posterior baby By Hayley Oakes LM, CPM ~

One of the things I loved most about co-teaching Two Doulas Birth (an LA-based childbirth preparation series) was their curriculum and emphasis on optimal fetal positioning. As once a doula and now a licensed midwife, I have seen many births in these past seven years and believe that a baby in utero intuitively knows the path of how to be born through his or her mother’s body without a lot of intervention. However, there are external factors that can make the path a bit trickier, and a natural labor more difficult.

The National Institute of Health published a study in 2012 showing a nearly 3-hour increase in the total length of labor of women today compared to women of our grandmother’s generation. What!? Why? Nothing has changed in a woman’s anatomy? Or has it?

While the study correlates a few contributing factors to this increase in length of labor, think about how we, the average American adult female, live in our bodies today: In a car or on some form of public transportation sitting, commuting to work, sitting at a desk at work all day, then sitting on the commute home to then plopping on the couch after work to kick back and relax. That’s a lot of time sitting to promote “C”-curved spines, lousy posture and a pelvis that tucks under itself (rather than straight). Then think about the women of Grandma’s generation: cars with upright seats, a lot more women at home which meant day in and day out up on her feet cooking, cleaning, gardening, taking care of little ones and then of course sitting with a straight back and “lady like posture” for that 5 o’clock cocktail… you get the picture.

How you live in your body is going to affect how your baby lives in your body. Wherever most of the woman’s weight is centered is going to be where the baby hangs out as well. The back of the baby’s head, called the occiput, is the heaviest part of the baby. When a woman spends most of her time leaning back or slouched, the heaviest part of the baby’s head is going to be in the woman’s back. Conversely, when a woman is consciously aware of hanging out in more forward leaning positions i.e. hands and knees, squatting etc., the heaviest part of the baby’s head is going to be in the front. You may ask yourself, so what does it matter where the back of my baby’s head is…

posterior babyThe position of the baby’s head greatly affects your labor pattern and possibly mode of delivery. You may have heard of ‘back labor’, or a baby born ‘sunny side up’? These are two indications of a baby in a posterior position, which causes a longer labor due a dysfunctional contraction pattern and more pain.

When a baby is in a posterior position, the back of the baby’s head is up against the mother’s sacrum, causing the head to be somewhat extended (rather than flexed) increasing the diameter of the head while not applying itself well to the cervix. As a result, there is slow dilation after hours of contractions and this is one reason some women’s labors are labeled as ‘failure to progress’, which is typically the start of the use of interventions.

This position also causes a lot of back pain, not only during a contraction but in between as well. The pain felt with back labor is not normal labor pain. The latter is characterized by intense sensation located in the lower part of your uterus, in the front of your body, where one would feel menstrual cramps for the duration of the contraction (60-90 seconds) and then when the contraction is over so is the pain or intensity of it as well. Then there is a break anywhere from 2-5 minutes when you feel nothing at all until the next contraction comes. Your body is designed to last and cope with labor, giving you intermittent breaks in between contractions so you can rest and endure the rest of the labor and birth. It’s a beautiful and unique design!

But with posterior babies or ‘back labor’, there is no break in between contractions, only searing back pain. This is a hard labor pattern to cope with naturally and a woman is much more likely to transfer from an out of hospital setting for ‘therapeutic rest’ aka an epidural or if planning a hospital birth, request an epidural for pain relief and rest. With an epidural comes a slippery slope though to the cascade of interventions that takes your labor from being normal to abnormal and with higher risks.posterior baby

Babies that are hanging out posterior in pregnancy are most likely going to remain in that position and perhaps even be born that way. However, there is another position that most likely will result in a posterior position in labor: right-side.

When a baby is presenting persistently on the right side in pregnancy (the back is on the mom’s right side with baby’s kicks felt on the left), those babies are more likely to go posterior rather than anterior (front) in labor.

There is a slight rotation at the base of the uterus that goes in a clockwise direction, and in labor the uterine muscles will naturally contract and rotate the baby in that direction. If a baby is on the left side of the uterus, it only has to make a 90-degree rotation to find the optimal ‘exit’ (the part of pelvis with widest diameter). Whereas the right sided baby will have to rotate to the back, then to the left side and then to the front, which is a much longer arc to travel in order to be born (and on the way will cause back pain to make such a long arc turn).

In order to stack the odds in your favor of having the birth that you intend and not get dealt a difficult hand in labor i.e. mal-positioned baby and slow dilation, here are some things you can do ahead of time.

Be aware of your baby’s movements

Also, where your care provider hears your baby’s heart beat the loudest will be indicative of the position of the baby’s back. If the baby’s back is persistently on the right side, try to spend more time leaning forward: use an exercise ball at work or at home while at your desk or watching TV. Spend time on your hands and knees doing ‘cat cow’ yoga exercises or squats and start sleeping on the opposite side you have been dominantly sleeping on.

Start getting routine chiropractic adjustments

This is key in pregnancy especially towards the end as you are coming up to your estimated due date.  You have a wonderful hormone coursing through your body called relaxin that does just as it sounds, relaxes your muscular structure. This is especially important in your pelvis in order to accommodate a little person navigating through your body. As your body is getting looser and more malleable in pregnancy, there is also more risk of misalignment. So, giving your body and pelvis an opportunity to re-align itself is going to create balance and thus facilitate an optimal environment for your baby to settle into.

For those of you living in Los Angeles – I would recommend seeing Dr. Elliott Berlin starting at 36-37 weeks. He is a very talented, intuitive and effective chiropractor who specializes in pregnancy and is the only chiropractor I know who works specifically on the round ligaments (two ligaments on either side of the uterus that holds the weight of uterus, baby and amniotic fluid up and grows 10x its pre-pregnant size) as they can be very tight and prevent the baby from engaging in your pelvis.

Spin Your Baby

 Spinning Babies is a website and an amazing resource started by Gail Tulley, a Midwestern midwife, who noticed how a baby’s position greatly affects a woman’s labor pattern – for better and for worse. She came up with exercises for mothers to do every day starting at 37 weeks to encourage a balanced pelvis and therefore an optimally positioned baby.

posterior baby

If you do all of these things and your baby is still presenting on the right side or posterior in pregnancy and/or in labor, then there is probably a reason we cannot see or know from the outside. We trust your babies know how to find the way out, and sometimes they hang out in not the most optimal positions for mothers because it is the best or safest way for them to be born.

In this unknown and uncontrollable process of childbirth, we can do what we can to prepare for the safest and most satisfying experience possible and then let go of the rest. If your birth experience ends up different from what you intended on, you are much more likely to integrate the unexpected outcome better knowing you did everything you could to prepare for a physiological birth.

Approaching the birth with this sense of surrender, also helps facilitate a smoother recovery – physically and emotionally – and a better breastfeeding and bonding experience with your new baby. And who doesn’t want that?