There is a growing dogmatism about fetal positioning. Remember, most posterior babies rotate in labor.
But, how do you know whether your baby will be the one that can be born normally, or if your baby will have a difficult time rotating or fitting without rotation? Birth offers a spectrum of possibilities.

Like a rainbow, the statistical tool called a bell curve is highest in the middle. The bell curve illustrates the common idea that most people will experience something similar to each other there are less usual variations on either end of the spectrum. For most women, childbirth involves more work then they expected. That's why we call it "labor." For a few women on the near end of the spectrum labor is easier, at least easier from her midwife's point of view! And on the far end of the rainbow, though their is a pot of gold, there is quite a lot of work, and sometimes a lot of surrender, to finish the birth.

Really, fetal position isn't the most dependent variable on the spectrum of ease. Some posterior babies have easy births.  Some anterior positioned babies take a long time. This article will begin to address what makes labor easier or harder. A woman carrying her baby in a posterior position shouldn't have to feel fear. But she should take some steps in pregnancy to help her baby, herself, and her labor. Active birth isn't passive.

Your labor is likely to be easier rather than harder if your body is in balance, you have a doula with you, and your expectations match your experience. These three things happen to speak to the body, the heart and the head.

How your care giver attends to, or manages, your labor will also effect your experience. Many women with a birth plan for a natural birth are still seeking care from surgeons - the obstetrician. While I know a few obstetricians who trust the birth process and are patient to wait during a long labor with a healthy mother and baby, many just don't have the exposure to spontaneous, natural birthing. When labor is long, or the mother gets scared from the unexpected, the hospital system offers drugs to dampen or hurry the experience, or surgical tools to shorten or finish the birth. Adding a doula to her hospital birth experience reduces the amount of pain a woman perceives (given that she asks for less pain medication) and has been shown to shorten active labor. Seeking help outside the medical system (homebirth midwife or doctor) is another way a woman might achieve her natural birth plan.

Questions about who you have helping you

Is your partner supportive? Generally interested and enthused to be a parent with you? No partner has to be perfect, but a supportive partner is associated with a higher rate of natural birth. A nervous partner can sway the hospital staff towards offering more medication, an epidural or a cesarean. Without the partner's support the birthing woman may feel she has little choice.

Do you want a doula with experience in natural childbirth? Do you think you may want an epidural, but know you don't want a cesarean, unless necessary? Seek a calm, open minded doula with experience helping parents with various comfort measures, maternal position changes and who knows something about helping a baby to rotate. But any pleasant doula is wonderful. All the doula studies showed clear benefits to doula care even though these research study guidelines did not ask the doulas to do advocacy. Little emphasis was put on fetal position, if any.  The soothing presence of the doula made the most difference.

The continuous presence of a doula has been studied widely and repeatedly. A doula has been said to be the only obstetrical intervention shown to benefit mothers without any harmful side effects.  Make sure the doula you hire is available 24/7 in the month around your due date or has a partner/back up so that one or both can be with you throughout your entire labor. 

Do you have a midwife? Traditionally midwives were taught ways of labor progress before surgery was an option. Today midwives are trained in settings with easy access to pain medication and surgery. If a midwife wants to use reassurance to sooth the mother, comfort measures instead of, or before trying, pain medications, or to keep her cesarean rate under 5-10% she has to seek out information beyond what she got in her college training. Ask your midwife if she is interested in the goals of your birth plan. 

A midwife is not a doula. She may think she gives the same care as a doula, but as a midwife and doula myself, I can assure you she cannot. she can be loving and kind, she can stay with you, but she can not be a peer. She is the person you choose to guide you safely through the passage of Birth. These are two different roles with different goals. The doula goal should be your emotional experience of birth and comfort measures to help you achieve your goals. Because a goal of a natural birth is important to many mothers and babies, doulas often have some skill in how to use maternal positions and activities for labor progress. But the doula doesn't assess you or your baby's health or your labor. She isn't following your care in the way your midwife or doctor does.

The midwife has responsibilities to see that equipment is set up for the birth right about the time the mother is in transition and needs a woman's reassurance. The midwife is checking the mother and baby's vital signs, charting and sometimes asking the mother to accept things she doesn't want, a position for progress that is not comfortable, a position to help her monitor the baby, perhaps even an intervention, etc. The doulas only responsibility should be to the mother.

