A guide to antenatal and postnatal use of birthing balls
How the Ball Works
The ball can be used in many ways but essentially it provides support. For example, when sitting astride the ball, there is no muscle tension because the thighs and perineum are supported by the gentle counter pressure from the ball. The feet are firmly grounded, and the spine will naturally adopt a position of good alignment. At the same time the muscles supporting the spine strengthen over time. Thus the incidence of pain in the lower back and pelvic joints decreases. In addition the ball appears to enhance the tone of the abdomen and support the pelvic floor, already under strain during pregnancy.
Before you Begin
Birthing balls are available in several sizes but the most common is the 65cm, which should be inflated to no more than 100cm when measured on the surface from pole to pole (i.e. half the circumference). Usually 96cm is about right. Alternatively, measure 65cm on the wall with a ruler and pump the ball up to this level.
Ideally, the ball should be inflated with compressed air from a garage. Use a foot or hand pump, such as you would use for an airbed, to top up thereafter. The ball should feel firm but give a little when you sit on it. However, it may soften a little over time so remember to check and pump it up again when necessary.
As you sit on the ball, keep your legs open with your feet firmly resting on the ground. Your hips should be significantly higher than your knees with thighs turned in the same direction as your feet. Make sure your knees are directly over your ankles.
Other sizes of ball include the 55cm (85cm pole to pole), suitable for women less than 5 foot 2 inches tall, and the 75cm (115cm pole to pole) for those over 5 foot 7 inches.
Use during Pregnancy
- Kneeling on the floor you can lean your upper body over the ball, either with your back horizontal, or by easing your hips down towards your heels. You can also circle your hips in the more upright kneeling position. This can be a relaxing position to ease backache and it also avoids tension and weight on the wrists. Resting and relaxing in these positions will encourage the weight of your baby’s body to lie forward against your belly. This is important in the last 6 weeks of pregnancy when your baby’s head is attempting to engage in the pelvis. This can help to avoid a “posterior birth” when the baby’s spine lies alongside the mother’s, a birth that can be associated with a long and difficult labour.
- Sitting fractionally forward on your ball, place your feet apart and allow your bottom to sink into the ball comfortably. This will enable you to sit with your spine in good alignment, which can relieve any backache or heartburn. If you suffer from pelvic pain, the ball can provide excellent support, relieving discomfort. Just make sure that the feet are not placed too far apart.
- You can also use your ball to sit at a table or desk. This will encourage good posture and discourage you from crossing your legs, a habit which can work against engagement of your baby’s head as well as reducing the circulation to your legs.
- Use the ball as a firm but comfortable support to sit back against generally during the day.
Use during Labour
- Once you have become familiar and comfortable with your ball during pregnancy, youwill know how best to use it during labour when the time comes.
- Your birthing partner can massage your lower back during contractions while you are kneeling and resting over the ball.
- Standing and leaning over the ball, either placed on a high bed or against a wall will enlist the help of gravity to encourage your baby to descend.
- Sitting on the ball you can sway and move your hips moving back and forth in whatever way you feel will help to move your baby through your pelvis and birth canal.
- Remember it is easy to get up off the ball and return to it later.
- Kneeling on the floor and leaning over the ball will help the weight of your baby to rest forwards without putting pressure on the major blood vessels (inferior vena cava and aorta). This will improve the blood supply to the uterus and ease the pain of contractions. Note: it is possible to use gas and air (Entonox) while using the ball.
- Using your ball is a comfortable way of feeling supported in labour whereas being on your back could slow down or make your labour more painful.
- Leaning over your ball and rocking helps your baby to turn and drop deeper into the pelvis with increasing flexion of your baby’s head (chin to chest). As labour progresses the back of your baby’s head creates an even pressure on the cervix, enabling effective dilatation and steady progress.
- When you are ready to give birth, you may need a different form of support. Your partner can sit on the ball, which can be wedged up against the wall, allowing you to kneel in front with your elbows resting on your partner’s knees.
After the Birth
The First Few Days
- Sitting on your ball can be comfortable, especially if your perineum is sore.
- Sitting on your ball and circling your hips will firm and tone the hip, buttocks, inner and outer thighs and abdomen.
Pelvic Floor Exercises
- The ball provides excellent support when practising pelvic floor exercises.
- Make sure the ball is sufficiently inflated so that when you sit on it, the angle between your upper body and thighs is about 100 degrees (slightly more open than a right angle). Your feet should be placed at a similar distance to a squat but with your knees above your heels.
- Next locate the Neutral Position. Roll back gently on to your coccyx until your lower back becomes slightly rounded. Now rock gently forwards until your bottom sticks out a little and your lower back curves inwards. Next move gently back to the midpoint between these two markers. This is the Neutral Position. Allow the buttocks to sink into the ball and elongate your spine in an upwards direction, with the crown of your head leading. Do not overarch the lower back.
- Next take a gentle breath in and as you exhale push your sitting bones down into the substance of the ball without clenching your buttocks or using your leg muscles. Allow the crown of your head to lift at the same time. Once you begin to get used to this, you will experience the pelvic floor working around the back passage.
- Next, take a gentle breath in and then slowly rock forward on the out-breath and observe what is happening to the pelvic floor. The muscles automatically begin to firm around the urethra and vagina. Work with this natural movement as you practise your pelvic floor exercises (see your hospital leaflet).
Other Postnatal Uses
- When you feel stronger you can begin to bounce slowly to improve general muscular strength. N.B. Bouncing would not be recommended if the pelvic floor was still weak. However, gentle bouncing should be possible by six weeks following an uncomplicated vaginal birth.
- Progress to firming your abdominal muscles by sitting on the ball with feet apart. As you exhale, tighten your belly below the navel, starting with your pelvic floor, lifting gently upwards and feeling your stomach becoming firm. Hold for 5 breaths before relaxing the muscles on an in breath. When you find this easy, sit on the ball and ensure that your lower back is not over-arching. Once you begin to feel the lift within the spine, tighten your belly as above and slowly lift one arm. Ensure that your shoulder blades do not lift. Try not to wobble and progress with both arms together and repeat 5 times (floating arms).
- Lie on your back with your legs resting over the ball and your head supported on a folded blanket or a cushion to prevent any arching of the neck. Place your hands lightly on your belly and breathe in slowly. As you breathe out, engage your pelvic floor and lift it upwards, feeling your abdominal muscles tighten gently. Rock your knees very slightly to the right (maximum 2 inches). Pause for a moment and take in a full breath, releasing your tummy muscles. Then, as your breathe out, engage your pelvic floor, lifting to make contact with your deep abdominal muscles before bringing your knees back to centre. Pause once more, breathing softly and steadily before repeating on the opposite side.
- The ball can be used to calm and soothe your baby. Simply sit on the ball with your baby and gently bounce or sway rhythmically.
- Some babies gain relief from colic by being placed on their stomach, face down with a firm hand at their back for support. Then gently roll the ball back and forth. The pressure on the baby’s abdomen appears to help with abdominal cramping.
- Siblings love the ball too!