Guiding Your Baby into an Optimal Position
This information is from Janet Balaskas and Pauline Scott
This information may help you to assist your baby into the most favourable position for birth before labour begins. This applies only if your baby is coming head first and is singleton baby rather than a multiple. From 34 weeks onwards, your own postural awareness and habits can potentially encourage your baby to lie with his or her back to your left front/side (occipito anterior) so that the baby's head engages in the pelvic brim in this position. This will increase the potential for a normal and straightforward birth.
A baby already lying the other way, with spine against your spine and facing forward (occipito posterior) can be encouraged to rotate to the anterior position in late pregnancy or during early established labour. A few babies will remain posterior and this may not be a problem. However, because the extra rotation needed can mean a longer labour and complications do sometimes occur with posterior births, it is worth doing your best to encourage your baby into the optimal position. Please note this advice is intended to complement your antenatal care, and may not be suitable for all women or all pregnancies. Always consult your childbirth or health professional.
DO • Use upright, forward leaning postures regularly. This allows more available space in the abdomen for your baby to lie rotate spine to the front. Be on your hands and knees now and then, swinging your hips (baby hammock).
• Always sit with your knees lower than your hips, with your back vertical. Do this by using 2 or 3 cushions to sit on and another one in the small of your back, if necessary. Sitting on a birth ball is another idea. Sit like this to read on a dining chair, with your elbows resting on the table, knees apart, leaning slightly forward. (Similar posture used when sitting on the toilet.) Or sit facing the chair back and resting your arms on the back of the chair. Sit on a wedge cushion when driving to prevent the pelvis tipping backwards.
• Kneel on the floor leaning over a large beanbag or floor cushion to watch TV.
• Use an office kneeling stool, birth ball Make sure the knee pad is wider than the seat to allow the knees to be kept apart and hips to turn outwards.
• Swim with abdomen forward (avoiding breaststroke - the kick can potentially strain the softened pelvic ligaments).
• Lie the majority of the time on your left side, with a pillow or two supporting the top knee to rest or sleep. It is ideal to use forward leaning postures when having Braxton Hicks (practice contractions) as this increases their effectiveness with regard to helping the baby manoeuvre into the optimal position.
DON'T • Relax in semi-reclining positions. These tip the pelvis back with knees higher than the hips so that gravity will encourage the baby's spine posterior.
• Take long trips in cars with bucket seats. If you must, use wedge cushion as above.
• Sit with your legs crossed. Don’t use the deep squatting position after 34 weeks as it may make it more difficult for the baby's head to engage optimally. Squatting in a modified fashion is OK because your pelvis is not so restricted and is able to move more. If you want to practice squatting during late pregnancy, it is desirable if you feet are flat on the ground with your bottom at least 45cm above the floor. Your hip joints should be in front of your ankles and your back supported against a wall
Tips to encourage persistent posterior positioned babies into OFP position.
• Pelvic rocking three times daily in sets of 20 mins.
• Knee chest position three times daily for 20 mins.
• Take warm baths. Gently massage and encourage your baby to “roll’ over.
• Talk to your baby and visualise him in the position you want.
• Acupuncture, acupressure and osteopathy may be helpful. Seek out a registered natural therapist.
• Your baby’s movements from right to left or from posterior to anterior may be very uncomfortable for you. There may be a lot of churning as your baby starts to rotate and your bones may feel as if they are grinding in your pelvis. Braxton Hicks are likely to increase too.
Wait until your baby is awake (when you can feel some movement) before starting pelvic rocking or adopting the knee chest position. An awake baby is more likely to be encouraged to move! Useful positions for labour - Some can be used in a birth pool
• Stand or kneel leaning forward and moving your hips during contractions.
• Lean forwards over a beanbag or birth ball or on all fours either on a bed or on the floor. Or sit your partner on a chair, kneel on the floor knees apart, and lean onto his thighs. • Hang onto something with arms well above waist height (e.g. your partner's shoulders) and let your body sag from time to time, turning your knees outward.
• If reclining, lie preferably on your left side well propped up with backrest and cushions. Avoid lying on your back in a semi reclining or supine position in bed.
• Marching on the spot, stepping on to a pile of books, or walking up stairs sideways can help a baby move into a more effective position. If your baby is in the posterior position in labour try making yourself comfortable, with pillows, in the knee chest position in early-established labour for up to 45 minutes at a time. This will encourage your baby to rotate. Otherwise use all fours, or forward leaning kneeling and standing positions. Effective labour has only begun when your tummy changes shape with each contraction.
Roll-Over Technique for turning baby in labour (www.spinning babies.com for more info)
- Start with the Hands-and-Knees position. For two to three contractions, the mother rests on her hands and knees. She can certainly have her forearms resting over the raised back of the hospital bed or leaning on a birth ball to save her wrists from strain.
- After three contractions, the mom lays on her side. Either side. Let’s say left side. A long pillow or rolled blanket separates her knees AND ankles to reduce pulling on her pelvic ligaments. She lies with the right hip directly over her left. Her back is straight and she doesn’t lean forward or backward in bed.
- After three contractions, she rearranges herself so that she is now leaning quite forward. A pillow is there for her higher shoulder. The pillow between her legs is moved in front of her abdomen so that her right knee can be bent and rest upon a high pillow. I call this “left lean-over.” It’s a common “yogababy class” relaxation pose. The mother’s belly button points into the mattress as much as possible without lying on the baby. A pillowy nest will raise the mother’s pelvis and ribs a bit to give baby room, if needed.
- After three contractions, the birthing mom gets into an Knee Chest position if she is able to move readily (if a woman is “on an epidural” she will need a lot of help and some open minded providers!). If not, she goes to the next position.
- After three contractions, she lies on her right side, Right-right angle.
- After three contractions, she lies on her right side, leaning forward as described above for the Left-lean over. So she is now, Right-right angle.
- She starts again with Hands and Knees position. Continue this for two more rounds, if that is even necessary.
Timeline for Baby positioning
Baby's position matches the shape of the room within the pelvis. This space is shaped by the abdominal and pelvic muscles, ligaments and connective tissue. Releasing tension or torsion in the soft tissues and joints may be helpful.
By 32 weeks: If baby is breech or sideways you may like to get serious about self care techniques such as Knee Chest position.
From 32-35 weeks: Many babies switch sides. You can tell by where the baby kicks, if that changes, too, then baby changed positions. If your baby is favouring only your right and kicks towards your left then you can enter a period of activity without stress to play with your baby to see if you can influence their position. Knee Chest, Hands-and-Knees, lying on the left hand side for resting after some time stretching and loosing the ligaments and soft tissues in the pelvis.
By 36 weeks: Baby is expected to settle and change position once or twice a week as there is less room.
By 38 weeks: Most first-time babies engage. The lack of engagement is an issue for the posterior baby in starting labour and keeping labour going.
At 41.5 weeks and more: Focus now on baby position and engagement in a relaxed way through out the day. Check out the engagement activities recommended in www.spinningbabies.com