Positions, please: how babies’ worlds turn

Your baby’s position in your uterus and pelvis will help determine the type of labour and birth you will have. The position of the baby is significant only in the last few weeks of pregnancy. As the due date approaches, your baby’s head – or bottom – should “engage”. This means they drop into the pelvis in preparation for birth. However, some babies may not engage until labour begins.

Optimal fetal positioning

Optimal fetal positioning (OFP) is a theory developed by New Zealand midwife Jean Sutton and antenatal teacher Pauline Scott.

They believe that the mother’s position and movement can influence the way the baby lies in the womb in the final weeks of pregnancy, and that changing the way the baby lies can make birth easier for both mother and baby.

Part of the OFP theory is that modern furniture (lots of relaxing in front of the TV); modern deportment (not sitting upright); and modern lifestyles (no scrubbing floors on our knees) all encourage babies into an occipito posterior (OP) position, rather than the best position for labour – occipito anterior (OA).

Ask your caregiver if they can tell you the position of your baby. If you lie flat and the baby is in the OP position, there will be a dip or hollow around your belly button.

To encourage a baby into the best position for labour, during the last six weeks of pregnancy (or the last three weeks, if you have given birth previously), try some of the following:

When watching TV sit upright in a chair, on a birthing ball, or on the couch, or kneel on the floor leaning over a beanbag, birthing ball or cushions.

Sit astride a chair that is placed back to front and place your arms on the chair back.

When resting or sleeping, lie on your side with pillows behind your back, and your top leg resting forward so that the knee touches the mattress. This ensures that the abdomen is forward. An extra cushion between the thighs can also be helpful.

Lying frequently on your left side can also encourage the baby into the “left anterior” position, which puts the baby’s spine on the left side of your abdomen.

Go on all fours – keeping your arms parallel with your upper legs – and rotate or rock your pelvis. Some women even crawl around the house to encourage a turn. If possible, spend 10 to 30 minutes a day on all fours in the last four weeks of pregnancy. This can help get the baby into the best position for labour.

Occipito anterior

– OA

The position midwives and doctors love to see a baby

engaged in is head-down, face towards your back, and back towards your tummy. In obstetric terms, this is known as occipito anterior (OA). In this position, the baby is able to flex their head, and the smallest part of the head will come through the pelvis, cervix and vagina first, which is easier on both mum and baby.

Occipito posterior – OP

This is where the baby is coming headfirst but is facing their mum’s tummy. In this position the baby’s head does not fit as neatly over the cervix, and dilation is slower without direct pressure on the cervix, so labour tends to be longer. This position can also cause a lot of backache for the mother during labour.

The majority of babies rotate from a posterior to an anterior position during labour, and this can also result in longer, more painful labours.

Braxton Hicks contractions before labour starts may be especially painful if your baby is OP, with lots of pressure on the bladder as the baby tries to rotate their head.

“You can encourage your baby into an anterior position [see optimal fetal positioning above]. And you may want to try this exercise: In the all-fours position, breathe in. As you exhale, slowly arch your back, relaxing your neck so that your head hangs down. Breathe in again, bringing your body back to the starting position. Try to keep your abdominal muscles relaxed as your gently arch and flatten your back. Repeat about 10 times a few times daily,” says Hanahoe.

Breech

By the end of pregnancy, at 37 weeks, a small percentage of babies are found to still be breech – bottom down into the pelvis and head up. The different types of breech positions are:

Footling breech: feet first;

Complete breech: baby sitting on heels (Buddha style);

Extended/Frank breech: bottom first, with feet up by head;

Kneeling breech

: baby in a kneeling position (this is very rare).

There may be a breech clinic in your hospital where a scan is taken to assess the size and position of the baby, and the amount of fluid around them.

An external cephalic version (ECV) will then be attempted. This is where the baby is encouraged to move by an obstetrician placing their hands on your abdomen and moving the baby through a somersault, and into place. It is usually attempted after 37 weeks but cannot be done if the breech is already engaged.

It is usually easier for the doctor to turn the baby of a mum who has given birth previously, because her muscle tone is less firm. The procedure can be quite uncomfortable, and the success rate is about 50 per cent. If an ECV is unsuccessful, it is still possible to have a normal breech birth.

Tips for turning:

Adopt the knee-chest position. To do this, kneel on your bed with your bottom in the air and your hips flexed at slightly more than 90 degrees (don’t let your thighs press against your bump). Try to keep your head, shoulders, and upper chest flat on your mattress. Maintain this position for 15 minutes every two waking hours for five consecutive days.

If you don’t have back or pelvic pain, try lying on your back with your hips slightly elevated and your hips and knees flexed. Gently roll from side to side for 10 minutes, three times a day.

You can also help encourage your baby to turn to a head-down position by spending time with your hips raised about 30

cm off the floor using firm pillows or cushions.

“Breech deliveries are possible, but many caregivers prefer to deliver by Caesarean section. However, if it is not your first baby, and the breech is well down into the pelvis, it may be worth giving labour a go as the cervix should dilate quickly and your recovery will be faster than after a section,” says Hanahoe.

Transverse

This is where the baby is lying horizontally in the uterus, and neither the head nor feet are in the pelvis. Obviously, this baby cannot be delivered vaginally and a Caesarean section will be required. Often a woman with a transverse lie will be admitted from about 37 weeks in case the waters break, causing a cord prolapse.

Unstable l

ie

This is where the baby cannot make up its mind what way it wants to lie, and moves on an hourly or

daily basis. It happens most often with women who are having a second or subsequent baby when the muscle tone is poorer.

The woman will normally be admitted to hospital at 37 weeks in the hopes that the lie will stabilise. If the baby ends up in a headfirst or breech position, an obstetrician will attempt to induce labour to avoid a Caesarean section. The lie sometimes does not stabilise until 40 weeks, so the doctor can often decide, late in the pregnancy, to carry out a section.

This is an edited extract from From Bump to Birth, an ebook by journalist Louise Ní Chríodáin and Margaret Hanahoe, assistant director of nursing and midwifery at the National Maternity Hospital, Holles Street, Dublin. The book offers practical tips and advice for pregnancy and labour, along with insights from mothers and links to online resources.

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