Doctors are individuals with as many differences as midwives. Their views on birth reflect the mentors that gave them training as well as the experiences they've had since school. They are juggling many patients and many tasks. Doctors are usually with the mothers a very short time in labor. They usually come in and check on a patient if the labor is occurring before or after office hours. But many times, they are speaking to the nurse on the phone rather than coming in to a labor room. That's how our system is set up, to get the most work from the fewest people.

A physician who attends births may be family-practice (general) or an obstetrician (surgeon who knows about childbirth and its complications). Some physicians trust birth, but most have been trained to see natural birth through the rear-view mirror. One doctor said, "a birth is normal only after the baby is born, before that anything can happen." Don't expect your doctor to know techniques for natural birth after 8 years of school to learn every complication imaginable. The doctor may be a little stressed in a long labor or when helping a vocal woman. Be patient and nurturing to your doctor, just as you would have your doctor be with you.

Nurses are of primary importance to safe birthing in the hospital setting. A warm, attentive nurse is remembered fondly for a lifetime.  Guidance without overbearance is a revered skill. Let your nurses know their importance for a pleasant birth memory by greeting them by name and inviting their views and skills to help you achieve your birth plan. If you want a natural birth in the hospital, welcome your nurse to be your ally. The nurse might think of something helpful when she doesn't have to have her guard up to protect her feelings when helping a family who is asking for something unique. She will enjoy working with an open articulate family who is eager to love their baby.

Hospital work culture effects birthing. To help themselves treat many patients at once, doctors have developed maternity wards, or maternity floors. This is useful in many ways, but it means that the mother has to leave her home environment and go to the medical place of business. This is a simple intervention known to lengthen labor, at least until the mother can "settle in" to her new location. Calm, nurturing staff help this transition. Visit the hospital before labor to see if the hospital you chose has a nurturing work environment. That's  important. But you also want to know that you can walk around in labor, eat and drink as desired, and maybe take a shower or bath in labor. You'll want to know you can bring your partner, doula and anyone else whom you choose who will nurture you in labor.

There are well developed communities of families and professionals who support natural birthing, vaginal birth after cesarean, woman-centered birthing, atttachment parenting, you name it. Online or in person. Find your niche. Hang on tight. The support of a confident peer goes a long, long way! 

Questions about your birth and reproductive history

Have you had a breech or posterior baby in a previous pregnancy? The causes leading to the baby being in a challenging position in one pregnancy are likely to still be present for the next pregnancies. See the 3 Principles.

If your uterus is tipped before pregnancy, it may effect labor progress in your first birth.  A uterus gets tipped when the supporting ligaments are not of equal length. A tipped uterus is one of an assortment of correlating factors that may be associated with fetal malpositioning. Painful periods are an indication of a tipped uterus, but not conclusive. 

Have you had a fall, fender-bender or big accident? A slip on the ice? Played soccer, or another sport with sudden stops? If your pelvis is out of alignment, or your ligaments were jerked out of balance, it may effect labor progress in any labor.

Have you had significant emotional stress as a child or a young woman? A history of abuse can tighten your psoas muscles protecting your abdomen. The tightened psoas (so-as) can hold your baby up high, lengthening labor or making a cesarean necessary if you don't have the time to labor, the necessary support to labor with, or even a simple psoas release in labor. Many women with a history of abuse labor just fine.

Having a history of one or more of these events could mean that your body is storing some of that stress via tightened muscles. Sometimes the pelvis twists a bit. One leg will be a little shorter than the other. You may feel no discomfort now if this condition happened long ago or came on gradually. Remember, I am addressing a variety of casusal factors. People are too complex to share the same results from the same events. Whether we wore a seatbelt on the right or left shoulder, if at all; whether a fall happened when we our bodies were tense or relaxed; whether we could effectively say no to the abuse; all these things and many more will change the outcome.

Which baby is this for you?

Is this your first baby? Or, your first baby to birth vaginally? Definitely use the pregnancy exercises on this site to achieve even more balance in your womb. Read further down to see at what level of effort you may benefit from the most.

Is this your second baby? Or have you given birth 3 or 4 times? Did labor proceed well? Then you aren't likely to have trouble, even if this baby is posterior.

It may take a couple extra hours in early labor to get baby rotated around or the chin tucked. And active labor may take an extra half hour or more. But unless this baby is particularly bigger and can't rotate in labor because of pelvic shape or an epidural before the baby is tucked in (so to speak) and low in the pelvis, the baby will follow those road signs left by earlier siblings to "turn here." These babies find their way. If you've had an accident or something else that would effect your fascia, pelvic floor, alignment, etc. read on for tips.

