Fetal positioning in labor plays a HUGE part in how labor flows.

“The occiput-posterior (OP) fetal head position during the first stage of labour occurs in 10-34% of cephalic presentations. Most will spontaneously rotate in anterior position before delivery, but 5-8% of all births will persist in OP position for the [second] stage of labour.” (Guittie, Othenin-Girard, & Irion, 2014)

Along with posterior, there are other positions the baby could be in that are not optimal, such as asynclitic, transverse, facial or brow presentation, shoulder presentation, and breech. The most ideal position for a baby to be in before and during labor is Occiput Anterior (OA). This is where the baby’s back is against the mother’s belly. She will feel kicking up front and more than likely feel the baby’s back as a hard spot on the front.

How can you tell a baby is not in an optimal position? Other than a cervical check or an ultrasound, there are signs or symptoms that may indicate the baby is not in an optimal position. A major sign is a woman experiencing hard back labor or back pain, labor may be prolonged or stalling, the belly may be flat or soft up front and kicks will be mainly up front, contractions may show a “coupling” pattern, or prolonged pushing with little progress. Even with all of these, sometimes babies can be OP and not show any of those signs. As a birth worker, it is important to recognize these symptoms early on and try and encourage a better position through labor position changes, movement, and rebozo to help minimize the length of labor.

What Can You Do to Help?

Changing positions during labor is the number one thing we as birth workers can do to help encourage an optimal fetal position. For mothers who are unmedicated, movement is a little easier. For those who have an epidural, this can make things a little trickier; however, there are still things you can do with positioning to help her sweet baby come down into the pelvis in the correct position. Using tools like the peanut ball, rebozo, squat bar, and pillows can help when you have a momma who is not able to move around as well as an unmedicated mom. The best way to help her baby be in a good spot is starting before labor begins, with positions and paying attention to posture. In your prenatal visits, you may want to incorporate talking about fetal positioning and how to get a baby in an optimal spot before labor begins. Remember, even if the baby starts in the right spot, there is always a chance that the baby may change positions and end up in an OP or other position at some point in labor. Positions that encourage good fetal position are listed below.

The Miles Circuit and Spinning Babies are wonderful sources of information for you to give to your clients. You may also want to give her some information on how to belly map. Spinning Babies has great links on how to map a baby’s position (see Appendix 2). Something that you can do is try your best to make sure the baby is in the best position prior to a woman’s water breaking. This is good information for ALL vaginal births, and ESPECIALLY relevant in VBAC, as providers tend to be less patient with a malpositioned baby. If labor is not progressing, she is having signs that the baby is not in a good spot, and it’s recommended that she rupture her membranes, encourage your client to ask about waiting and working really hard to get the baby in a better position before proceeding with that option.