Hello and welcome back to episode 67 of Your Birth Bestie podcast. Today, I am less than a week to my due date of July 8th so positioning of baby and helping my body be ready for birth has of course been on my mind a lot lately. So I wanted to share some information with you about positioning and tips for how to promote optimal positioning during pregnancy for an easier labor and delivery.
I first want to put a disclaimer out there, that I don’t think there is truly a “best position” that is universal for all babies and pregnant moms. Just like everything else we talk about, this is individualized. However, in this episode when I talk about optimal positioning, I am referring to the occiput anterior position or ‘OA’, because this is the position that has been shown to have the best labor outcomes in terms of vaginal deliveries without medical intervention and complications. Typically, by 34 to 36 weeks we like to see babies settling into these optimal positions, but it really varies. The larger baby gets, the harder it can be when they are running out of room to encourage them to turn, but I’ve also heard of head down babies in labor turning breech or vice versa. Pregnancy and birth is so unpredictable, but we can still prepare as best as possible and control what we can, not worrying though if ultimately our experience has to pivot. You can be prepared and confident in all situations, I am optimistic that it is possible for you!
We can start though by understanding what ‘baby’s position’ means, specifically OA. And this means that your baby is head-down with their back facing your belly and their chin tucked into their chest. So basically envisioning that as your baby is born, they are head down and if you are lying on your back, which hopefully you aren’t right?!, the baby's face would be looking down. In this position, the smallest part of the baby's head leads the way through the birth canal, making it easier for the baby to navigate through your pelvis.
But this isn’t always the position babies settle into, which then can make labor more challenging. So I wanted to talk through some of these positions.
First, occiput posterior, is when the baby is still head-down, but their back is against your back. This is often called the ‘sunny side up’ position because if you are lying on your back, baby is delivered and is looking directly up at the ceiling, instead of like OA which we talked about baby is the opposite direction. Babies in the OP position can lead to longer and more painful labors because the baby's head may not align as easily with the birth canal. This can also cause back labor, which is intense pain felt in the lower back during contractions, and overall just makes things progress more slowly and can be more difficult on mom.
Breech position is where the baby is positioned with their butt or one or both feet, pointing down towards the birth canal instead of the head. Breech positions can complicate vaginal delivery; however, the more I am learning, the more providers are starting to become trained again in vaginal breech birth and have it be an option for families, rather than scheduling a cesarean section automatically. More of an informed choice situation, which I love and hope education and resources continue to be available for women whose babies are breech.
There is transverse lie, where the baby is lying horizontally across your belly and this would not be a possible position to deliver vaginally unless they shift to a head-down or breech position before labor begins. A c-section would be needed in this case.
The last lie I want to talk about is an oblique lie, where the baby is positioned at an angle, with their head or butt pointing towards one of the mom’s hips. This can also complicate vaginal delivery.
And just generally, the position of your baby can affect the length and comfort of your labor. When the baby is in the occiput anterior position, it can make the birthing process more efficient and less painful, where the less ideal positions can lead to longer, more difficult labors and may require interventions, such as turning the baby manually or opting for a cesarean delivery.
Understanding your baby’s position can help you take proactive steps in pregnancy or even during labor to encourage an optimal position.
So now let's talk about some practical tips and techniques that can help encourage your baby to move into the optimal position for labor and delivery. I will talk about daily activities, specific exercises, and some alternative therapies that you might find helpful. Of course, I am not your medical provider, so these are general recommendations that might be a good option for some moms, but individualized care is so important, so please check with your provider if you are unsure if these apply to your situation.
One underrated piece of baby’s positioning is in general staying active and incorporating certain exercises into your daily routine, early on in pregnancy. It doesn’t have to be this huge complicated list of exercises to promote good positioning from the beginning, just a few things to try.
These include just two things, pelvic tilts and walking. Swimming is also a great exercise if you’re up for that, where it takes the weight off your joints, allowing for full range of motion, and the buoyancy of the water can also help the baby move into a better position. I don’t personally have access to a pool on a regular basis so haven’t done that, but pelvic tilts are a simple and effective exercise too and walking is something I enjoy doing with my family, so have made that more of a priority during pregnancy too.
For pelvic tilts, what you would do is get on your hands and knees, keeping your back straight. Tilt your pelvis forward, pulling your belly button in towards your spine. Hold for a few seconds, then release. There really is no rules to how often to do this, but maybe two sets of ten, doing that in the morning and night to help encourage your baby to settle in a good position. The guideline on walking isn’t rigid either, but it does help keep your pelvis loose and flexible and helps baby into a head-down position. 20-30 minutes per day would be great and seems totally doable for most people!
If you’re looking for something more specific in addition to those regular daily activities, there is a well-known method called the Spinning Babies approach that you might have heard about before. Spinning Babies covers several exercises that help create space in the pelvis and encourage the baby to move into the optimal position. A few of the most popular exercises are the forward-leaning inversion, side-lying release, and lunges. There is also the breech tilt to help turn a breech baby.
