Around 26-30 weeks gestation, pregnant parents are pleased to hear their breech or sideways-lying baby is now head down. Some parents aren’t informed of baby’s position until around 36 weeks. During the last the provider wants to know whether a baby is breech and may need help turning head down or to schedule a cesarean on their operating calendar.
But head down is only half the story as which way a baby faces can also mean the difference between a vaginal birth and a cesarean, though for much fewer babies than those found to be breech.
Frightening birth givers?
There are discussions among birth educators, midwives and doulas on the pros and cons of telling pregnant persons whether their baby is posterior or not. Some express the opinion that babies can change their position at any time and so whether the baby is posterior in pregnancy is not worth alarming parents. Others feel that knowledge is power and since the intervention rate is higher, even though not absolute, with posterior presentation, that parents want to know in time to do more preparation for easing the efforts of labor to rotate the baby.
What’s the evidence?
One hospital studied 103 births in which the baby persisted in a posterior presentation (facing the front) compared to 1054 births with anterior presentations (facing the back). A little more than half the babies were known to be posterior before birth and 45 were found to be OP during the emergence of the baby.
When trying to turn baby manually, by turning baby’s head during a vaginal exam, the cesarean rate came down to 16.7%. Five babies who couldn’t be turned and were born by cesarean and 11 babies who couldn’t be turned were born vaginally. Compare that to 60% cesarean when no attempt was made to manually rotate the baby to anterior.
What else can we do?
Spinning Babies asks providers to try a physiological technique first. We find that by activating the neuromuscular signal that muscles lengthen temporarily. Often this is enough to make room for baby so that the posterior baby has the needed room for turning.
Success in these objectives inspires Labor and Delivery staff to adapt the Sidelying Release and other techniques we recommend frequently, like Shake the Apples as a buffer before going for a cesarean when labor doesn’t progress.
Because we see success, not 100% but still a high percentage, we consider
parent education to be empowering and choose a gentle but honest approach about fetal position questions.
Yes, babies do change and can change at any time, but that doesn’t mean all babies can change position at any time. Babies don’t float in a water balloon.
The womb is connected by fascia (ropey ligaments and membrane sheets) to the pelvis and abdominal organs. The pelvis is aligned or misaligned by muscles and tensions in the connective tissue, as well. Body balance means bringing the baby, womb, and pelvis all together in alignment.
Once that occurs, through self care techniques or through professional bodywork, then the function of the body works with more ease. I believe a flexed baby is reflecting best function. Head down is a response to gravity. With body balancing this becomes more possible. Again, not 100% of parent-baby pairs will have an anterior, head down baby even with good balance. We don’t have to be perfect, either.
The best baby position is the position in which baby fits the pelvis during labor with progress and without trauma. If you’d like more help, see SpinningBabies.com or check our our
- Daily Essentials for full range of motion and sitting tips to enhance the balance you have
- Parent Class for techniques to restore balance and recognize a well progressing labor and what to do if it is taking long or feeling too intense.
Sen, K., Sakamoto, H., Nakabayashi, Y., Takeda, Y., Nakayama, S., Adachi, T., & Nakabayashi, M. (2013). Management of the occiput posterior presentation: a single institute experience. Journal of Obstetrics and Gynaecology Research, 39(1), 160-165.