Guiding Your Baby into an Optimal Position

Tips to encourage persistent posterior positioned babies into Optimal position

This information may help you to assist your baby into the most favourable position for birth before labour begins. This applies only if your baby is coming headfirst and is a singleton baby rather than a multiple. From 34 weeks onwards, your own postural awareness and habits can potentially encourage your baby to lie with his or her back to your left front/side (occiput anterior) so that the baby's head engages in the pelvic brim in this position. This will increase the potential for normal and straightforward birth.

A baby already lying the other way, with spine against your spine and facing forward (occiput posterior) can be encouraged to rotate to the anterior position in late pregnancy or during early established labour. A few babies will remain posterior and this may not be a problem. However, because the extra rotation needed can mean longer labour and complications do sometimes occur with posterior births, it is worth doing your best to encourage your baby into the optimal position. Please note this advice is intended to complement your antenatal care, and may not be suitable for all women or all pregnancies. Always consult your childbirth or health professional.

DO • Use upright, forward-leaning postures regularly. This allows more available space in the abdomen for your baby to lie rotate the spine to the front. Be on your hands and knees now and then, swinging your hips (baby hammock).

• Always sit with your knees lower than your hips, with your back vertical. Do this by using 2 or 3 cushions to sit on and another one in the small of your back, if necessary. Sitting on a birth ball is another idea. Sit like this to read on a dining chair, with your elbows resting on the table, knees apart, leaning slightly forward. (Similar posture used when sitting on the toilet.) Or sit facing the chair back and resting your arms on the back of the chair. Sit on a wedge cushion when driving to prevent the pelvis from tipping backward.

• Kneel on the floor leaning over a large beanbag or floor cushion to watch TV.

• Use an office kneeling stool, birth ball  Make sure the knee pad is wider than the seat to allow the knees to be kept apart and hips to turn outwards.

• Swim with abdomen forward (avoiding breaststroke - the kick can potentially strain the softened pelvic ligaments).

• Lie the majority of the time on your left side, with a pillow or two supporting the top knee to rest or sleep. It is ideal to use forward-leaning postures when having Braxton Hicks (practice contractions) as this increases their effectiveness with regard to helping the baby maneuver into the optimal position.

DON'T • Relax in semi-reclining positions. These tip the pelvis back with knees higher than the hips so that gravity will encourage the baby's spine posterior.

• Take long trips in cars with bucket seats. If you must, use a wedge cushion as above.

• Sit with your legs crossed. Don’t use the deep squatting position after 34 weeks as it may make it more difficult for the baby's head to engage optimally. Squatting in a modified fashion is OK because your pelvis is not so restricted and is able to move more. If you want to practice squatting during late pregnancy, it is desirable if your feet are flat on the ground with your bottom at least 45cm above the floor. Your hip joints should be in front of your ankles and your back supported against a wall 

Tips to encourage persistent posterior positioned babies into OFP position.

  • Pelvic rocking three times daily in sets of 20 mins

  • Do belly sifting/rebozo 3 - 5 mins daily

  • Knee chest position three times daily for 20 mins or Forward leaning inversion daily for 30-40 secs

  • Take warm baths. Gently massage and encourage your baby to “roll’ over.

  • Talk to your baby and visualise him in the position you want.

  • Acupuncture, acupressure, and osteopathy may be helpful. Seek out a registered natural therapist.

  • Your baby’s movements from right to left or from posterior to anterior may be very uncomfortable for you. There may be a lot of churning as your baby starts to rotate and your bones may feel as if they are grinding in your pelvis. Braxton Hicks are likely to increase too.

Wait until your baby is awake (when you can feel some movement) before starting pelvic rocking or adopting the knee-chest position. An awake baby is more likely to be encouraged to move! Useful positions for labour - Some can be used in a birth pool

• Stand or kneel leaning forward and moving your hips during contractions.

• Lean forwards over a beanbag or birth ball or on all fours either on a bed or on the floor. Or sit your partner on a chair, kneel on the floor knees apart, and lean onto his thighs. • Hang onto something with arms well above waist height (e.g. your partner's shoulders) and let your body sag from time to time, turning your knees outward.

• If reclining, lie preferably on your left side well propped up with backrest and cushions. Avoid lying on your back in a semi-reclining or supine position in bed.

• Marching on the spot, stepping onto a pile of books, or walking upstairs sideways can help a baby move into a more effective position. If your baby is in the posterior position in labour try making yourself comfortable, with pillows, in the knee-chest position in early-established labour for up to 45 minutes at a time. This will encourage your baby to rotate. Otherwise use all fours, or forward-leaning kneeling and standing positions. Effective labour has only begun when your tummy changes shape with each contraction.

When to start noticing your baby’s position

The Baby's position matches the shape of the room within the pelvis.  This space is shaped by the abdominal and pelvic muscles, ligaments, and connective tissue.  Releasing tension or torsion in the soft tissues and joints may be helpful.

By 32 weeks: If the baby is breech or sideways you may like to get serious about self-care techniques such as Knee Chest position.

From 32-35 weeks: Many babies switch sides. You can tell by where the baby kicks, if that changes, too, then the baby changed positions. If your baby is favouring only your right and kicks towards your left then you can enter a period of activity without stress to play with your baby to see if you can influence their position.  Knee Chest,  Hands-and-Knees, lying on the left-hand side for resting after some time stretching and loosening the ligaments and soft tissues in the pelvis.

By 36 weeks: Baby is expected to settle and change position once or twice a week as there is less room.

By 38 weeks: Most first-time babies engage.  The lack of engagement is an issue for the posterior baby in starting labour and keeping labour going. 

At 41.5 weeks and more: Focus now on baby position and engagement in a relaxed way throughout the day.

Active BirthSuzanne SwanActive Birth Skills