Positioning - For You and Baby
In this blog I’m going to be looking at foetal positioning, (the position baby is in), and positions you can use during labour.
Babies move around throughout pregnancy and even during labour and birth.
Some will move more than others, depending on their size, your size, length of cord, position of placenta, the shape of your uterus (some of us have cylindrical shaped uteruses some are heart shaped which can restrict babies movements). Point is, we are different, our uteruses are different, and our babies are different! So we’re not all going to have the same experiences.
When it comes to giving birth the Optimal Foetal Position, meaning the best/easiest/most straightforward position for birth is called Occiput Anterior (OA). Which simply means head down (occiput) and babies back to your belly (anterior).
They may be facing slightly right or left, but still coming under that OA.
This is great for labour and birth because babys head is in the best position to help the cervix open and the soft skull bones in baby’s head are able to change shape as needed and move more easily down the birth canal.
An OA position for baby often means a quicker and less painful labour and birth as baby is able to descend easily.
Not all babies will be in this position, that doesn’t mean you definitely won’t be able to birth them vaginally, if that’s what you want to do, it will likely mean that labour may be longer and more uncomfortable.
For many reasons baby might not be in the Optimal Position. Baby might be Occiput Tranverse (OT) – so still head down but they’re facing either right or left. Babies often start labour in the position and will move into an OA position as labour progresses.
They could be Occiput Posterior (OP) – head down but back to your back.
Baby can be breech, meaning bum down, could be Frank breech so the first thing you’ll see as baby is born will be their bum. There’s Complete Breech, where baby’s knees are bent and feet come under their bums. And Footling Breech, where baby’s foot or feet will be the first thing that you’ll see.
Breech is famously the scary one, the position you’ll have to have a cesarean for, whilst that may be the case it is possible to birth baby vaginally. A conversation with your care provider and consideration in advance should this be the case is a really good idea.
And the final one here, tranverse lie, so baby is lying across your stomach, and they could be back down, shoulder down or face down. Only about 1 in 300 tranverse lying babies will remain in this position. If baby doesn’t move you will be offered a cesarean.
So that’s all the different possible ways baby might be positioned, now let’s think about your positioning during pregnancy, labour and birth and how might this affect babies position.
Positions during pregnancy
During pregnancy, it’s important to remain as active as possible, I’m not saying start going the gym for some HIT workouts and take up marathon running but regular walks, swimming is a great low impact exercise, prenatal yoga and pilates. All of these not only help keep you fit and healthy they also all keep you moving, which is great for helping baby find their positioning. Whilst rest is important too, it’s finding that balance. As lots of lying down and sitting on the sofa isn’t helpful for giving baby space to move and encouraging them into an optimal position.
With rest in mind, birth balls are great during pregnancy, as they encourage you to sit up straighter rather than slouching on the sofa, which creates space for baby to move and you’ll likely feel more comfortable too!
Sitting with knees higher than hips, sitting with a straight back and lifting your ribcage, brief forward-leaning inversions once a day are a great way to create space in the uterus to allow baby to move and position themselves. Spinningbabies.com have a great online article showing you exactly how to do it, essentially you’ll be kneeling on say the sofa with your forearms down on the floor in front of you, so head down bum high. Do not do this by yourself! Make sure you have someone who can support you with this.
Positions for labour and birth.
We’ve all seen the movies/the dramas, birthing person is lying on their backs in a hospital bed screaming and the midwife is shouting and the birth partner has fainted, it’s a mess! Birth doesn’t have to be like this.
Do you know where this lying on our backs to give birth came from?
Being in an upright and forward position allows our pelvis to open more than it would if we were lying down. This UFO (upright, forward and open) position actually gives baby 30% more space in the pelvis for them to manoeuvre into, down and out the birth canal as well as releasing pressure on the nerves in bottom of the spine.
So, if we’re not lying on our backs what are we doing?
Whatever feels right!
Positions like kneeling, all 4s either hands and knees on the floor or hands/head resting on your birth ball/chair/partner/on a bed leaning over the top of the bed. Sitting on a birth stool/toilet/straddling a chair. Squatting might feel good, although be careful with this as it can increase risk of tearing as it can add to the pressure on the perineum, birth partner can support you here with arms under your armpits and taking your weight.
Standing, knees soft making circles/figure of 8s with your hips can feel so good in early labour.
Try some of these with your birth partner, see how they feel, how do they work.
Just because it feels good now doesn’t mean it will later on in pregnancy or during labour and equally there might be some positions where you feel a bit daft doing it now or you can’t imagine how it would help during labour, but then when labour comes it’s the perfect position for you. That’s the beauty of practising stuff like this, just getting it your brain, sewing that seed that you might use later on. You might be struggling to find a comfortable position and then this pops into your head and it’s just what you need.
If baby is in an OP position, you’ve got what is often referred to as a back to back labour. Positioning to help with this is getting on all 4s, head lower than bum where possible and once in this position you might ask your midwife or birth partner to massage your lower back and/or hips which can help you manage the contractions.
Birth balls are great for resting during contractions whether your sat on it or leaning on it, you could have a nice big pile of cushions/pillows to rest against.
Comfort isn’t necessarily a word you might think of during labour and giving birth, but it is important that you are as comfortable as you can be as that will help your oxytocin keep flowing and keep everything moving.
Listen to your body, it will likely tell you it needs to move and birth partners you are there to support physically but also little reminders might be helpful – ask questions – ‘can I help?’ ‘what if you leant on me?’, ‘what if you used the birth ball/toilet/etc?’ Birth partners you need to be fully engaged here to be watching and listening and supporting as needed.
Positions for labour when movement may be restricted
It might be that you are on the bed for various reasons like maybe you’ve had an epidural or you’re hooked up to a monitor/drip. You still have options, so you might lie on your side with your birth partner taking the weight of your leg. You can make use of the bed, bringing it into almost a chair position and using the bar to hold on to you’ll come into this squat like position. Mamastefit.com has some other really good options, so I’d recommend having a look at their site.
What all of these movements have in common is you are making space for baby, we are opening the hips/pelvis, we are adjusting our posture and creating as much space as possible to allow baby to do their thing and get in the best position they can be for labour and birth.
The most important thing for you to remember is to find the position or positions that feel best for you.