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Getting baby into the best position for birth
Otherwise known as 'Optimal Fetal Positioning'.
Why is it important that your baby is in the best position for birth?
Simply - it is much easier and more comfortable to birth a baby that is in the optimum position. There are several different fetal positions that your baby can be in, and some are better for birth than others. If your baby is in a less-than-ideal position, it can cause painful and prolonged labor, fetal distress, and possibly even interventions like a C-section.
How to tell what position your baby is in?
You will be able to tell in scans what position baby is in. As you progress in your pregnancy, your midwife will check your baby's position at your appointments. They will record this in the Badger Notes App - you might see 'cephalic' written which means 'head down' or 'breech' which means head up or 'transverse' which means your baby is lying longways. You may see abbreviations such as 'OA', or 'OP' sometimes with a 'L' or 'R' before them - more on these below.
You can also tell by feeling your bump. If you feel your stomach and identify a wide, hard shape, this indicates that the baby’s back is facing forward. If however you feel a lot of small lumps and protrusions, this indicates that you’re feeling the baby’s limbs, and that baby is facing forward. Sometimes the position of the placenta, tone of the abdomen, abundance of amniotic fluid, or excess weight can make it difficult for you to figure out baby’s fetal position on her own so don't worry if you can't work it out.
What positions are there?
To keep things as simple as possible, lets take these 5 terms.
Occiput – This refers to the back of baby’s head, and means head down. Your baby may be lying left or right so you may see 'LO' in your notes for Left Occiput example.
Transverse – Sideways, or laying horizontally across
Anterior – The front of the mother
Posterior – The back of the mother
Breech - Baby is bottom down, head up.
Which position is best?
The best position is known as 'OA' which stands for 'Occipito Anterior'. The 'Occipito' refers to the baby's head and means that it is head down. The 'anterior' part means the baby is facing your back, with their spine coming up the front of your tummy, bottom under your ribs.
Which position is worst? *
A transverse baby must be born via c-section. In most cases, hospitals will advise a breech baby also be born via c-section. Although it is possible to birth a breech baby vaginally, it does come with increased risk and many care providers are uncomfortable with supporting a breech vaginal birth.
'OP' is when baby is head down but instead, their back is coming up your back with their limbs in the front of your tummy. This is known as 'back to back'. A baby lying 'OP' or 'back-to-back' can lead to a lot of back discomfort in labour. Unlike contractions coming in waves, the discomfort can be constant and prolonged in your back, and labour can last significantly longer as baby can't tuck their chin down to move through the birth canal. 95% of OP babies will turn in labour eventually, although 5% will be born in this position. There is also an increase risk of having an assisted birth or a tear with an OP baby.
*It is important to mention here - don't stress about your baby's position until about 36-37 weeks pregnant. Baby will move around a lot during pregnancy, and it is common for a baby to be sitting breech at a 32 week scan but to have moved head down by 36 weeks.
So how can you get baby into the best 'OA' position for birth?
Baby's head is really heavy, and it will move with gravity. If you are reclining a lot, baby will move round into that position back-to-back. So the key is to try to lean forward as much as possible. (Watch the video above for a quick demo).
Way's to lean forward:
Swimming - this is my best tip! Get in a pool and float on your front. This creates a lovely hammock in your tummy for baby to turn into. You could hold onto a wall and float your body behind you, or practise some breast stroke for a few lengths, creating even more space in your pelvis. The key is you are on your front - which you can't do on dry land without lying on your bump. If your baby is breech - many report handstands in the pool can flip them around!
Sitting cow-girl style on a chair - Take a chair and spin it around. Straddle it and lean on the back of it. You can prop some pillows up here so that it is comfortable. Watch T.V. this way instead of reclining.
Hands and Knees - also known as the 'Table Pose' in pregnancy yoga. This is not ideal or practical for long periods of time, but getting onto all fours for tasks can help get baby into the right position. I decided to weed the garden patio in between the slabs, the week before birth which meant I was on my hands and knees a fair bit. I deliberately left this task up until I was 39 weeks pregnant for this reason! So scrub the floors, weed the garden, practise yoga, use a birth ball, but get on all fours! You can also practise cat curls to strengthen your abdomen. If you are having pain in your back from the baby in a OP position, get on all 4's in the bath and run a shower on the base of your back to relieve discomfort,
Birth Balls - When sitting, make sure your ball is blown up enough that your hips are above your knees. Swaying and tilting your pelvis side to side can help baby to move. You can also roll your hips in a circle or try writing your name with your hips. Alternatively you can go on all fours, as above, and hug the birth ball whilst swaying side to side.
The Ironing Board Trick - For a breech baby, lay an ironing board (or surf board or plank of wood) from your coach to the floor. Lie on it so your head is down and feet are up so you are slightly upside down.
Hot and Cold - Baby will move to warmth. Sit in a warm bath and drink something icy cold like an iced smoothie, or rest it on the top of your bump. This can encourage baby to move away from the cold in your stomach and towards the warmth of the bath water below.
Light and Dark - In the same way a baby will naturally move towards heat, they will also move towards light. Try shining a light at the base of your pelvis for baby to move towards.
Try to avoid
Deep squats - which opens up the pelvis and encourages the baby to move down, until you know he or she is facing the right way.
Knees higher than hips - this can happen when driving especially, so if you have to do a lot of driving and you have a low car where your knees are quite high, you can get a wedge cushion that tilts your pelvis forward.
Putting your feet up - Lying back with your feet up encourages posterior presentation.
Reclining - if you are wanting to chill and watch a movie, lie on your side instead with some pillows stacked between your knees.
Crossing your legs - This reduces the space at the front of the pelvis and opens it up at the back. For good positioning, the baby needs to have lots of space at the front.
For more information - Download an information leaflet from NHS Forth Valley here.
Did you find this helpful? Book a course with me to learn even more hints and tips for labour and birth.