INTRODUCTION:

Birthing ball is one of the great tools for you during pregnancy and birth. Midwives and doulas have been using exercise balls for decades as a way to help speed up dilation and move the baby down into the pelvis. Once labour begins, similar exercises can help manage pain and assist you in finding a comfortable birthing position.¹

When is the Good time to Start using the Birth Ball?:

You can sit on it as early as you want in your pregnancy. Many of them start using it by 32 weeks of pregnancy.

Qualities of Birth Ball:

The ball has anti-burst feature, non-slippery surface, can hold up to 250- 300kg weight, completely latex-free and right size

Table 1 : SIZE OF BIRTH BALL

Your Height	Birth Ball Size	Fig 1: birth ball
Up to 165cm/ 5’5’’	55cm
Up to 173cm/ 5’9’’	65cm
Over 173cm/ 5’9’’	75cm

Benefits of Birth Ball:

· Increases blood flow to the uterus, placenta and the baby.

· Can relief spinal pressure.

· Will provide comfortable support for your knees and ankles.

· Will give counter-pressure to the perineum and thighs.

· The upright posture works with gravity which will encourage the descent of the baby.

· You can make different moves and still rest by leaning forward, pelvic rocking, swaying, doing hip circles and figure eights and of course gently bouncing to help move the baby down.

· Can increase the pelvic outlet as much as 30%, which also encourages baby’s descent.

· One of the most important benefits of using birth ball during your pregnancy is positioning baby in the right position right before the birth.²

How to use Birthing Ball for the First time?:

· Place your ball on a carpet rather than a smooth floor. This will make it more stable. When you first sit on your birthing ball, it's best to have someone with you to support the ball from behind you (especially in the later stages of pregnancy). This will give you a chance to get used to staying balanced on it. Make sure you're wearing non-slip shoes or socks. Better still, go barefoot.

· Place your feet flat on the floor, about 60cm (24in) apart, so you've got a good balance. Now place one hand on the ball and lower yourself to sit on it.

· Once you're comfortable, place your hands on your knees and try rocking your pelvis from side to side or back to front. Then, if you feel secure, have a little bounce!

· If you feel too unsteady to rock or bounce on your own, hold on to whoever is with you. Alternatively, put a chair in front of you, facing away from you, and hold on to the back of it for support.

^·If you're going to use your ball for exercise, make sure you have a clear area around you. Exercise in a slow and controlled way. Breathe normally, and stop if you feel any pain or discomfort.³

How to use Birthing Ball?

During Pregnancy:

· Sit Comfortably while you're working or Relaxing:

You may find your ball much more comfortable, and easier to get on and off, than a hard chair or soft sofa. Also, sitting on a birthing ball gives you a mini-workout. As you rock or bounce on it gently, your tummy and back muscles will be working hard to keep you upright.

· Get some gentle exercise:

This helps your body to support the weight of your pregnancy. It can also protect your back, and help you get back into shape after you've given birth. Try:

ü Sitting on the ball and rocking your pelvis from side to side and front to back. When you do this, try to keep your shoulders still so the movement comes from your waist and below.

ü Rotating your hips clockwise then anti-clockwise.

ü Leaning over your ball from a kneeling position, then rocking your hips forward and back.

· Help change the position of your baby in late pregnancy:

If your baby is in a upright posterior (back-to-back) position, forward-leaning positions may encourage him to switch around. Try getting on to your knees and leaning forward over your ball. This may encourage your baby's back to swing forward so he's in an anterior position. Even if baby change its position before labour, mother will get some temporary relief from backache.

DURING LABOUR:

Exercises to induce labour:

C-Shape Push Back:

Put the birth ball against the wall and sit on the floor as you press your back against the ball. Breathing is the key to this exercise. So when you exhale, imagine you are forming letter “C” with your spine and still pushing the ball towards the wall. Exhale now. Release the ball from pushing. Do it again. This exercise will make transverse abdominal stronger.

Wall Squat:

Hold the ball towards the wall so you can support it with your lower back. Your hands should be resting on your hips and your feet should be open shoulder-width and little more forward from the wall than your body. As you inhale, bend your knees and try to sit down while rolling down together with your ball behind your back. Do it until your knees are at 90 degrees. Exhale now and stand up. This exercise will massage your back, might open the pelvic area and of course will make your legs stronger.

The Hula Hoop:

Sit down on the ball and position your feet apart as wide as your hips, your knees should be at around 90 degree angle. Your hands should be on your hips. And now imagine you are doing the hula hoop: circle hips to one direction, and keep your back in one straight position. Now circle your hips the other way. This exercise will help to open the pelvic area during your labour.

