Concerned that your baby’s in a posterior position rather than the more favourable anterior?
Registered nurse and midwife Jacqueline Cuthbertson offers her tips on how to get your bub round the right way for labour.
As you hit the last trimester of your pregnancy, you’ll probably start to wonder what you can do to make your labour shorter and easier.
Well, the way you sit, work, and even the way you travel, all have an important part to play in your labour.
When your baby is in its most favourable position for delivery, it has its back leaning towards your tummy, slightly to the left or right, its limbs facing inward and its head down. You may hear your midwife refer to this as the anterior position. When your baby’s back is lying against your spine this is called the posterior position. Although it may seem a minor point, your baby’s position has an impact on the type of labour you will have. If your baby is anterior, the chin can tuck into the chest and the smallest part of the baby’s head can fit snugly onto the cervix, which then dilates as a result of the pressure. Progress through labour is usually consistent.
If the baby’s spine is against your own, its chin cannot tuck into the chest and so the fit between your cervix and the baby’s head is not snug. Because of this the baby cannot usually deliver in this position. Problems that may arise include back pain in late pregnancy and labour. You may also experience strong Braxton Hicks contractions. These are the body’s way of turning the baby around before labour, and they often feel like the real thing. Unfortunately, because of the uneven pressure on the cervix, pregnancy may go over the due date. Sometimes the membranes rupture early, and if so, you will need to have an induction if you are not contracting.
How does a posterior position affect labour?
When you go into labour and your baby is posterior, it can often turn by itself, but this increases the time that your labour takes, along with the level of back pain. These births can end in forceps deliveries or Caesarean sections, either because the mum is tired or the baby has not turned and can go no further. Rarely, the baby can stay in the posterior position. When this happens the baby is looking up at the ceiling when it is born, descriptively termed “face to pubes”.
Donna Brooking, the midwifery manager at Community Midwifery in Western Australia, says, ‘There does seem to have been an increase in posterior labour, and a lot of the interventions now encourage women to lie down.’ She recommends mobility during birthing: all-fours position and rocking from side to side, sitting on a birthing ball or a straight-backed chair, and climbing stairways if they are available. However, she points out that, for a variety of reasons, some babies are just not going to turn. This is when intervention is necessary and the outcome of your beautiful baby is more than recompense. However, if it’s possible to help your body perform its major miracle unaided, then it makes sense to try.
Is my baby posterior?
How will you know if your baby is posterior? First, take note of where you are feeling the kicks. If they are off to either side of your tummy, or towards the back, and your tummy feels smooth and concave, this indicates that the baby is probably in the right position.
If the kicks are directly in front, and your tummy has a saucer shaped appearance dipping around the navel, it may be posterior. In this case you can clearly feel the limbs and you are usually having a lot of back pain. If you’re still not sure ask your midwife at your next check-up.
Take an active role
It’s important to remember that your body is incredibly efficient, and can often sort its own problems out by turning the baby, but it’s good to understand what’s happening. New Zealand midwife Jean Sutton and antenatal educator Pauline Scott have written a book entitled Understanding and Teaching Optimal Foetal Positioning (OFP). They state that women can take an active role in determining the position of their baby before birth. Sutton says, ‘Women need to be taught optimal foetal positioning exercises by their midwife so that they can deliver normally.’
They discuss how the frequency of posterior-positioned babies has increased, and that this is mostly because of our lifestyle. Unlike the 1960s, we may spend much of our leisure time relaxing in an armchair, more time travelling in cars, and labour-saving devices have eliminated the need for physical work for many. Women will often work late in their pregnancy, sitting at a desk in front of a computer.
Plus when you sit in an armchair, your knees are usually higher than your hips and this causes the weight of the baby’s spine to swing around towards your back. However if you change your posture during the last six weeks of pregnancy you may be able to change the position of your baby. The worst that can happen from this focus on posture is that your baby’s position remains unchanged, but your backache is substantially relieved.
Activities that will help get the best position for baby are:
- Watching TV on a dining chair, even turning the chair around and leaning over the back
- Leaning over a beanbag
- Sitting on a lounge with a pillow under your bottom
- Lying down with one leg forward, and a pillow to support the tummy
- Sitting on a fit ball if you are doing office work
- Using a pillow in car seats so that your knees are lower than your hips
- Swimming and yoga, as these are both good exercises – but avoid any deep squats
- Pelvic rocking for 15 minutes every day, if you can. This involves getting on all fours and rocking from side to side. If you have steps, climb up and down them in a sideways position.
To have a chance at turning the baby, it will take more than a few minutes a day. It involves checking your posture at all times and doing some daily exercises. During the last six weeks of pregnancy you should choose upright postures where your knees are lower than your hips. With constant vigilance you may succeed in changing or preventing a posterior baby and shortening your labour.
Acupuncture, homeopathy, shiatsu, and chiropractic are also sometimes used to help turn a posterior baby so you may also wish to contact your local practitioner.
Manually turning a baby
You may have heard of manually turning a baby. This is done for breech babies (babies with their feet down) or babies in the transverse lie (lying across the uterus). It is not required for babies in the posterior position as the baby’s head is down. Breech and transverse positions are more serious, especially in first-time mums. It is for these positions that an obstetrician may consider manually turning the baby. This has some big risk elements and is not always successful. It is usually done under sedation or light anaesthetic.
Helpful positions in labour
- Squat with your feet flat and a straight back, supported by your partner so you can throw your pelvis forward, helping to lift the base of the spine out of the way.
- Kneel on your hands and knees. You can shift your weight between your hips. This makes the pelvis uneven and allows the head to move through.
- Birth stools should be more than 45cm from the floor so you can arch your back.
- Walk up stairs rocking from side to side or stand with one leg elevated.
- If you are tired, lie on your side with a pillow under your tummy.
Positions to Avoid
- Lying on your back or sitting. In these positions the coccyx curves inwards making the space between it and the pubic bone smaller.
- During the second stage, lying on your back and lifting your legs increases the curve of your pelvis and creates an uphill course for your baby.
– this article was kindly supplied by My Child magazine
Image credit: leela2414/123RF Stock Photo