Is this your 6th baby or more? Wearing a pregnancy belt can help lift weaken abdominal muscles so that baby is positioned well and aimed towards the pelvis when labor starts.

A few babies, whether first, second or which ever number, have trouble getting through the pelvis. Do a self check for the following:

In pregnancy, ask these questions

Was/Is my baby head up after 34 weeks gestation (seven months)? This is about when you started seeing your midwife or doctor twice a week for appointments.

Is baby sideways in my womb (transverse) and it is after six months?

Did I have one or more times when I got a piercing cramp in my side in the second trimester, a round ligament spasm that made me catch my breath and hold my side for several seconds or a couple minutes?

Do I have hip pain, more than usual uncomfortability when baby kicks or stretches, or uncomfortable pressure "grinding" against my bladder, pubic bone or behind my clitoris?

This indicates tight ligaments. The grinding against the bladder or pubic bone may be the baby's forehead trying to move past a tight round ligament (late pregnancy). Spasms in the broad or round ligaments generally come from a twist, or torsion, in the womb. Myofascial release and Chiropractic adjustment does help. At home, do the Forward-leaning Inversion repeatedly to release your ligaments and help the womb back into balance. A woman who is quite uncomfortable in pregnancy because of twinges and aches is more likely to have a posterior baby. This is because the tension and twist in the uterine ligaments causes the discomfort as well as the fetal malposition. That's not to say that a comfortable woman can't be carrying a posterior baby or an uncomfortable woman doesn't have an anterior baby, but on the spectrum of ease, the woman who is often bothered by pregnancy discomfort is more likely to have a posterior baby, in my experience. There is anecdotal agreement among chiropractors and craniosacral/myofascial release people that I've spoken with and learned from. I see this frequently, but not 100%.

Baby's movement pattern at the end of pregnancy

Does it seem like the baby, at 8 months, shifts back and forth, back and forth, not settling on one side or the other for more than a few days? There are two pertinent interpretations of this. One is that the head is not changing but the baby shifts his or her trunk to try to turn the head. The other is that the baby simply settles to the right when you lie on yoru right side and settles to the left when you lay on your left. By noon, or after you've been up and walking abit, the baby settles into a more central - or more preferred position for when you are vertical. This baby isn't changing sides, but simply leaning. The feet are always on the same side, either always to your right and the back is always to the left, its just that the baby leans because the uterine ligaments are loose. This isn't a problem unless your womb is too loose to direct the baby into -and through- the pelvis. A pregnancy belt (in pregnancy and in labor)or the Belly Lift (in labor) will help the baby aim in to the pelvis.

Note if your baby been in one single position, with the feet kicking, but always in about the same place, since 7 months along?  This baby would have it's back in one place, probably on your right side. Baby doesn't seem to shift its bottom or trunk position much at all, except to stretch his or her bum up once in a while or stretch a foot or hand. The baby may lean to your right, may have hands in front where they are felt above your pubic bone and below your navel. See Amanda's note at the bottom of this article...

Belly Mapping is a method I've developed to help you make a picture of fetal position out of the baby's kicks and wiggles in the womb.

If you said yes to any of the above questions

Spend a portion of each day doing 4-5 exercises on this website.

• Rebozo sifting to relax the broad ligament
• Standing Sacral release to release the sacrum and hlep your pelvis become more mobile

• Forward-leaning Inversion to balance your uterine ligaments and adjust your own pelvis with many repetitions of this type of maternal inversion

• Psoas release
• Symphysis self adjustment
  
• Pelvic floor release
• When baby is active, then do 40 pelvic tilts on hands and knees, especially immediately following a Forward-leaning Inversion
• Crawl around on all-fours for 5 minutes
  

Not all of these techniques are shown on this website. I'm entering content as fast as I can!

You may need professional help to get the baby situated in a better position. These are each signs that your abdominal ligaments and your pelvis is out of alignment. When the mother's body is not symmetrical, or aligned, the baby can't lie symmetrical and head down in the womb. Getting body work or other professional help for optimal fetal positioning can improve flexibility in the womb so baby can reposition.

There are several things you can do at home, too. Some women won't have access to professional help. There are still things you can do if you are willing to get busy. Start now. Yes, now.

