presented by Angel J. Miller, MSN, CNM

From the 34th week of pregnancy and onward,  your own postural awareness and habits can potentially encourage your baby to lie with his or her back to your left front/side (occipital anterior) so that the baby’s head engages in the pelvic brim in this position.  This will increase the potential for a normal and straightforward birth.

A baby who is already lying the other way, with spine against your spine and facing forward (occipital posterior  or “sunny side up”) can be encouraged to rotate to the anterior position in late pregnancy or during early established labor.

A few babies will remain posterior and this may not be a problem. However, because of the extra rotation needed, it can mean a longer labor and complications do sometimes occur with posterior births (i.e., prolonged latent phase (early labor), slow progress in active labor, prolonged second stage.)  It is worth doing your best to encourage your baby into the optimal position.

How to help your baby into an anterior position:

Use upright, forward leaning postures regularly. This allows more available space in the abdomen for your baby to rotate spine to the front. Be on your hands and knees now and then, swinging your hips (pelvic rock exercise.) You can do 100 pelvic rocks on hands and knees, several times a day (100 pelvic rocks takes about 1 ½ minutes). Pelvic rocks are a quick rocking motion of the pelvis, without much arching or movement of the back.

You can encourage your baby to take up an anterior position by making sure that your knees are always 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. Sit like this to read on a dining chair, with your elbows resting on the table, knees apart, leaning slightly forward.  Sitting on a birthing ball is another idea.

• Sit on a cushion in your car to lift your bottom up and to prevent the pelvis tipping backwards.
• Check that your favorite chair doesn’t make your bottom go down and your knees come up
• Kneel on the floor leaning over a large beanbag, birth ball or floor cushion to watch TV.
• Assume a knee-chest position (knees, head and chest on the bed, with buttocks up in the air) for 20 minutes, three times a day.
• Sit your partner in a chair, kneel on the floor knees apart, and lean on 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.
• Swim with abdomen forward (avoid breaststroke- the kick can potentially strain the softened pelvic ligaments).
• Scrub all your floors and skirting boards! – Our grandmas used to say that washing the kitchen floor was a good way of preparing for labor. When you are on all fours, the back of your baby’s head swings to the front of your abdomen.
• Take regular breaks and move around if your job involves a lot of sitting.
• Lay the majority of the time on your left side, with a pillow or two supporting the top knee to rest or sleep (roll over almost on the stomach, left arm behind back, right leg bent and proper on a pillow, left leg straight). However, you do need to turn onto your right side sometimes too.
• It is ideal to use forward leaning postures when having Braxton Hicks contractions as this increases their effectiveness with regard to helping the baby to maneuver into the optimal position.

Positions to AVOID:

• Avoid ALL RECLINING POSITIONS, which encourage the baby to flop onto its back. These tip the pelvis back with knees higher than the hips so that gravity will encourage the baby’s spine posterior. Instead, relax in forward leaning positions.
• Do not take long trips in cars with bucket seats (these tip the pelvis back). If you must, use wedge cushion to prevent the pelvis from tipping backwards.pelvic-rock-position