5 ways to encourage optimal positioning in labour

There are so many factors that contribute to a birth experience, both controllable and uncontrollable. One major factor is the position of your baby. Dilation might feel like the most important action in childbirth, but I’d argue position takes the cake. The position of your baby effects every other facet of birth. The rate at which dilation will occur. Where you’ll feel labour pains, how intense they’ll be. The duration of your labour and delivery. It isn’t the only deciding factor, but it’s definitely a big one.

Babies fit through the pelvis best when they begin in an LOA (or left occiput anterior) position, with their little chin tucked down. This means the crown of your baby’s head will be facing up (towards your abdomen) and to the left. Your baby will be face down, as if they were looking at the bottom right side of your pelvis. We want babies to start of LOA because they must rotate to fit through your pelvis, and the vast majority of babies will do so by spinning clockwise. Starting at LOA will allow your baby to arrive OA (looking straight down, crown of the head being the first body part to emerge at birth) with this least amount of wiggling.

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Little Mister Anatomical Model is very O.T.

Not all babies begin their journey in the ideal position. Some little chins don’t tuck down. Some babies favour the right side (ROA). Others like to make an attempt to enter the world face up (OP, LOP, ROP). Some get a little too cozy facing mom’s side (right or left OT), and others have their little heads tilted to the side (Asynclitic). And those are just the typical, head down babies.

Malpositioned babies are not the end of the world. If you find out your baby is in a less than ideal head down position, don’t panic. Your baby may need a bit more rotation and descent time, and perhaps you may experience more back labour. But there is good news! We doulas have a few tricks up our sleeves to help encourage your baby to find their way. Talk to your doula about repositioning techniques, or click the following links to learn more about each maneuver.

A note first. While we’re happy to get you into a position that encourages natural progression into an ideal position, we aren’t able to physically reposition your baby. Performing internal or external versions falls well outside of our scope. If you and your baby require anything more than basic position changes, please talk to your care provider.

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Just like yoga. Just maybe no handstands.

The Miles Circuit – pro level baby spinning. The miles Circuit is a three step process. Time consuming and labour intensive, but it works. If you need to budge a stubborn baby, this will likely do it. If it’s not possible for you to make it through the entire circuit, each of the three steps (Open Knee Chest, Exaggerated SIMS, Walking/Stair Climbing/Lunging) will help when performed as a stand alone maneuver. There are warnings suggesting not to attempt an open knee chest on a baby who is well positioned and/or not yet engaged in the pelvis. Open knee chest gives baby a lot of wiggle room, we don’t want to risk a well positioned baby flipping into a less than ideal position.

Welcher’s Method – When the back is arched, the angle of the pelvis changes. This maneuver is sometimes referred to as “opening the brim”. It opens up the inlet of the pelvis and allows for easier entry. A true Welcher’s involves bringing your bottom right to the edge of the bed and letting the legs hang down. This creates a convex bend, and opens that pelvis right up. This can be performed in a modified way by propping up into an arched back position. You can do this with a pillow, or a rolled up towel or blanket.

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Abdominal lift and tuck – Another great tool for getting baby well positioned into the pelvis. The great part about this maneuver is it’s simplicity. It’s performed exactly how you’d imagine. The pelvis is tucked (curling the hips forward, flattening the lower back), and the abdomen is lifted. Aim to lift two inches up, and press two inches in. You can also perform this with a rebozo. With either the doula holding the rebozo, or the birther crossing the rebozo over their shoulders for leverage. By doing so you’re quite literally opening your pelvis and scooching that baby in.

Sidelying Release – The side lying release, when performed properly, will temporarily soften and enlarge the pelvis, giving baby more room to properly engage. You’ll want to try it on both sides, starting with whichever side your client (or you) feel most comfortable with. This technique involves laying on one’s side with hips straight. One on top of the other. The hip is securely braced by the doula or birth partner. The top leg is carefully lifted and allowed to dangle down and over.

Rebozo Sifting

Rebozo Sifting is right up there with the double hip squeeze on the list of doulas favourite things. The rebozo is placed over the entire abdomen, lifted up and in, and rocked. Starting slow, and increasing in speed. Rebozo Sifting relaxes ligaments in a way the mother cannot consciously do herself. Malpositioned babies may have taken a less than ideal favoured position due to tight ligaments limiting their movement. Rebozo Sifting feels great, allows baby to move more freely, and relieves pain by bracing and lifting the weight of the uterus. Some say rebozo sifting should not be performed over an anterior placenta. It’s also important to note that while quick movements are okay, jerking movements are not. It might be tempting, when you know the position of the baby and want to move them somewhere else, to just jerk them in the right direction. ECVs are performed with ultrasound guiding for a reason. The last thing we want is to compress a cord, or cause an injury. Be firm, but mindful of your movements. Keep in mind, rebozo sifting is a lot harder than it looks. Your arms will get tired, fast. I like to teach my client’s partner how to sift ahead of time, so we can take turns and allow our arms to recover.

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OA and on the way!

Five simple steps, yours to learn. As always, be cautious about safety, and considerate of the birthing party’s comfort and boundaries.

 

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