Specific Situations

When baby seems to change position frequently

Have the midwife carefully assess to see if the baby's forehead is leaning against the pubis rather than the nape of the neck. The forehead and the nape of the neck are the same width and can fool even experienced birth attendants. Which they are matters, as one indicates a well tucked head and the other (the forehead) indicates an un-tucked, or deflexed, head.

The baby didn't engage

If a first time mom's baby doesn't engage into the pelvic brim by the time labor starts (or doesn't during very early labor) her chance of having a cesarean is far greater than for women whose babies have "dropped." First babies usually drop around 38 weeks or two weeks before the due date. Some earlier some a little later. Babies of the moms who have given birth before may drop before labor and may not drop, or engage, until labor is under way. They are not at higher risk, per se, for a cesarean unless they have other factors, like induction with an unripe cervix, epidural before engagement, having the doctor break their water, etc., factors that have been shown to increase cesarean birth. Women with a triangular pelvis and women with a pelvic entrance that is wide side-to-side but short front-to-back have to help their babies into an LOA or LOT position in midpregnancy. Read about pelvic shape and fetal rotation.

Some first time moms and some first time VBAC (Vaginal Birth After Cesarean) moms have straight forward births, remember, even posterior births. Contractions help soften the abdominal structures and the posterior baby will usually rotate and come down. It is the 20-30% of posterior babies that need our help to finish the birth.

Solutions

You will want to make sure your abdomen is relaxed, balanced, or symmetrical, and toned enough to aid rotation and descent. Don't worry, you don't have to be an athlete. You can use a pregnancy belt to "fake it," to help give you the tone for birthing.   Read "The 3 Principles."

Here is an email from a woman whose baby has been in the same position, maybe a posterior position, for weeks. She is concerned because this is a sign that labor may be longer and harder.

 Sat, Feb 7, 2009

"Thank you for a very interesting page.
Here is my situation:
I'm a short, narrow-hipped woman of 26, 34 weeks with my first. He's spent most of the last two months stuck in something seeming like ROT or ROA. He hardly moves at all.
If I've understood all correctly, this is not good at all, and my chances of a natural birth seem very small...I feel very anxious and sad by this.
I live in Holland and don't know where I could find help for this, or if I can afford it.
I'd be very thankful if you could give me any advice...
I thought everything was going fine and I have spent so much time reassuring myself that with patience and effort even I can make it, but luck [doesn't] seem to be on my side...

Thank you for taking your time to read and hopefully also answer.."

Gail wrote and told her some things to do:

 
"First of all, most women in your situation most often do have their babies under their own efforts. Being short and narrow-hipped is no prediction of being able to give birth. I'm short and, at nine months pregnant, my hips fit easily in a baby's highchair! (Even though I'd gained 45 pounds.) I had a rather short labor and my boy was 8 1/2 pounds (3800 grams) with his hand up by his face. He had (and has) a big head.

Now the ROT  situation adds the posterior variable to your situation. It is unlikely that your first time baby is ROA, see Belly Mapping for why, but it is possible. That your baby hasn't moved his or her back out of this position may mean that you have tight uterine ligaments. It may mean you have a placenta in the anterior wall of the uterus on your left side. I certainly can't assess over the internet. Your baby may be ROP, also. You would tell this by your ability to feel small, wiggly (not thumping) movements near your bladder. Thumping there could be a head. Frequent thumping or grinding on your pubic bone is often the forehead. Neither the OA baby, nor the OT baby, whether ROT or LOT,  thumps their head on the pubis.  Or might once, if descent to the pubis was quick. Repeated thumps on the pubis are a habit of the posterior baby.

There are ways you can soften your ligaments. The last trimester of pregnancy will do some of the work for you, but I'd suggest you do some activities every day.

Foremost, do the inversions. Do 2-3, short, 30-second inversions a day for the next week or two. That may help loosen up your soft tissues.
Psoas releasing poses will help baby descend.  Hip openers (yoga poses) and pelvic rocking will help your pelvic joints be looser.

Sifting.

Begin with sifting your belly (and broad ligament) with a long woven scarf, in Mexico such a scarf is called a Rebozo.  Its 3-6 meters long.

Inversion.

After sifting, do an inversion. You can also do your 2nd and 3rd inversions of the day without sifting, or 1st and 2nd, doing the sifting in the evening when you have a helper to do this relaxation of your broad ligament for you.

Pelvic Floor Release.

