You were made to move easily out of my body. This is your first pilgrimage, your first calling, your first holy journey. I invite you to take the time you need; come when you’re ready to come. (Words I wrote to my daughter in utero.)
Birthing women can face fear-mongering in pregnancy forums and from family or medical staff if they’re baby isn’t in the ‘right position’ before 38 weeks.
But what is the ‘right’ position? There’s lots of talk about ensuring baby is ‘head down’ and ‘anterior’ in the final weeks of pregnancy. Could there be multiple ‘right’ positions?
The best position for your baby is the one that gets them out. Does this sound silly? ‘Ofcourse the right position is the one that gets them out,’ you might say. In this statement I’m simply trying to encourage you that no matter what position your baby is in, there are options for you. There is hope! (You’re not doomed to have a surgical birth if your baby is ‘breech’ or ‘posterior’. Doom never helps!)
And in truth, there are multiple ‘optimal’ fetal positions. The one that’s works for you will depend on your body and, more specifically, your pelvis shape¹.
That being said, Occiput Anterior (OA) is generally believed to be the most useful position for your baby to be in for labour (see the image below).
Occiput Anterior is head down with the back of your baby’s head (i.e. occiput), towards your anterior (i.e. front). Facing forward (Occiput Posterior or OP) makes the baby’s head seem bigger. OA, however, makes the baby’s head seem smaller because the baby’s head angles into the pelvis in a smaller diameter.
Image sourced from Spinning Babies
So, why does baby positioning matter? Your baby’s position is important for how she engages in the top of your pelvis, and how she descends through your pelvis down the birth canal. The way she engages and how easily she can descend are two main factors determining labour length. An optimal position can significantly shorten active labour.
(Now, it’s not worth dwelling on fearful thoughts if your baby is not OA! Mine never were and I rocked two home births without drugs. Trust the process. Birth has worked in tribes all over the world since the beginning of time. Your body is well-designed. Your baby knows how to get out—he is built for the journey).
We can’t go into everything right now, but here are a few questions to ask yourself in regards to your baby’s position:
Where is my baby positioned right now? (If you are 30 weeks gestation or more, you may have a good idea of this. If you’re not sure, search ‘Baby Mapping’ online for some cool resources.)
If my baby is ‘posterior’, ‘transverse’ or ‘breech’ during pregnancy, what ‘Spinning Babies’ exercises can I do to help my baby rotate to an anterior position? (As mentioned, OA is traditionally an ‘easier’ position for birth. But don’t worry if he never turns during pregnancy. He may prefer to turn during labour or be born OP).
If my baby is ‘breech’ (feet first), which medical provider will I choose to support me through this natural variation of normal? Or who will I receive care from during pregnancy if she wants to turn but needs a little help?
Has my medical provider mentioned any methods to help my baby’s progression in labour if things slow down because her position isn’t optimal (i.e. rebozo, side-lying release, assisted lunges, ‘shaking the apple tree’ etc.)?
What do I know about the well-designed physiological process of my baby engaging, moving through the pelvis and descending down the birth canal? (And more importantly than knowing facts, have I listened to stories of other women who’ve had low intervention births?)