing impairs sacral movements and foetal accommodation. Postures are prescribed by midwifes. They support the progression of labour allowing the opening of the pelvis. On demand epidural analgesia using low concentrated anaesthetic solutions does not impair pregnant movements during delivery provided there is no motor blockade. Changes in posture do not interfere with the diffusion of epidural analgesia. Management of ambulatory analgesia requires technical devices (portable pumps, telemetry) and monitoring protocols to guarantee the safety of physiological delivery.