Fetal positioning is one of those topics that is super important, but a lot of the times gets glossed over in prenatal visits, and even in the labor space. Maybe if you've taken a birth education class, you will have learned a little about Anterior vs. Posterior babies, but what does this really mean for your labor and your birth experience?
Fetal positioning plays a key role in how your labor progresses, but without a more macro understanding of what is going on in there ("there" being inside your pelvis), it can be easy to hear words like "optimal fetal positioning" and "posterior baby" and think the worse.
First, let me just explain what these terms mean. An anterior position is one where baby's back is aligned with your belly, and the hard part of their head, the occiput, is facing your front. A posterior position means baby's back is aligned with your back and the occiput is facing your spine. Labor with a posterior baby sometimes means that during contractions, the hard part of baby's head will be compressed against your spine, which create more intensity with your surges. In some cases, it may mean that sensation lingers even between the surges, however a posterior baby does NOT mean that your baby cannot be born vaginally. Just like an anterior baby doesn't always mean that labor will be a slam dunk.
And I am here to tell you that, in my humble opinion, there is no such thing as "optimal fetal positioning", and posterior babies are not necessarily malpositioned. Your baby chooses their positioning based on the parameters they are given, which are completely unique to your pelvis shape and your baby's shape. How your body chooses to work with those parameters in labor will be completely unique, as well. But what I can tell you in that your pelvis and your baby were genetically engineered to make it work, no matter what position your baby is in. Your pelvis was engineered by nature to expand. Your baby was engineered by nature to compress and mold to your bone structure. And the purpose of your contractions is help position, align, and guide your baby through your pelvis through labor and in pushing.
In fact, did you know that your baby will make two quarter turns just during the pushing phase, alone? The will make one turn as they are descending through the pelvic outlet and another turn once their head has been fully born.
So, what does this mean for your baby's positioning?
It means that the way your baby enters your pelvis puts them on a trajectory that will change as they descend. It also means that your body already has plans to help move them through your pelvis, no matter which way they enter.
Now, what is important to know is how to work with your body in labor and in pushing to create opportunities for your baby to descend in the way that works best for them, depending on how they have engaged in your pelvis.
Ok, so pause for a second. I've thrown some buzz words out at you at this point. Posterior baby. Engaged. Pelvic Outlet. If any of these words is causing you to reach for doctor Google, then I invite you to check out my workshop on The Art of Pushing where I talk about what all of these terms mean. The class is being taught live on February 25, but the replay will also be available for purchase. Hop on over to my website for more details: https://www.b-earth-mama.com/childbirtheducation
Once you have an understanding of what the heck your body and your baby are actually trying to do, you can forget about thinking of your baby's position as something to fix, and you can start thinking about it as just one piece of a larger puzzle - in important piece that will inform how you can be actively working prenatally and in labor to facilitate your baby's downward progression. There are things you can be doing before labor starts, and things you can be incorporating throughout the labor process to achieve this.
Three things I encourage you to think about before labor begins to support the big picture are:
Explore movement that encourages balance in the pelvis
Things like walking and taking the stairs are great for this. You could consider sitting on a yoga ball instead of your office chair. And keep an eye out for favoring one side versus the other. If you tend to sleep on one side, try to balance time spent on the other side, as well. Even if that means you start sleeping on the opposite side knowing you will switch at some point in the night.
A couple of other things you could try are:
Seated Leg Rotations
Standing Leg Circles
2. Incorporate stretches that lengthen the muscles in and around the pelvis.
I specifically like to work with the glutes, the psoas, the hamstrings, the calf muscles and the lateral abdominal muscles. These muscles all connect to the pelvic floor, which supports your baby. The more you can soften and lengthen your your pelvic floor, the more your baby will be able to settle into your pelvis.
Some stretches that accomplish this are:
Pigeon pose
Figure Four
Lateral Reach in Table Top
Psoas Release
Calf stretches
3. Hone your connection to you body
Ultimately, it is your own connection to your body that will give you the most feedback about what it and your baby needs to support their downward progression. Spending time connecting to your body is one of the most valuable ways you can prepare yourself to be responsive to your body's needs in labor. And this can happen in many different ways. Spending time in quiet mediation will work for some people. For others, it may just be checking in with your body throughout the day. Practice asking it what it needs from you and delivering on those requests. If your body tells you it needs rest, give yourself 5 minutes to disconnect from everything and find stillness. If your body needs movement, go for a walk. If there is pain, try to explore the sensation. Where is it coming from? Is it isolated or is it connected to other parts of your body?
Once you are in labor, there is one other piece of the puzzle that you need in order to fully asses what the best approach is to helping your baby descend: Baby's station.
Baby's station (meaning how much have they descended in your pelvis) tells us where you should be focusing your attention, either opening the inlet to help baby engage, opening the mid-pelvis to help them descend, or opening the outlet so they can pass through the birth canal.
Opening the pelvic inlet is achieved with wide kneed positions, like deep squats.
Opening the mid-pelvis is achieved with a-symmetrical or one-sided positions, like side-lying poses or lunges.
Opening the pelvic outlet is achieved with an interior rotation of the femur, or knees in with ankles wide.
Depending on what station your baby is at, and if they are anterior or posterior facing, variations of these approaches I've listed above can be used to help facilitate your baby's descent in labor and in pushing.
If you've made it through this article and still want to know more, I invite you to check out the Instagram Live video I made on this topic!
Or check out my workshop, The Art of Pushing.
As always, please feel free to leave questions for me in the comments, or reach out if you want to chat more!