Why is it important?

Influencing the way the baby lies and promoting optimal positioning could help to make the birth easier for both mother and child.

Ideally, the baby will be lined up to fit through the pelvis as easily as possible. To be in this position, baby needs to be head down, facing the back, with his back on one side of the front of the tummy. In this position, the baby’s head is easily ‘flexed’, i.e. his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. This position is called ‘occiput anterior’ (OA).

The ‘occiput posterior’ (OP) position is not as ideal - the baby is still head down, but facing the tummy instead of the back. Mothers of babies in the ‘posterior’ position are more likely to have longer and more painful labours (backache labour), as the baby usually has to turn all the way around to face the back in order to be born. He cannot fully flex his head in this position, and the diameter of his head, which has to enter the pelvis, is greater. This means that often, posterior babies do not engage (descend into the pelvis) before labour starts. The fact that they don’t engage means that it’s harder for labour to start naturally, so they are more likely to be born post-dates. Pre- labour Braxton Hicks contractions may be especially painful, with lots of pressure on the bladder, as the baby tries to rotate while it’s entering the pelvis.

When do you need to start doing something about this?

There may be little point in practicing OFP techniques in late pregnancy as a matter of course - for instance, if your baby is already occiput anterior. However, if your baby seems to have settled in an OP position, then it may well be worth putting in some effort to shift him/her.

Pay attention to your posture at the time when your baby may be starting to 'engage'; the last six weeks of your first pregnancy, and the last two or three weeks of subsequent pregnancies. In your second and later pregnancies, the uterus is roomier and the baby will not normally start to descend into the pelvis until later, and often not until labour starts.

How can you avoid a Posterior Presentation?

As the baby’s back is the heaviest side of its body, it will naturally gravitate towards the lowest side of the mother’s abdomen. So if the tummy is lower than the back, e.g. if sitting on a chair leaning forward, the baby’s back will tend to swing towards the tummy. If lying on your back or slouching on a sofa, the baby’s back may swing towards your back.

Good moves:

• Kneeling and leaning forward on a beanbag while watching TV
  
  
• Pelvic rocks on all fours (several sets a day)
  
  
• Scrubbing the floor, crawling, or doing other tasks that require being on all-fours a lot in the week or two prior to labor (but not just for a few minutes, for 20-30 minutes at a time at least)
  
  
• Use yoga positions while resting, reading or watching television – for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)
  
  
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright
  
  
• Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front
  
  
• Only put your feet up if your doctor has advised it or you need a quick rest, as lying back with the feet up encourages posterior presentation
  
  
• Sleep on your side, not on your back
  
  
• Avoid deep squatting in late pregnancy, until you know he/she is the right way round.
  
  
• Swimming with your belly downwards is said to be very good for positioning babies, breaststroke in particular helps with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
  
  
• A fit ball can encourage good positioning before and during labour.
  
  
• Various exercises done on all fours can help, e.g. wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.
  
  

How can you improve baby's position during labour?

If your baby is in a posterior position when labour starts you can still use upright or forward postures to try to help your baby to turn and to relieve your pain. Babies often change position during labour and most babies get themselves into an anterior position by the pushing stage, no matter what position they were in at the start of labour. Sometimes women have niggly pains for several days before labour really starts. This can be wearing, but the pain can be a sign that your baby is trying to turn into an anterior position.

• Try to get plenty of rest at night
  
  
• Remain upright and active during the day
  
  
• Eat and drink nutritious things regularly to keep up your strength
  

You may find that the best posture to labour in is on all fours. In this position, your baby drops away from your spine, helping to relieve backache and hopefully helping him or her to turn, too.

When in actual labour, try to:

• Stay upright for as long as possible.
  
  
• Lean forward during your contractions – use a birth ball, beanbag, your partner or the bed to lean on.
  
  
• Ask your birth partner to massage your back
  
  
• Rock your pelvis during contractions to help your baby turn as he passes through the pelvis
  
  
• Don't stay sitting in a chair or on a bed in a leaning-back position for too long.
  
  
• Avoid having an epidural if possible; it may increase the chance of baby being in a posterior position at birth, making an assisted birth more likely.
  
  
• If you get exhausted during labour, lie on your left side, as your pelvis can still expand to give your baby space to turn while you are resting.
  

What position is your baby in?

This is important because you need to know when your baby moves into a good position, so that you can encourage it to stay there! You can learn to tell what position your baby is in by asking midwives to show you what to look out for, and by practicing feeling for the baby yourself.

If your baby is posterior when you are in labour.

You may try your hardest to get your baby into a good position, but he may be determined to stay the way he is - if so, there are things you can do in labour to help a posterior baby to be born.

The majority of babies who experience a posterior labour, actually start labour in an ideal position, and then turn posterior while you are in labour. Gardberg et al (http://midwifeinfo.com/articles/the-dreaded-persistent-occiput-posterior) found that 68% of posterior babies took this route. This seems very unfair - but if it happens, these tips should still help.

These movements can help the baby wriggle through your pelvis, by altering the level of your hips. They are also helpful if the baby is anterior but has a presentation problem, e.g. his head is tipped to one side.

• In early labour, walk up stairs - sideways if you need to
  
  
• Rock from side to side
  
  
• March or 'tread' on the spot
  
  
• Step on and off a small stool
  
  
• Climb in and out of a birth pool
  

For the second stage

• Use kneeling or all fours positions. Kneeling on one knee can help.
  

The most recent research on using hands-and-knees position in labour, where the baby is known to be OP, has supported OFP theory. Stremler and colleagues confirmed that babies were OP by ultrasound, then asked the women concerned to spend at least 30 minutes out of an hour on hands-and-knees while labouring. The baby's position was checked after an hour. Twice as many babies had turned OA at the end of that hour in the hands-and-knees group, as in the control group. However, because of the small numbers involved this did not reach statistical significance. I think most of us would be prepared to take a chance on that! What did reach statistical significance, however, was the women's experience of back pain; the hands-and-knees group experienced significant reductions in persistent back pain than the control group.

http://www.homebirth.org.uk/ofp.htm#stremler

• Supported squatting - the mother must be lifted quite high up; her bottom needs to be at least 45cm (18 inches) form the floor.
  
  
• Birth stool seats should be at least 45cm (18 inches) from the floor.
  
  
• Avoid lying on your back, semi-reclining, sitting or semi-sitting, as they reduce the available space for the baby to turn. Lying on the left side is OK.
  
  

Useful websites:

http://prenatalyogacenter.com/blog/explanation-of-fetal-positions-what-poses-are-beneficial-and-what-poses-should-be-avoided-during-pregnancy/

http://www.homebirth.org.uk/ofp.htm#whatis

http://www.spinningbabies.com/baby-positions

http://www.spinningbabies.com/spinning-babies-and/yoga

http://www.askdrsears.com/search.asp

http://www.nct.org.uk/pregnancy