So what is the optimal birthing position and what makes it optimal? Surely babies just lie in a position comfortable for them and there's little to nothing we can do about it. Babies do find a position that's comfortable for them, but this is often moulded by us as mothers and what we do with our bodies during the day. So our lifestyle habits may well position our baby, as may the shape of our pelvis, and our body in general. So, our bodily structure, as in the shape of our pelvis, there isn't much we can do about. However, we can absolutely assist our babies choice in position by altering our lifestyle. Not only can this help to ease some pregnancy discomforts but it can also make the birthing of the baby easier!
The 3 main positions for baby to lie in are:
With a transverse baby unless the baby turns a mother will be offered a Caesarean section. With a breech baby the mother can try resting in different positions to encourage her baby to turn, and can be offered to have the baby turned if the baby is still too comfortable on this position.
If baby has chosen to rest head down this is the better way for us to labour, but even then, the way it's body lies, and what part of its head is presenting at the cervix can still make a difference.
Optimal position is baby head down with their back at the front of mum’s tummy. LOA (left occiput anterior) helps the baby’s head be the smallest diameter to fit the pelvis. Back is on mother’s left side, baby facing towards mothers back between the right hip and the spine of mum. The crown of the baby’s head enters the pelvis first and in this position they are able to tuck the chin in a way that the baby’s head can mould effectively to fit the pelvis at an average diameter of 9.5cm. Perfect when we can dilate to 10cm. Our cervix is tilted backwards so with the head angled towards the cervix it encourages the cervix to open as pressure is put on it.
In a back to back positioned baby, the baby can be lying to the left or right, but have its back against mum's back. In its birth journey it presents a larger diameter of its head at an average of 11.5cm as the head is not able to flex and chin tuck. So this can be a little tricker for the birth itself and make it longer or more difficult. A back to back baby has to move straight down rather than onto the cervix so the pressure is on the front segment of the uterus and not onto the cervix. With this positioning mum will feel contractions in her back and less in her front and can be quite intense. There can also be an intense grinding sensation in the front behind the pubis as the baby tries to turn. The baby needs to try and turn and flex their head to be born and this can take some time. Contractions may come and go and disappear completely for a few hours and become an irregular process which can be exhausting. Early labour at about 3-4cm can take longer so this isn't ideal. Back to back babies have apparently become more common and seem to tie in with our lifestyle changes.
So what can be done?
At any midwife checks from about 20 weeks ask your midwife what position your baby is lying in. Babies do keep moving but we can encourage them into settling into certain positions if we try early enough and our pelvis shape allows for it. On the whole if a tummy sticks out straight in front with the belly button popping out and kicks to the side, ribs and hip your baby is in a good position. If the bump is neat and tidy and kicks are mainly to the front this may be a back to back baby, but always go with what your midwife or health professional tells you on examination. 87% of babies do turn in labour but this can be tiring and can take time.
We need to make the baby feel its most comfortable in this optimal position. We may need to make some small lifestyle changes that will ensure our baby wants to lie in this position and stay there!
Always try and sit with as good a posture as possible. A lot of sofas now have what I call bucket seats where you are encouraged to slouch rather than sit upright. Sitting like this will encourage the baby to lay in a back to back position. Try propping your back up with cushions or pillows so you can sit straight, or slightly forward.
Keep legs out in front of you rather than tucked up to one side. Not only is this not good for your pelvis but will encourage awkward positions for the baby if done regularly.
If sitting a lot at work make sure your feet can touch the floor with ankles, knees and hips aiming at 90 degrees with hips slightly higher than knees which helps to open the pelvis. If you find you slouch in your chair tuck a small towel under your sacrum at the back to just tip it slightly. This is the same for car journeys. Especially if you're driving everyday. I tell all my clients once they are seated in their car to sit up straight and look into the rear view mirror, which they may have to alter slightly. Then keep it there. As you drive along and you slouch a little you will need to keep sitting up to be able to use it! Easy reminder to sit up!!
You can also try sitting on a large exercise ball as this allows you to keep using your core well and you are able to lean slightly forward, again encouraging baby into a good posture. You can also then try doing pelvic tilts, circles etc whilst you sit!
Best exercise for you so as long as it is comfortable keep doing it. However, walk as correctly as possible which means trying not to waddle as the months go on, and use your body correctly! Walk at a nice steady pace and aim for a couple of miles everyday if you can. Start slowly of this isn't something you are used to.
Make sure you get enough and for that you need to be comfortable!! Sleep decreases our stress levels and lowers adrenaline. Sleeping on your left side is obviously advised which is good but make sure you support your bump as it grows so that it isn't pulled down to one some. Have some support between your knees and ankles so that your leg lies level and doesn't flop down and pull the pelvis and leg round and down. Try resting during the day listening to some meditation or some music to calm and breathe to.
Even if you haven't exercised before joining a specific pregnancy exercise class is perfect at this time. In my classes and I'm sure in most, you will learn so much about your body, how it will change and how through good nutrition, posture, good breathing techniques, strong movement we can prepare it for the challenges ahead and use movement to encourage baby into an optimal position. Exercise is good and should not be feared. Exercise from 12 weeks is beneficial to both mum and baby.