But the forward-leaning inversion is where you will kneel on the edge of a couch or bed with your hands on the floor and your head lowered. Hold this position for about 30-45 seconds, then carefully return to an upright position. If you are doing this during labor, holding the position through one contraction, coming back up to kneeling and then once more for another contraction is what is recommended. This exercise helps to relax the lower uterine segment and ligaments around the uterus, giving the baby more room to move. It can be helpful if baby isn’t in the best position or maybe labor is stalling a little bit.
The side-lying release also helps make room for baby and can be done every 4-6 hours during labor for moms with an asynclitic or posterior baby, are having a long labor, back or pelvic pain, anxiety, or it is requested by the laboring person. It can also be done during pregnancy at any time as long as it’s comfortable for mom. This one is more difficult to explain, but I will link all of these positions in the show notes as well with visuals, so hopefully that is helpful. You’re basically lying on your side as close to the edge as possible with your belly hanging off and your top leg dropping down in front of you with the support of your doula or support team. You would lie on one side for three contractions and switch to the other side for three contractions. This exercise temporarily lengthens the pelvic floor muscles by releasing tension and evening out the pelvis to help baby navigate into a better position.
And then if the baby is breech, so butt or feet first, you can do the breech tilt. This is where you lie on your back with your knees bent and your feet flat on the floor. Place a pillow under your hips to elevate them about 9-12 inches off the ground. This position can help encourage a breech baby to flip to a head-down position. Hold for 10-15 minutes, and repeat two to three times a day. There are also other exercises specifically for breech if that is the situation you are navigating and I will dedicate an entire episode to turning a breech baby in another episode.
I also want to touch on posture and body alignment because it also can play a huge part in baby's positioning, so being aware of this as your pregnancy progresses hopefully helps.
As far as sitting positions, it is best to sit forward, with your knees lower than your hips and your back straight. Use a cushion to support your lower back if necessary, and avoid reclining if possible because that can direct baby’s head in the opposite direction of where we want it to be. Also, not crossing your legs if possible because that can create an imbalance or tightness on one side limiting baby’s ability to navigate the pelvis and descend into an optimal position. This one is hard for me typically, but as my belly has gotten bigger I honestly don’t feel the need to constantly cross my legs, so I guess that is probably a good thing!
A great tool to use at any point in your pregnancy and I recommend everyone gets one for themselves to use at home or work or both, is a birthing ball or an exercise ball, they are the same thing. Sitting on a birthing ball can help improve your posture and keep your pelvis in an optimal position, also allowing you to gently rock and do hip circles to encourage your baby to move within your pelvis.
Some moms also find relief regarding pregnancy discomforts and also improved baby positioning through chiropractic care and prenatal massage. Finding providers that specialize in assessing and treating pregnant women is the most important piece. Chiropractors who specialize in prenatal care can perform adjustments to help align your pelvis and spine. There is a technique called the Webster Technique, specifically for chiropractic adjustments that aims to balance the pelvis and reduce tension, which can help the baby move into the correct position. I did this early in my third trimester for a few sessions and the provider I saw was great, really knowledgeable, and the adjustments were very gentle and intentional.
I also saw a prenatal massage therapist that I personally was able to find more relief with due to what I was experiencing with pubic symphysis pain and sciatic pain and was able to find relief relaxing tight muscles and ligaments, hopefully creating more space for my baby to move. Making sure to see a massage therapist who is trained in prenatal massage is an important part of this too. Both are great options to do together or try either to see which you prefer.
Lastly, there are alternative therapies like acupuncture and moxibustion that can be beneficial in helping baby move into an optimal position. I have heard several stories of these working to help turn breech babies into a head-down position which is pretty cool. Acupuncture involves the insertion of thin needles into specific points on the body and I am no expert so if this is something you’re interested definitely more to learn about that. And moxibustion is a traditional Chinese medicine technique that involves burning a herb called moxa near specific acupuncture points. It's often used with acupuncture to encourage a breech baby to turn like I mentioned and is something I have heard has pretty promising results, but I don’t personally know all that much about it. I am scheduled to take a training in moxibustion at the end of this month, so I will keep you posted about what I learn and maybe will do another episode specifically on moxibustion which I’m excited about.
Overall, I hope it is reassuring to know that there are a lot of things that can be done to encourage your baby into the best position. This is not an exhaustive list, just a few commonly used ideas to help. For more information, spinning babies is an amazing resource to look at their website and see what recommendations there are for wherever you are in your pregnancy journey or whatever situation you are navigating. I also follow the body ready method on instagram and they have amazing programs for professionals and parents to prepare the body for birth, a lot of which is exercises to create more room in the pelvis and help align the body for labor.
Thank you so much for tuning in to Your Birth Bestie podcast! I hope you found today’s episode helpful. If you did, please subscribe, leave a review, and follow me on Instagram @bethconnors_cnm. I will be back next week with another episode, all about prenatal breastfeeding education with my favorite board certified lactation consultant and postpartum nurse. Bye everyone!
