The position of your baby is SO KEY for a smooth and quick labor. All three of my labors involved a baby positioning issue - 2 were super long (24+hours) and the other was a breech birth that resulted in a c-section. Let’s dive into the different positions a baby can be in while they’re snug as a bug in a rug so you can be better informed and know what to do if your sweet babe is in a not-so-great position.
Anterior:
When the baby is in an anterior position, they are engaged head down and are facing the back (spine). This is the best possible position for labor as it engages the baby’s head at an angle that allows for it to move through the pelvis and birth canal with ease. There are a few different kinds of anterior positions (like whether baby’s body is facing right or left), but either one is just fine for labor.
Posterior:
This is also known as “sunny side up” - when baby’s head is down, but they’re facing outward (toward your belly button). Baby is head down, which is good, but with her facing outward, this can cause some pain and prolonged labor. Don’t cry if your baby is posterior and you’re near the end of your pregnancy. A 2005 study found that up to half of babies are posterior when labor begins, but only 20 percent are actually born posterior.
If you do have a baby who is posterior, be prepared to need some help during labor. There are some increased risks associated with posterior babies:
Increased pitocin use
Increased episiotomy & vacuum/forceps use
Increased risk of postpartum hemorrhage
The best way to turn baby during labor is to labor on your hands and knees. You can also try an abdominal lift. The use of a rebozo is also helpful. Lastly, the Miles Circuit is very helpful to encourage baby into the best position. This is what I did with my 3rd pregnancy, and a couple hours after I did it, my water broke!
Transverse:
Transverse means that baby is lying sideways. This is a common position earlier in pregnancy, and most babies will turn head down later on.
If your baby is transverse and you’re further along, your provider may suggest an external cephalic version (ECV). An ECV is basically when the doc will try to turn baby by pressing hard on your abdomen. Doesn’t sound very relaxing, huh? They will usually give medication to help relax you and your muscles, as well as monitor the heart rate and position of baby through ultrasound. There are some risks associated with this, so be sure to ask your provider lots of questions!
If baby won’t move, then you will have to deliver via c-section. There is a risk of cord prolapse (when the umbilical cord falls down through your cervix into your vagina) with a transverse baby, so if you have any signs of labor, be sure to go into the hospital ASAP.
Breech:
When a baby is breech, that means that they are “upside down” - with their head up and their booty down. There are three different types of breech presentation:
Complete Breech: booty is facing down with feet crisscrossed - almost like they’re sitting criss-cross applesauce...in your uterus!
Frank Breech: booty is down but their legs are sticking straight up, with their feet near their face.
Footling Breech: one or both of the baby's feet are dangling downward toward the birth canal. This breech presentation is the most likely to result in a c-section due to the risks associated with the feet being birthed first.
As I hinted at earlier, just because your baby is breech does not mean that you’ll need a c-section. There are risks associated with vaginally birthing breech babies, such as the umbilical cord becoming looped or the baby inhaling amniotic fluid.
Most doctors, especially in the U.S., are not trained in how to deliver breech babies vaginally, so most will recommend a c-section. There are obstetricians and midwives out there who are trained to deliver breech babies vaginally. As always, it’s important to assess the risks and benefits before making a decision, and to listen to your doctors!
The same methods to turn a transverse baby apply to a breech baby. You can try an ECV or other ways to turn your baby around. Some babies even turn during labor! Spinning Babies is another great resource about how to help your baby be in the best position before and during labor. Check it out!
Baby positioning can be an anxiety-inducing topic since so much of it is out of our control. If you find out that your baby is not in an ideal position, do what you can to help baby move, but above all else - stay at peace. This can be hard when you have to let go of all your plans for your birth. Your mindset is key to your birth satisfaction... we talk about this and more in our free Mini-Birth Class for Couples. Click here to sign up.