Baby Positions in the Womb: Preparing for a Smooth Labour
Occiput Anterior (left) and Occiput Posterior (right)
When it comes to preparing for labour, understanding your baby’s position in the womb can be both reassuring and informative. Expectant parents often wonder how their baby’s position might affect labour, and whether certain positions are more favourable than others. In this article, we will explore the different baby positions in the womb, how these positions prepare your body for labour, and what steps you might consider to encourage an optimal positioning for a smoother delivery.
Understanding Fetal Positioning
Fetal positioning refers to the location and orientation of the baby in the womb as they get ready for birth. While many expectant parents hear about the ideal position known as occiput anterior (OA), there are several other positions to be aware of, including occiput posterior (OP), breech, and transverse lie. Each position can affect labour differently, making it important to understand the potential implications and ways to encourage the best possible position for delivery.
The Occiput Anterior Position
What is Occiput Anterior (OA)?
The occiput anterior position is when your baby’s head is down (Cephalic), with the back of the head (occiput) facing your front. Baby can be in either a left occiput anterior position or right occiput anterior position. This position is often considered ideal for labour because:
Efficient Passage: The baby’s head is optimally aligned with the birth canal.
Less Complicated Labour: This alignment typically leads to a smoother and quicker labour process.
Reduced Interventions: There’s a lower likelihood of requiring medical interventions, such as a cesarean section.
Why OA is Considered Ideal
The OA position allows the baby to navigate the birth canal with minimal resistance. Healthcare providers often encourage positions and activities, such as walking or certain prenatal exercises, that help nudge the baby into this favourable position. A left occiput anterior (LOA) position is generally considered better than a right occiput anterior (ROA) because the left side of the uterus tends to be more rounded and spacious, allowing the baby to tuck their chin and present the smallest diameter of their head to the pelvis, making for a smoother and easier delivery compared to a right-sided position where the angle might be steeper, potentially causing more difficulty during birth. However, it is important note that any OA position is favourable and to not be fixated on left vs right.
Occiput Posterior: The "Sunny-Side Up" Position
What is Occiput Posterior (OP)?
In the occiput posterior position, the baby’s head is down (Cephalic), but the back of the head is facing the mother’s back rather than her belly. This position is sometimes referred to as the “sunny-side up” or ‘back-to-back’ position. Again, similar to OA - baby can be in a position or left occiput posterior or right occiput posterior.
Implications for Labour
Longer Labour: Labour may be longer and more painful due to increased pressure on the spine.
Increased Interventions: There is a higher chance of needing manual rotation or other interventions to help the baby rotate to the OA position.
Natural Adjustments: Many babies rotate naturally during labour, but if the OP position persists, your healthcare provider might suggest positions and movements to encourage a rotation.
Breech Position: When the Baby is Feet or Bottom First
Left to right: complete, incomplete and frank breech
Understanding Breech Position
A breech position occurs when the baby’s feet or bottom are positioned to come out first rather than the head. Breech positions are less common but require careful monitoring as they can complicate labour.
Considerations for Breech Births
Increased Monitoring: Your healthcare provider will closely monitor the baby’s position as the due date approaches.
External Cephalic Version (ECV): In some cases, doctors may attempt an external cephalic version, a procedure to manually turn the baby into a head-first position.
If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.
Possible Interventions: If an ECV does not work, you will discuss options with your midwife and obstetrician. If you plan a caesarean and go into labour prior to your caesarean, you obstetrician will assess whether it’s sage to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for a vaginal breech birth. The Royal College of Obstetricians and Gynaecologists advise against a vaginal breech birth, if (source NHS):
your baby's feet are below its bottom – known as a "footling breech"
your baby is larger or smaller than average – your healthcare team will discuss this with you
your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
you have a low-lying placenta (placenta praevia)
you have pre-eclampsia
Transverse Lie: When the Baby is Lying Sideways
What is a Transverse Lie?
In a transverse lie, the baby lies horizontally in the uterus, meaning neither the head nor the bottom is pointing toward the birth canal. This position is rare at term and typically requires medical attention.
Managing a Transverse Lie
Early Detection: Regular prenatal check-ups and ultrasounds can help detect a transverse lie.
Potential Interventions: If the baby remains in this position as labour approaches, healthcare providers may consider procedures to try to rotate the baby or may plan for a cesarean section.
Factors That Influence Baby’s Positioning
Several factors can affect the way a baby positions itself in the womb, including:
Uterine Shape and Size: Variations in the mother’s uterine anatomy can influence positioning.
Placental Placement: The location of the placenta might encourage or discourage certain positions.
Amniotic Fluid Levels: Adequate levels of amniotic fluid provide the baby with the space to move into an optimal position.
Maternal Activity: Regular physical activity and specific prenatal exercises can promote favourable positioning.
Tips to Encourage Optimal Fetal Positioning
While many factors are beyond your control, here are some strategies that may help your baby settle into the best position for labour:
Stay Active: Regular walking and gentle exercise can help the baby move into an ideal position.
Pelvic Tilts and Positions: Specific exercises, such as pelvic tilts or the “cat-cow” stretch, may encourage the baby to rotate.
Prenatal Yoga: Yoga can improve flexibility and promote optimal baby positioning.
Side-Lying Positions: Sleeping on your left side may improve blood flow and encourage the baby to shift into a head-down position.
Always consult with your healthcare provider before starting any new exercise regimen or making significant lifestyle changes during pregnancy.
When to Consult Your Healthcare Provider
Understanding your baby’s position in the womb is crucial, especially as you approach your due date. If your baby is not in the optimal position or if you have concerns about how their position might affect labour, it’s important to:
Schedule Regular Check-Ups: Routine prenatal visits allow your provider to monitor the baby’s position and overall health.
Discuss Options: Ask your provider about interventions such as external cephalic version if your baby is in a breech or transverse lie.
Plan Ahead: Understanding your baby’s position helps you and your healthcare team create a birth plan that prioritizes safety and comfort.
Conclusion
Fetal positioning plays a significant role in preparing for labour. While the occiput anterior position is ideal for a smoother and more efficient delivery, other positions like occiput posterior, breech, or transverse lie require additional monitoring and sometimes intervention. By staying informed, engaging in recommended prenatal exercises, and maintaining open communication with your healthcare provider, you can feel more empowered and prepared for the journey of labour and delivery.
