Why Being ‘Head Down’ isn’t Everything: The Importance of Your Baby’s Position.

Have you noticed that some women seem to have start and stop contractions for hours, or even days, whereas others quickly progress to regular, productive surges and experience a relatively ‘short’ labour? Or other women say that they had this intense back pain that they couldn’t relieve no matter what they tried? A new mum I was speaking to last week said 'it was just that back pain, contractions were very managable, it was just the constant backache'. This mum also mentioned that her contractions were on and off all day, sometimes being very close together, other times spacing right out.

I hear this so often, and almost every time I think that their baby may have been posterior. What does this actually mean? I’m sure you know that your baby needs to be head-down, not bum-down, but do you know which way they should be facing? This post will tell you what you need to know to make sure that you know what position your baby is in, how their position can affect your labour, and also how you can encourage your baby to be in the optimal position for birth.

The Anatomy of Foetal Positioning

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Now bear with me for a minute while we go through the anatomy. This can be a little confusing at first but once you get it it will make so much sense!

Take a look at the image above of a pregnant woman’s torso while she is standing. The image shows baby in the anterior position, and the posterior position. What we are referring to is the bony part at the back of baby’s skull (the occiput), and whether this is along the front of your belly (anterior) or whether it is along your lower back and spine (posterior). You can see that on the left baby has their chin tucked in to their chest, which means that the smallest part of their skull is entering into the pelvis. On the right, there is lots of room between baby’s chin and chest, and you can easily see that it is a much larger part of the skull that is coming into the pelvis. I love this image as you can quite clearly see how the position of baby can affect how ‘big’ their head seems to be. Some other terms that you may hear for a posterior baby are ‘OP’, ‘sunny- side up’, or ‘back-to-back’.

Another important feature of a posterior baby is that the bony part of their skull is pressing near your spine and coccyx, instead of against the soft organs and muscles at the front of your body. This can often lead to intense backache and increased pain intensity during labour.

It is reported by some sources that up to 50% of babies will be in a less than optimal position as they approach their estimated due date. That is a huge number, and I would bet that most midwives would agree that this is what we see reflected in the women that we care for.

How can a posterior baby affect labour?

  • Intense Back labour – feeling surges in the lower back more than your tummy.

  • Start and stop labour patterns, with a longer early labour period.

  • Delayed descent of baby into the pelvis, or sometimes baby may not engage.

  • Longer labour.

  • Longer ‘pushing’ or bearing down stage

  • Increase in interventions.

It is important to note that many women do labour and give birth to posterior babies quite easily, just as some women who have a baby in the anterior position may experience a difficult labour.

How do I know if my baby is in the posterior position?

  • Ask you care providers! Midwives and obstetricians are usually able to determine what position your baby is in when they are feeling your tummy.

  • You may feel movements all along the front of your tummy, not just up the top or the sides.

  • You may have a ‘dip’ or curved in spot around your belly button, or your belly may not be as ‘rounded’ or uniform in shape.

Alright, lets get on to what you can do if your baby is posterior. Even if you are not sure what position your baby is in, these techniques are still beneficial and worth a shot.

How can I help my baby to turn to the anterior position?

  1. Check out the Spinning Babies website. This is the ‘holy grail’ of tips and tricks to encourage your baby into an anterior position, and is frequently recommended by midwives and doctors.

  2. Ensure that you are spending lots of time in forward leaning positions, or on all fours. Leaning over an exercise ball, or leaning over the back of a chair while you watch TV can help.

  3. Avoid reclining positions that encourage your spine into the curved position, such as lying back on the couch, or even having your car seat reclined too far back.

  4. Keep active – walking and yoga are both great. Swimming is also fantastic during the later stages of your pregnancy.

There is loads of information online about posterior babies, and we also discuss optimal foetal positioning and what you can do if your baby is posterior in our Hypnobirthing classes. We can also use self-hypnosis to assist in positioning baby– contact me if you would like to learn more. This short video below is a great summary of optimal positioning,and includes some more practical tips for posterior babies.

Now that you know the importance of your baby’s position you will be able to carry on with your pregnancy, knowing that if your baby happens to be posterior at 34-35 weeks you have some techniques that you can use to encourage your baby to move into that optimal anterior position.

Have you heard of any other tips or tricks for helping your baby into the anterior position? I would love to hear your thoughts!


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