Once now, once at about 39 weeks, and once in early labor, do a pelvic floor muscle release.

Myofascial Releases.

If you can find someone to do both the sacral release and a diaphragmatic (abdominal) release (both myofascial techniques) have this done 2-3 times a week for two weeks and then once a week and once in early labor.

Labor, in general

Give your self time, eat small amounts often of nutritious, easy to digest food during labor, sleep whenever you can and don't have expectations of time or intensity. Let it be what it is. Get a calm, mature person to stay with you throughout labor, not having to leave you, someone who trusts birth and knows how to calm you and keep you going - a doula.

In Early Labor

Do  the Myofascial Releases, the Sifting, an Inversion and one Pelvic Floor Release. Then sleep in a Rest Smart Position or go about your day with vertical and leaning forward maternal positions. Stay off your back and out of recliner/rocking chair. Drink 12 oz of fluids an hour. Eat lightly and every 2 hours. Move when you are awake. A birth ball is a useful tool, keep your back straight. Rest when you are tired. Get really into a good sleep if at night, but with back rubs, warm drinks and deep breathing. Have an electrolyte drink.
If you get really strong contractions early on : Try and avoid medications if you can be patient with the turning contractions. They will ease up after the baby rotates. Get into positions that help the baby rotate, Sitting on a birth stool for 4  contractions then standing for 2, for instance. Hands and Knees is another, and laying on your side with your top leg lifted, bent and resting on a tall pile of pillows from your knee to your ankles so that your lower leg is not twisted.

In Active Labor

Rest Smart when you are resting.
Use good maternal positioning and movement when you are not.
Drink 8 ounces of fluids an hour, pee often, and eat small amounts every 2 hours. If you get really tired, sleep to snoring. Then eat a big bowl of oatmeal with honey, lots of honey, to get labor reved up again. Have an electrolyte drink.

You may feel like pushing before its time.

Pushing.

Don't curl to push. Straighten your back or arch backwards as the birthing instinct leads you. Let the urge come before you work hard. Once pushing actively you may have to push hard and maybe long, so rest between contractions and have honey in very warm water, like honey tea, frequently. Have another electrolyte drink.

Sometimes women don't feel like pushing when they are fully dilated. If you do not feel like pushing, take a nap.  After you snored, then eat a meal, then sit upright on a toilet or birthing stool for 4 out of 6 contractions, standing for 2 contractions.
Once the baby is on the perineum, rock your baby out gradually. Push and release, push and release. This is a first baby so you probably will have to do some pushing, like moving a piano. Breath and rest in between, getting good oxygen exchange for you and your baby.

I hope you give labor a good chance. Labor is so good for a healthy baby. Get a good birth doula and hopefully your midwife knows about the pelvis and maternal positions and, possibly, long labors.

Happiness,

Gail "

This email is also posted in the About Breech article. Wed, Feb 11, 2009

 

"...I'm 30 weeks and the baby is what I'd describe as oblique breech - his head is on my right side next to my belly button, his hips/butt are in my pelvis on the lower left side (my left) and his feet are in front of his face. I think he's facing forward - towards my belly button. I've known this for weeks just because his big head is so hard I always bump that spot on accident.
.... my first son was 9 lbs and born posterior, so I'm really hoping this baby is in the ideal position for delivery... so both of these things make me nervous that he won't move. He has been in this position for a few weeks now. ...
Anyway, just wondering if I should worry and what, if anything, I can do to help him move now. My Midwife suggested a Chiropractor that can do some adjustments. I'd like to do the couch inversion too. Would it help for me to walk more? Also, should I sleep more on one side than the other?
Thanks for your help! Great site!"

"Hi....

It is common for babies to be breech at 30 weeks. However, now is a good time to take action, not so much that your baby is breech, but because your first baby was OP. You see, a pelvic misalignment and/or round ligament spasms (they often go together) can result in either a breech or a posterior fetal position. So, a breech will often flip to a posterior position and may stay that way unless you resolve the underlying issue.

Maternal positioning is often not enough by itself to correct a posterior fetal position when there is a history of previous posterior or breech babies. While certainly, most breech babies flip head down, its beneficial to help correct the symmetry of your uterine ligaments now, while the baby is still small enough to have plenty of room to flip head down once the reason for the previous posterior position is remedied. 
See some things a Chiropractor can do for breech and posterior by clicking on the title of Profession Help, under Techniques.

Happiness,
Gail "