Once you reach your 28 week appointment your midwife will start to feel your tummy to check the position of your baby. This will be offered at every appointment from now on and the position of baby recorded in your notes.
At this stage it is helpful to know what baby is up to but really nothing to worry about if they are still very mobile. Most babies will start to go into a head down position by around 34 weeks but even if you get there and your baby isn’t where you would like them to be, don’t panic! Babies can, and do, move right up until birth. If you have been pregnant before babies don't always settle into position until later in pregnancy as there is more space due to everything being a bit more, erm, stretchy.
What sort of positions are we talking about here?
Generally when someone is checking your baby’s position they are feeling for a head and a bottom to determine which way up they are. Then they are checking which direction your baby is facing in.
So your baby can be head down (cephalic/vertex), head up (breech), sideways across your tummy (transverse/lateral) or somewhere between on an angle (oblique).
In terms of direction this is with reference to the occiput – the back of your baby’s head and where in your body that lies. So a baby with the back of their head towards your tummy and their face towards your back is anterior. A baby with the back of their head towards your back and their face looking out towards your tummy is posterior.
In your notes you will see this as O (for occiput) and a letter for the direction – OA, OP and then another letter for the side. LOA means baby is slightly to the left of your body, their back towards your tummy. ROA would mean the same with baby on the right side of your body.
If baby is breech the O can be an S as now we are referring to baby’s sacrum (lower back) rather than back of the head.
Image Credit: Student Midwife Studygram
Why does all this matter?
The position of your baby can have a significant impact on your birth. This is why there is an ‘optimal’ when it comes to fetal positioning.
The ideal situation is for baby to be head down – the pressure of baby’s head on the cervix helps stimulate oxytocin to keep contractions coming.
When baby is in an OA position their head has the best fit on the cervix meaning labour is likely to progress in the best way possible. If they are OP their head is on the cervix but doesn’t fit quite so well and labour progress can be a bit slower.
As your baby moves down through the pelvis they will turn to be born facing backwards, towards your bottom. If baby starts off on the left side of your body they only need to turn a small way to do this – most babies will go clockwise. If they are on the right side chances are they will still go clockwise but have much further to rotate.
So when it comes to defining optimal LOA is considered the ideal position for a baby to be in.
The problem is that not all babies are in this position. What does this mean if baby is not in the optimal position?
Sometimes it can mean labour is a little slower or more complicated and that you will need more help but, of course, we can’t judge what would have happened had your baby been in a different position so it is tricky to say far sure. And plenty of people have straightforward births with babies is varying positions.
What if my baby isn’t in an optimal position?
Knowing that your baby isn’t in quite the right position can be a bit worrying when we say that it might make labour a bit trickier.
There are lots of reasons babies might be in a different position and you might be able to encourage them to wriggle themselves round a bit. In order for them to be in position your body needs to be in balance. The uterus sits in the pelvis supported by four ligaments and if these are pulled or twisted the uterus is pulled out of alignment which might affect the position your baby can be in.
If your pelvis is out of alignment it can affect baby moving into position, sometimes your uterus is an unusual shape, or the cord is very short and baby just doesn’t have space to move round.
Sometimes these factors are due to lifestyles, the fact we like our comfy sofas, that car seats are bucket ones, that we wear heels or carry bags on one side. Go back a few generations and people would be more likely to be on their hands and knees cleaning that relaxing on the sofa. Gravity!
If you are on hands and knees or leaning forwards, gravity will encourage the heavy spine of your baby towards the floor/front of your body – an anterior position. If you are leaning back on your chair gravity will do the opposite and baby might be in a posterior position with their back towards your back.
What can I do?
Think about your posture during the day, be comfortable but try not to lean back too much. If you do, balance out with some time on all fours – a gym ball can really help with this.
If you are aware of any problems with your pelvis you might want to speak with a chiropractor to see if anything can be done to balance your body out.
If you know what position your baby is there are movements you can do to try and move them, https://www.spinningbabies.com/pregnancy-birth/baby-position/ is a really helpful website with exercises to help you. If you have any concerns or complications with your pregnancy speak to your health care professionals before you try anything.
Encouraging the muscles and ligaments around your pelvis, abdomen and back to release can help balance out the body so uterus and baby sit as they should. Regular pregnancy yoga can help with this as you learn how to release the important muscles to create space and symmetry and do movement to encourage baby into position. Come and join me for classes https://www.bethowen.uk/birthing
If your baby is transverse or in a breech position you might be offered an ECV, external cephalic version, where a doctor tries to manually turn your baby in your tummy to move them to a head down position. An ECV is successful just over 50% of the time.
What if my baby doesn’t change position?
If your baby is transverse, a caesarean birth will be recommended due to risks associated with labour in this position.
If your baby is breech you can opt for a caesarean birth or a vaginal birth. If you would like a vaginal birth speak to your care providers as it is important you find someone confident to support you.
If your baby is in a back to back (OP) position or on your right side and you want to encourage them to rotate then time on all fours or lying on your left side can help.
If you want to improve the chances of your baby getting into a good position come and join me in a Birthing Class for weekly yoga and relaxation where we have movements specifically designed to help with this.
But whatever you try sometimes your baby doesn’t get into that LOA position that is considered optimal. In which case there may well be a good reason why that positions works best for you and your baby and we need to trust they have found their optimal position and work with it.