Friday, February 8, 2013

Optimal Fetal Positioning

In the past year, I've had some clients whose babies were malpositioned, either during pregnancy or (suprise!) during labor.

A baby who isn't positioned exactly right can make labor difficult. Ideally, a baby will be head down, occiput anterior (OA, facing mother's backside), and not get stuck in a left or right position. Not so ideally, a baby could be breech transverse (head up or laying sideways), occiput posterior (OP or 'sunny side up'), left occiput anterior/posterior, right occiput posterior/anterior. Babies can also present face-first or with their hands beside their faces!

Some postulate that our sedentary lifestyles may contribute to a baby becoming malpositioned during pregnancy - we do a lot of reclining! - and suggest trying to avoid this during late pregnancy, if possible. In a Bradley course I once heard some "tricks" to try to get or keep baby head-down: playing music down low so the baby turns toward it, same thing with heat packs, handstands in the pool, and so on.

A baby can turn in pregnancy and labor right up until the last second, especially if you employ some techniques to help the baby along. External version or Webster's Technique are two ways that professionals might try to help a breech baby turn.

Chiropractic care can open up tight abdominal ligaments, which aid in a baby's positioning through your pelvis. is a great resource for moms who are worried about the position of their baby. As long as you don't have blood pressure issues, one can practice the Inversion daily. Prenatal yoga is also a great way to stretch everything out and get stronger at positions that will help you in labor (not to mention help you learn to breathe well for labor!)

Since the goal is often to avoid a Cesarean section or a long, painful labor, many mothers are looking for ways to promote optimal fetal positioning. 

Doulas have a lot of tricks up their sleeves for helping reposition babies who may not be in the most ideal position for birth. Signs during labor that the baby might be mis-aligned include a prolonged active labor (first stage), back labor, or a prolonged pushing stage. Use of a rebozo, the Captain Morgan stance with a lunge, open knee chest position, and the breech tilt are some that I know for repositioning babies during labor.
captain morgan pose

open knee chest
breech tilt

rebozo sifting
Many of these positions work by opening up the pelvis, lifting the baby out of a position he/she might be stuck in so that they are loose and able to move, and allowing for rotation.

Recently, someone suggested that I look into using the Miles Circuit with my doula clients.

It takes 90 minutes to complete and, like many of these techniques, are somewhat difficult and require preparation. It consists of:
1. Knee chest for 30 minutes
2. Exaggerated SIMS (side lying or semi prone with top leg bent at right angle) for 30 minutes
3. Upright movements - can be lunging, movement on a birth ball, climb stairs, for 30 minutes

It seems like this could really work! It already incorporates things that doulas already do - get mom moving, side lying for when she needs rest, and the classic open knee chest to first lift baby out of the pelvis.

Have you ever heard of this?   Used it yourself?

One question that often comes up is whether these things can put the baby in a worse position. Probably not, but just in case, I couldn't actively do something like the Miles Circuit during pregnancy or labor if the baby was already in an optimal position!


  1. Great post!

    It's funny, I see that picture from the spinning babies picture pop up everywhere. And I always do a double take because I actually took that photo at the workshop in New Bedford, MA. LOL!


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