Before the Birth
The best position for a straightforward labour and birth for a baby is left occipito lateral / anterior. This means that the back of the baby should be on the left hand-side of the mother, slightly to her front. This positioning takes place from 32 weeks of pregnancy for a first baby and from about 37 weeks for subsequent babies.
A baby in the occipito-posterior position (with his/her back on the mother’s back) cannot tuck his/her chin in because of the mother’s spine is in the way and therefore presents a bigger head diameter to enter the pelvis.
Furthermore, in the occipito anterior position the contractions of the uterus are directed onto the cervix, allowing it to dilate smoothly. For a baby in posterior position, the contractions are directed about 1 inch away from the mother’s cervix: many more contractions, and much stronger ones are needed to dilate the cervix.
Factors which influence the baby’s position
Negatively – furniture designed to relax in leaning backwards
– crossing legs (reduces the space in anterior part of the pelvis)
– travelling in bucket type car seats for long distances)
– lying flat on the back
– anterior placenta
– tight abdominal muscles like in athletes
Positively – leaning forward with hips higher than knees
– lying on left hand side
– scrubbing floors on all 4’s
– posterior placenta
How to encourage your baby to rotate into the left occipito-lateral / anterior position
– upright and forward leaning postures especially in the last 6 weeks of pregnancy ( last 2-3 weeks for subsequent babies)
– crawling around when the baby is awake and kicking or when experiencing Braxton-Hicks contractions.
– knees lower than hips, pelvis NOT tucked in (pregnancy lordosis helps the baby to go down)
– swimming (not on the back)
– walking (legs slightly apart)
– yoga but without low squat
A first baby in right occipito-posterior position needs to rotate to the left side of the mother. This means pressing on the mother’s bladder (very uncomfortable). The mother’s normal reaction is to lean backwards to ease the discomfort and her baby stays in ROP position because he/she can’t turn uphill.
During labour: it is difficult for the foetus to rotate from occipito-posterior to occipito-anterior but the mother can create more space by altering the level of her hips (such as walking on the spot or climbing up the stairs sideways)
Maternal positions during the second stage of labour
The best squatting position is flat footed, with a straight back and the knees lower than the hips. A good support for this position is essential.
Kneeling or hands and knees:
This position increases the internal transverse diameter of the pelvis. The sacrum and coccyx are free to move away to let the baby go through.Hands and knees position is also very good if the baby is in occipito-posterior position.(Adapted from “Understanding and teaching optimal foetal positioning” By Jean Sutton and Pauline Scott).
During the Birth – Top 10 Tips
1) Stay upright and mobile
Not necessarily standing; leaning over a birthing ball, a beanbag or with your arms around your birth supporter is great for example. Gravity helps, and the stretching of the mother’s tissues is evenly spread when she is upright. The space inside the pelvis increases by 30% during the birth, unless the mother is lying on her back or sitting on her sacrum. In those circumstances, the baby will have to make do with a much smaller pelvis, hence an increased likelihood of a baby finding it hard.
In the first stage of labour, it is a good idea if the mother keeps her knees below her hips to increase the space at the entrance of her pelvis. She should also ideally lean forward. Indeed, the uterus contracts forward so a mother who is leaning backwards needs to lift her uterus against gravity (more work for the muscles). Leaning forward also relieves pressure on the blood vessels that bring oxygen to the baby and to the uterus.
If the labour is progressing slowly, it might help to walk up and down the stairs sideways from time to time.
2) Make a noise if ou feel like it and keep your mouth soft
Groaning, moaning, rhythmically chanting, swearing and singing have been found to help some women in labour. And there seems to be a link between a tense mouth and a tense pelvic floor, so keeping your mouth soft will keep the pelvic area soft and as a result, opening more easily.
3) Choose a good birth partner
Studies have shown that having a supportive companion can reduce a woman’s need for pain killers and even result in fewer interventions during labour. Bring your birth partner to the birth preparation class or brief them thoroughly as they need to be prepared too.
4) Use hypnosis or visualisation
Our mind can have a powerful influence on the birth (positive or negative). Work on letting go of tension, visualising the body working well in labour, and on whatever you are looking forward to doing with the baby (holding, smelling, cuddling…). Studies have also shown that labour is less likely to start late when a woman has prepared for the birth using hypnosis techniques.
5) Be informed
Preparation will help you decide what is right for you before, during and after the birth. Everyone is different, but it is important to realise that you are ultimately in control of what is going to happen. The medical team cannot do anything without consent. It is the woman’s responsibility to choose what the medical team is going to be allowed to do. Their responsibility is to do it well. Unfortunately, the vast majority of procedures have both pros and cons. Understanding those and what alternatives are available allows the parents to make an informed choice about their care.
6) Use water and massage
Many women find it helpful. It is worth practising the massage before the birth so that your birth partner knows how you like it done.
7) Communicate with your carers
It is lovely to get to know the midwife ahead of the birth, but unfortunately, this is no longer common. It is a good idea to have in-depth discussion with your birth partner(s), so that they know what your hopes are and how you have prepared for the birth. They’ll be able to pass on this information to your midwife if needs be and act as your spokesperson if you withdraw from conversation during the birth. It is also a good idea for the birth partner to communicate as much as possible with non-verbal communication or if words are needed, very softly to minimise interfering with the mother’s possible withdraw into her own world or place of safety.
8) Stay at home as long as you feel comfortable
Getting to the hospital too early can have a slowing effect on the labour, and some women are sent back home if they have not gone far enough in the labour. This obviously doesn’t apply to women who have medical reasons to get to hospital early, or those who are expecting a long journey there.
Staying at home longer offers many benefits. Home is normally comfortable and private. Access to snacks is easy (for both mother and birth partners), and women do not normally have to share their toilet or bathroom with strangers. Access to one’s own bed is also a plus (familiar sounds, smells, sights…).
I’ll always remember a lovely story told to me by a friend who said that when she first went to the hospital, she was promptly sent home without even being checked. When she questionned this decision, the doctor said that she was obviously not in labour as she’d put on make-up before leaving the house. She went home and ran the bath, spent a few hours there and then was dragged out by her mother who had arrived, and taken to hospital. She gave birth about 30 minutes later. Needless to say, she had totally forgotten about make-up that time, her mind utterly absorbed by the birthing process.
9) Think Positively
Think of labour as a collection of small steps, each and every one of them achievable. After all, the genetic selection for the women giving birth nowadays has been extremely stringent. Their mothers, grand-mothers, great grand-mothers, great great grand-mothers… have all given birth and most of them un-aided. Women are now lucky to have access to medical help if they need it, but this is a recent addition to our world. And remember to use everything you have practised and learnt during the pregnancy.
Relax your muscles and relax your mind, letting the primitive part of the brain to take over and listen to what the body is asking you to do. Play some music or a hypnotherapy recording, and go with the flow. It will lead you to meeting your baby for the first time.