The Rocking:

Position yourself so your back is on the ball and your feet are put firm on the floor. It is a good idea to ask your partner for help to get into this position. Open your body up by putting your head down on the ball, your hands on the floor and your chest will be stretched out. It is like hugging ball exercise, only this time – with your back. When you comfortable in this position try rocking back and forth by bending and straightening your knees. This exercise will massage your back and will stretch your chest.

Positions of birth ball during labour

Ø Sitting aside the ball and rocking your pelvis from side to side or back and forth.

Ø Leaning on your birthing ball from a kneeling position on the floor.

Ø Getting into a hands-and-knees position by hugging your birthing ball and lifting your bottom up from a kneeling position. You can then rock your pelvis from side to side.

Ø Leaning over your ball from a standing position, with the ball on the bed or another surface. All these techniques can be used during first-stage labour.

Fig2: positions of birth ball during labour

Ø During the pushing stage you'll want to avoid sitting, so use the leaning or hands-and-knees positions. They will take the pressure off your bottom and give your baby lots of room to descend. These positions give your partner to support you, massage you or apply pressure to your lower back during contractions.

Exercises to Progress Labour:

· Sitting as straight as possible on the ball.

· Slight bouncing will open up your pelvis and will have more space for the baby to go down.

· Moving in circles with your ball. Vigorous circles done with ball will bring on contractions.

· Leaning on the ball will take the pressure of your back and will decrease some pain. Also it makes a good access to your back for some massage which can help with the baby’s positioning too.

· A mother can sit down on the bed with her legs open so the birthing ball can fit between her knees. Mother hugs the ball and leans from side to side. There must be 2 assistants on each side to support mother from falling. This may fix baby’s head position.

AFTER DELIVERY:

·Deflate the ball little bit to make it softer.

·When you get a hang of breastfeeding, sit on the ball while you curdling your baby. IT will keep your posture straight.

·Use your birth ball to exercise and get back in shape.

·If you have a “colicky” baby, the ball will be your best place to sit on. Hold your baby in your/his favourite position and gently bounce on the ball. Or you can even put the baby on the ball (stomach down) and GENTLY bounce. This soft pressure and rhythmic movements will help to sooth the baby. Make sure to keep all safety precautions when using birth ball with the baby.

DO’S and DO’NTS:

·Make sure to use a non-bursting birth ball. If it is punctured, the ball should not burst suddenly, but deflate little by little so you can get off the ball safely.

·get the ball with non-slippery surface with right size for you, based on your height

·when using the birth ball – move carefully

·before sitting down on the ball – put your hands on it to keep it steady

·make sure your feet are apart from each other so you can have a solid foundation when you sit down on the ball

·Don’t hold your breath. Breath in through your nose and exhale through the mouth

·Stay bare feet when using birthing ball. Less chance to slip/slide. If you do have to wear socks or shoes – make sure they are not slippery.

·Especially in the beginning of using a birthing ball have your partner be there to help you. Start with very simple sitting on the ball to feel comfortable.4

RECENT RESEARCHES:

· The study done in Indian hospital found that the practice of birth ball during labour had an effective maternal outcome and that there was no harm to the baby.

· Brazilian study with 11 women showed that using a birthing ball and doing other activities such as breathing exercises, massage, baths and vertical positions help mothers control the pain much better.

· Chinese study with 203 mothers also found that there were statistically and clinically significant differences in back pain level, stress and anxiety levels, as well as pressure level over the lower abdomen before and after the birth ball exercise

· Another research says that birth ball (when used every day from 32 weeks) can help the baby to be in the ideal position for birth (Sutton, 1995)

· Effects of birth ball exercise on pain and self-efficacy during childbirth: A randomized controlled trial in Taiwan This study showed that mothers who used birth balls through the pregnancy and labour had shorter 1st stage labour, less epidural cases, fewer C-sections than the control group of mothers in the study. There were large improvements in childbirth self-efficacy and pain

REFERENCES:

1. http://www.livestrong.com/article/420676-exercises-with-an-exercise-ball-to-help-induce-labor

2. http://www.attachfromscratch.com/birthing-ball.html

3. http://www.babycentre.co.uk/a1048463/using-a-birthing-ball

4. http://spinningbabies.com/learn-more/techniques/other-techniques/birth-balls.

Received on 13.08.2016 Modified on 29.08.2016

Int. J. Adv. Nur. Management. 2017; 5(1): 85-88.

DOI: 10.5958/2454-2652.2017.00019.1