Positioning for birth

Getting your baby into the right position for birth could mean less pain, less intervention and even prevent a caesarean. We look at the most common problems with positioning and give some top tips on what you can do to help.

Beyond the breech

Breech babies are the most common problem people think about when it comes to foetal positioning. Around 15 per cent of babies are breech at 32 weeks. This doesn’t become an issue until 36 weeks, when the chances of them turning decrease significantly. At this stage, you will be referred to a consultant to discuss your options. Normally a scan will be done to check the baby’s exact position and weight, and to see if you have a low-lying placenta (praevia), which can sometimes be the reason behind the breech position.

Breech babies lie in one of three positions:

  1. Extended or frank breech: the hips are flexed, thighs are against the chest and the feet are by the baby’s ears.
  2. Flexed breech: hips are flexed, thighs against the chest, and knees are also flexed with the calves against the back of the thighs and feet just above the bum.
  3. Footling breech: As above, except the hips aren’t flexed as much and the feet are below the bottom.

External cephalic version (ECV)

It is possible to manoeuvre a baby from breech position to head-first. This procedure is called external cephalic version (ECV) and is usually done after 37 weeks, with a 50 per cent success rate. However, it’s worth noting that 2.5 per cent of babies just seem to prefer the breech position and flip back into it after a successful ECV!

During an ECV, the doctor will place their hands on your womb and guide your baby through a forward somersault. Some babies (aspiring gymnasts perhaps!) get the hang of this and will help the doctor turn them by kicking against the womb! Some doctors will use a drug to help your womb relax, especially with first-time mums. The procedure may feel a little uncomfy during the turn but it shouldn’t be painful.

An ECV is a relatively safe procedure and the baby’s heartbeat will be monitored beforehand and afterwards to check everything is OK. In the very unlikely event that your baby becomes distressed, a C-section will be necessary. This is not harmful as the baby will be mature enough to be born healthily.

Self-help

Some health professionals recommend women spend 15 minutes every two hours of the waking day in the knee-chest position to help turn their baby. This is called Elkin’s manoeuvre. You could also try an alternative therapy – acupuncture and chiropractice in particular have had some success in turning breech babies. Do make sure you check with your local practitioner that they have had experience in dealing with this procedure, or contact the therapies’ national bodies to get the name of someone near you.

If all else fails …

If your baby stubbornly insists on remaining breech, most doctors will offer you a caesarean as the best form of delivery. C-sections are safe but, as is the case with any surgery, they carry risks, mainly post-operative problems such as blood loss and infection. This is why many doctors and midwives believe normal vaginal births are possible for breech babies, although it must be said that intervention, in the form of forceps or ventouse delivery, is quite common.

Optimal foetal positioning

Even if your baby is not in a breech position, there are still better and worse cephalic positions for him to adopt! The ideal position is occipito-anterior (OA in your maternity notes!), when your baby is head-down and with his back against your tummy.

However, not all babies favour an ‘anterior presentation’. Some are occipito-posterior (OP) which means they are head down but with their spine against yours. An OP baby and mother will have to work harder in labour to have a vaginal birth, and labour is often longer and more painful while the baby tries to rotate to the anterior position. A common side-effect of OP labours is excruciating back pain, caused by the hard surface of the baby’s skull pressing on the mother’s lower back. Posterior births are more of a problem for first babies than for subsequent births; when a mother has given birth before, there is generally much more room for maneouvre, so it is easier for the baby to rotate.

Get moving!

Posterior presentations have shot up recently and this is thought to be due to our current lifestyle, with mums driving more and relaxing in squishy sofas. How does this have an effect? The baby’s back is the heaviest side of its body so it will naturally gravitate towards the lowest side of your abdomen. Therefore, if your back is lower than your tummy, eg you are lying on your back or leaning back in an armchair, then the baby’s back may swing towards your back. Try these following tips to reverse the situation:

  • Spend lots of time kneeling or sitting upright, or on your hands and knees, so your knees aren’t higher than your pelvis. Try resting against a birth ball.
  • Relaxing yoga positions can help. The tailor pose is ideal – sit with your back upright and the soles of your feet together, knees to the side.
  • When you’re in the car, sit on a wedge cushion so your pelvis is tilted forwards. Keep the seat-back upright.
  • Don’t cross your legs. This reduces the space at the front of your pelvis where your baby needs it most.
  • Sorry, but don’t put your feet up! Lying back with your feet up encourages posterior presentation.
  • Sleep on your side, not on your back.
  • Try some breaststroke or front crawl – swimming with your belly downwards is said to be very good for positioning babies.
  • On all fours, wiggle your hips from side to side, or arch your back like a cat.

This might all seem like a lot of hard work, but remember it might save you from even harder work during labour if you can get your baby into the best position!

Best birth positions

Try as you may, some babies either will either not turn at all or will turn from an anterior to a posterior position in labour. There’s not a lot you can do about it and no point feeling guilty either – you’ve tried your best. If your baby is posterior during labour, there are some things you can do to help you and your baby.

Early labour

  • Walk up stairs – sideways if you need to!
  • Rock from side to side.
  • March or ‘tread’ on the spot.
  • Step on and off a small stool.
  • Climb in and out of a birth pool.

Second stage

  • Use kneeling or all-fours positions. Kneeling on one knee can help.
  • Ask your birth partner and/or midwife to support you squatting, making sure you are lifted quite high up; your bottom should be at least 45cm (18 inches) off the floor. Where’s that ruler …?
  • Try not to lie on your back, semi-recline, sit or semi-sit as these positions all reduce the available space for the baby to turn. Lying on your side is OK.
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