How to Line Up Your Baby

There are many different positions that a baby may be born in. Some are easier and others are longer and more painful. Knowing which position your baby is in prior to labor can shorten your labor and make it easier for both you and your baby.  In this post, we will review some tips and tricks to get your baby lined up.

‘Optimal Foetal Positioning’ theory was developed by midwife, Jean Sutton.  She noticed that the mother’s position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. She further noted that many difficult labors result from this malpresentation. Where the baby’s head placement makes it hard for the baby to move through the pelvis.  She then studied and shared her observations, that the baby’s position could be noticed, corrected, and improved for vaginal birth.

 

The occiput anterior (OA) position is ideal for birth – it means that the baby is lined up perfectly and can fit through the pelvis as easily as possible. In this position, the baby is head down, facing your back, with their back on one side of the front of your abdomen. In this position, the baby’s head is easily ‘flexed’ or aligned with the chin tucked onto the chest. Meaning the smallest part of their head will be applied to the cervix first. This position is further delineated by which way the baby is facing:  Left Occiput Anterior (LOA) or Right Occiput Anterior (ROA).

 

The occiput posterior (OP) position means the baby is still head down but facing your abdomen with the baby of their head grinding against your spine and pelvis. Think like a sunny-side-up egg.  When the baby is in the posterior position, you are more likely to have a longer and more painful labor.  Most babies rotate in the pelvis and tuck their chins (OA position) so that they face the spine which makes it easier for them to fit in the pelvis.

 

It is important to remember that posterior babies may not engage or descend into the pelvis before labor starts.  The fact that they don’t engage means that it’s harder for labor to start naturally.  Oftentimes, these babies go postdate or ‘late’. Additionally, the uterus may try to help these babies to align with Braxton-Hicks contractions before labor starts. These may be painful as the baby tries to rotate and enter the pelvis. Additionally, posterior presentation is more of an issue for first babies and births than it is for subsequent births. When a mother has given birth before, there is generally more room for the baby to maneuver and rotate during labor.

 

Bodily actions and positions impact our baby’s positions.  Sitting in car seats, reclining at work, and leaning back on comfortable sofas encourage OP babies. Paying attention to your posture in the last few weeks of pregnancy can help to align your baby.  Try replacing a chair with a birth ball, sit your car seat more upright, ditch the high heels and wear flats.

 

When do you need to start considering your baby’s position?

Starting around 32 to 34 weeks of pregnancy, you should start paying attention to your posture. This is a critical time, as this is when babies start to engage or descend into the pelvis.

 

How to know what position is your baby in?

This is important to know when your baby moves into a good position so that you can encourage it to stay there! You can learn to tell what position your baby is in, by asking your provider to show you what to look out for, and by practicing feeling for the baby yourself. Spinning Babies has a belly mapping worksheet to help parents to learn more about their baby’s positions.

 

When the baby is anterior (OA), their back feels hard and smooth like a rounded brick on one side of your abdomen. You will feel kicks under your ribs. Your belly button will poke out, and the area around it will feel firm.

 

When the baby is posterior, your tummy may look flatter and feel squashier, and you may feel arms and legs towards the front, and kicks in the front towards the middle of your abdomen. Your belly button may dip into a concave, saucer-like shape.

 

The head feels hard and round like a grapefruit. The buttock feels soft and round.  You may find it easier to feel your baby’s position if you lie on your back with your legs stretched flat out.

 

Steps to avoid posterior positions.

The baby’s head is the heaviest part of the body with the back favoring gravity.  So:

• Avoid positions that encourage your baby to face your tummy. The main culprits are reclining in armchairs, couches, and the car where your knees are higher than your pelvis.
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seatback upright
• Spend most of your time sitting upright or leaning forward slightly.
• Several times a day go to your hands and knees for cat/cows. Try wiggling your hips from side to side, or cat cows (arching your back like a cat, followed by dropping the spine down).
• Try replacing a chair or couch with a birth ball, floor cushions, or sit on a dining chair. Or try straddling a chair facing the back.
• Avoid high heels which change the alignment of your pelvis.
• Don’t cross your legs! This reduces the space at the front of the pelvis and opens it up at the back.
• Don’t put your feet up! Lying back with your feet up encourages posterior presentation.
• Sleep on your side, not on your back.

 

If your baby is already posterior.

 

• Avoid deep squatting until you know your baby is aligned. Instead, use the ‘knee to chest’ position. When on hands and knees, stick your bottom (butt) in the air, to tip the baby back up out of your pelvis so that there is more room for him to turn around.
• Sway your hips while on your hands and knees.
• Crawl around on hands and knees as if you are washing the kitchen floor for 30m or so.
• Try curb walking, with one foot on the curb and the other on the street, switch halfway through your walk.
• Don’t put your feet up! Lying back with your feet up encourages posterior presentation.
• Marching and step-ups on a small stool, alternating the primary foot.
• Work with your doula to help correct the baby’s position.

 

 

Final thoughts

Some babies choose the OP position because it is best for them. Some babies will choose a posterior position to avoid an anterior placenta. These babies may rotate later in labor. Talk to your provider to see if there is a reason to work or not to work on your baby’s position.