When should baby be head down? What if baby is breech? What does it mean if baby is back-to-back? What does is mean if baby is engaged?
These are definitely high up on my list of "most frequently asked questions as a midwife". The anatomy of the pelvis and baby's positioning was something I found so fascinating when studying Midwifery at university. The diameters of your baby's head vary significantly, depending on their position in your pelvis which in turn has a significant impact on how easily they can navigate their way out. Baby being in an optimal position plays a significant role in the start of labour, reducing the length of labour, reducing the chance of assisted births or caesarean births. Therefore, it is important you have an insight into baby's "ideal" or optimal position.
Ideally, the position you want baby to be in is:
- Head down (cephalic)
- First babies are ideally starting to dip into your pelvis (engage) by 38 weeks, second or subsequent babies might not until labour starts
- Back to your front (or back slightly to your left, with feet to the right)
- Chin tucked in to their chest
By being in this position, the smaller diameter of baby's head can fit through your pelvis with more ease, and in labour their head is applied evenly to your cervix, encouraging more efficient and effective contractions that will encourage dilation.
If baby is not in this position, there is a wider diameter of baby's head trying to fit through your pelvis and the head is not well applied to the cervix which can result in irregular contractions which are not as efficient and effective in encouraging dilation. The wonderful "Student_Midwife_Studygram" shows this so well below.
Now that you know what the optimal position is - how can you encourage baby into this position to ease the journey for them and you?
The Spinning Babies website is invaluable for all birthing people. They have incredible online resources explaining the different positions that baby can be in and what you can do to encourage them to get movinnnn'!
Helpful links for head down babies:
How do I know what position baby is in?
At your antenatal appointments, your healthcare provider (midwife or doctor) will listen into baby's heartbeat. To know where to listen, they will ask to feel your bump to work out where baby is lying. It's worthwhile asking where baby is lying as this allows you to become more in tune with baby and their positioning. As your pregnancy progresses, you might find you are able to work out yourself where they are lying. You can also give "Belly Mapping" a go.
This means baby's buttocks (or sometimes feet or knees) are in your pelvis first. It's common for babies to flip between breech and many other position throughout your pregnancy. Ideally by 34 weeks, we would like baby to be head down. However, it is important to note that breech babies can be born vaginally (some breech positions are easier than others), it is likely that you will be encouraged to opt for an elective caesarean birth. I would recommend reading Breech Birth - What are my options?
If you're keen to find out more about why baby might be breech or how to get baby to get movinnn' - have a look here!
This means baby is lying across your abdomen with their head at one side and buttocks at the other. This is common in the second trimester, but ideally by 29-30wks baby is moving into a head down position. If you have been told your baby is lying in a transverse position, I would recommend reading Spinning Babies' Sideways/Transverse.
Back-to-Back/Occiput Posterior (OP)
I mentioned above that baby's ideal position to ease their journey through your pelvis would be with their back to your front (baby facing your spine). If baby's back is to your back (spine to spine), this can be ideal. In this position - baby's are unable to tuck their chin in as shown above, the wider diameter of their head has to fit through your pelvis and and their is usually uneven pressure of their head on your cervix.
Labouring with baby back-to-back can be something we hear about often, and usually it's negative. It can cause contraction patterns to be irregular (not always), it can cause increased lower back discomfort/back labour (not always), it can result in assisted births or caesarean sections (but yet again, not always). Those who have birthed vaginally previously, can find it not so problematic. However, I have also supported a first time Mum in an unsuspecting "back-to-back" labour and birthed wonderfully with baby looking up at me when they made their appearance. But this is not always the case, so I would really recommend reading Spinning Babies' OP Truths & Myths - regardless if you've been told baby is back-to-back or not. Healthcare professionals can get it wrong when palpating or even on scan. Epidural use in early labour can have a significant impact on baby's journey if they have no had the chance to rotate into an optimal position and then descend into the pelvis. Meaning, they may descend in a suboptimal position or are unable to descend.
I LOVE rebozo use in pregnancy, labour and birth! A rebozo is a large woven cloth which is commonly worn by women in Mexico and Guatemala. It's use includes; keeping warm as a shawl or blanket, used to carry babies, older children or even shopping. Versatile fashion or what?! They are long enough to stretch round your whole body and roughly 70cm wide. So how is this relevant to labour and baby's position?
"Manteada" is a gentle sifting, or rhythmic jiggling motion creating using the rebozo which can relax tight uterine ligaments and abdominal muscles, help a baby rotate in pregnancy or labour more easily and help a birthing person relax into their labour. I would recommend giving it a go - sooo relaxing! More info - here!
You will probably have heard about "birth balls" but what about "peanut ball" (PB)? I first saw these in use on a labour ward by a women labouring with an epidural. The midwife who I was taking over their care from, explained that they can be great for encouraging babies into an optimal position when the birthing person's mobility is restricted or limited. On my break, I did my own research and managed to find some promising research results such as those using the PB with an epidural had a lower chance of caesarean birth and shorter first stage of labour (4cm-10cm) and shorter pushing stage of labour. Further research would be beneficial but for a tool that is low-cost and simple to use, I think they're great!
For more information, Lamaze have a great resource. I have also listed the PB research articles below.
Another versatile prop to have in your birth toolkit! Birth balls can be great to use throughout pregnancy to ease lower back discomfort, improve posture, strengthen back and abdominal muscles and encourage baby into an optimal position. When using a ball to sit on, it's so important that you get the correct size. If when sitting on your ball, your knees are higher than your hips - that's going to encourage you to lean back and then baby is encouraged into a back-to-back position. So make sure your ball is big enough that your hips are higher than your knees.
However, there is more you can do with a birth ball than just sit on it. Forward leaning and allowing your belly to hang is going to encourage baby's back to swing round to your front, getting them into a good position.
Upright, Forward, Open! No matter how you choose to birth - on dry land, in the water, with an epidural... remember upright, forward, open. By birthing upright you are allowing gravity to aid baby's descent, less likely to have concerning patters in baby's heart-rate, less likely to have an instrumental birth and increasing birth satisfaction.
So remember Upright posture, Forward leaning, Open pelvis!
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