Fetal Positioning Makes a Difference: Easy Ways to Reposition For an Easier Birth

A typical midwife home exam includes checking the size of the fundus, as well as verifying the baby's position. Image by eyeliam

A typical midwife home exam includes checking the size of the fundus, as well as verifying the baby’s position. Image by eyeliam

One of my favorite parts of every prenatal appointment is fetal palpation, which takes place during the same time as other clinical checks such as maternal blood pressure and fetal heart rate. Fetal palpitation gives the midwife a good idea of the position of the baby. After around 24-28 weeks, a midwife is able to use her hands in a series of movements called Leopold’s maneuvers to feel the position of the baby, noting where the baby’s back is, if the head is down and how well-tucked the head is.

The position of the baby, much less than the size, has a very big influence in determining the ease and length of labor. Fortunately, there are many things a woman can do to influence the position of her baby and give herself the best chance to have as easy of a labor as possible, rather than trying to get a baby into a good position after she goes into labor.

Fetal Position: Why It’s Important

The shape of the human pelvis means that our infants must turn and flex their bodies in a spiraling motion as they are being born.  In order for this to happen in the easiest way possible, the baby needs to be in a good position when labor begins. An ideal fetal position is one in which the baby’s back is turned toward the front of the mother’s body and their head is well-tucked, with their chin to chest, as is shown below in the accompanying image, in the positions labeled ROA and LOA.

Which way is your baby facing? If it's any direction other than OA, you may need to change his position before you go into labor. Image by Gray's Anatomy/Decoded Pregnancy

Which way is your baby facing? If it’s in the wrong direction, you may need to change his position before you go into labor. Image by Gray’s Anatomy/Decoded Pregnancy

When a mother goes into labor with her baby in a good position, the occiput – the crown of the baby’s head – is the presenting part, that is, the part of the baby that is sitting directly over the cervix and therefore, the part of the baby that is pressing on the cervix during labor.  Because the occiput is the narrowest part of the baby’s head, it helps to open the cervix much more effectively than any other part of the baby. Labors with a baby in a less than ideal position can be what is called incoordinate. That is, the contractions may not ever be regular, they may come and go, and the labor may be long.  This is what happened to me with my first daughter.  She was posterior when I went into labor and we spent many days trying to get her into a more optimal position.

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Why’s Baby Not in a Good Position?

Unfortunately, many of our habits do not lead to a good fetal position. The shape of our couches, chairs, office chairs, and vehicle seats means that we spend a lot of time slouching. The lower part of the back curves out, rather than in, which means the pelvis tilts up and the belly is pulled back. Because the back of the baby is bulkier and heavier than the arms and legs, when the mom is habitually in positions with her lower back slouching out, this can lead to the baby’s back swinging towards the mothers back. This leads to what is called a posterior position, as is shown in the positions labeled ROP and LOP.

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  1. Rosemary Drisdelle says:

    I sure wish that someone – anyone – had told me this years ago when I had my first baby.

  2. This is SO important, but I can’t tell you how many moms have told me that their OB never EVER palpated for fetal position. A couple of moms, when I asked if they know what position baby was in, would just say “They did an ultrasound and s/he is head down.” Blargh!

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