Your Birthing Ball
	Before you begin During pregnancy During labour Postnatal References
	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 adductive muscle tension as the counter pressure from the ball gently supports the thighs and perineum. 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 lumbar spine and sacroiliac joints decreases. In addition the ball appears to enhance the tone of the abdomen and support the pelvic floor, already under strain during pregnancy. The Birth Ball is a valuable tool, which can help you remain in control during labour. Its unique design provides physical support for you in pregnancy, labour and the postnatal period. It is an excellent alternative to a chair for sitting and can also be used in a dynamic way to practise exercises and positions in preparation for labour. At the same time it induces a sense of calm and relaxation. Working with the ball helps to move your baby into the best possible position prior to and /or during labour. Such a position favours an easier and shorter labour. The beauty of the ball is its simplicity: it is comfortable, fun and easy to use.
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	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. Use a foot or hand pump such as you would use for an airbed to do this. The ball should feel firm but give a little when you sit on it. Your knees should be lower than your hips, and directly over your ankles when sitting. The ball may soften a little over time so remember to check and pump it up again when necessary. 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 in 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 typically 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 at any time of the day.
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	Use during Labour Once you have become familiar and comfortable with your ball during pregnancy, you will 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 hospital 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 great 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 sitting astride the ball. Using your ball is a comfortable way of feeling supported in labour whereas being on your back could slow down labour making it more painful. Rocking over your ball helps your baby rotate and descend deeper into the pelvis with increasing flexion of the head (chin to chest). As labour progresses the diameter of 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 deliver your baby, 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 Sitting on your ball can be comfortable, especially if your perineum is sore. The ball provides excellent support when practising pelvic floor exercises. Sitting on your ball and circling your hips will firm and tone the hip, buttocks, inner and outer thighs and abdomen. When you feel stronger you can begin to bounce slowly to improve general muscular strength. Progress to firming your abdominal muscles by sitting on the ball with feet apart. As you exhale, tighten your belly below the navel, drawing your stomach in as flat as possible. Hold for 5 breaths before relaxing the muscle on an in breath. N.B. Bouncing would not be recommended if the pelvic floor were still weak. However, gentle bouncing should be possible by six weeks following an uncomplicated vaginal birth.
	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. Try not to wobble. Progress with both arms together and repeat 5 times. 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, draw in your abdomen and rock your knees very slightly to the right (maximum 2 inches). Pause for a moment and take a full breath before bringing your knees back to centre as you breathe out. Pause again, 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!
	Written by YogaBirth 2003
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	References Anderson T. (1998) Me and my birth ball The Practising Midwife September 1998 vol. 1 no9 pp38 Johnston J. (1997) Big Balls and Birthing Australian College of Midwives (Victorian Branch) Open Line Winter 1997 vol. 5 no3 pp7 Perez P.G. (2000) Birth Balls: use of physical therapy balls in maternity care Cutting Edge Press Richards B. (2000) How to use your birth ball (unpublished information sheet) Shallow H. (2003) My rolling programme: The birth ball: ten years experience of using the physiotherapy ball for labouring women MIDIRS Midwifery Digest vol. 13 no1 March 2003 pp28-30 Sutton J. (2001) Let Birth be Born Again. Birth Concepts UK