Optimal Foetal Position Makes A Labour of Difference

This is my all time favourite chapter from my second A Labour of Love book -Empowering through knowledge to create the birth you want and desire. The reason being is because it highlights what pregnant women can be doing each and everyday from 30 weeks to encourage her baby into a good Optimal Foetal Position in preparation for labour. I hope you enjoy reading this information as much as I enjoyed writing on this topic.
Chapter Seventeen
Optimal Foetal Positioning Makes a Labour of Difference!

Any of my aqua-specific class participants will tell you what a stickler I have become for getting women to acknowledge where their baby is sitting inside their body and just what they can do to assist their baby into a favourable position for birth. This acknowledgement and push came after reading Understanding and Teaching Optimal Foetal Positioning by Jean Sutton and Pauline Scott who live and work in New Zealand. They suggest due to our Westernised/sedentary lifestyles, women are no longer leaning forward at all throughout their day due to not having to perform tasks and skills of manual labour around the house, like chopping wood or scrubbing the floors. The cause and effect being we are witnessing more and more babies being in a posterior position or OP (Occipito Posterior) as it is technically referred to, where the baby’s spine is to the mother’s spine and back of the pelvis.

Jean and Pauline, like myself, believe it is of utmost importance to get a baby into the optimal foetal position as early on in the pregnancy as thirty weeks, for this is when a baby is starting to rotate around and is settling into the pelvis in readiness to be born.

Having run aquatic and fitball pregnancy specific classes for many years, optimal foetal positioning was something I was always aware of and it was always at the back of my mind, however until I read Understanding and Teaching Optimal Foetal Positioning, I did not consciously tune in to just how important optimal foetal positioning is in relation to birthing outcomes. That wake up call came to me about five years ago when I was noticing so many women coming to me with posterior positioned babies who would literally endure these long hard drawn out labours as their body tried to turn their baby with the contractions to the anterior position in labour, or they birthed their baby in a posterior facing position with intense back pain.

It is for this very reason that I now encourage women to do some fundamental activities from thirty weeks through to the baby’s birth day once they know they have a baby head down.
The three things I get women to do are what I call:
Tummy time (between 30 to 40 plus weeks)
Ball time (any time from 30 weeks onwards- when head is down in pelvis)
Peri Prep time (from 35 weeks onwards – every third day until birth)

Tummy Time Firstly I will focus and explain what tummy time is: Tummy time is about getting a woman to lean forward for twenty minutes a day two to three times a day if possible. This can be done incidentally while carrying out other tasks or on purpose in a desired place and position. I find women can easily perform this task while: Talking on the phone—leaning over the kitchen table or bench top Watching TV—leaning over a fitball, bean bag or back of yout arm chair or couch Swimming in the pool—in a prone (face-down) position with mask or snorkel (gravity is best though) Participating in a Yoga class—child pose, dog pose and cat pose Attending antenatal childbirth educational classes—sitting on a fitball, leaning over a fitball or beanbag (not sitting upright in an uncomfortable chair) Scrubbing and cleaning the floors—on your hands and knees (No, I am not kidding!) If on the computer, sit on a fitball or ergonomic chair that forces your body forward and back to be straight
Playing on the floor on your hands and knees with your other children
Pulling the weeds out of your garden or planting new plants in garden beds
Chopping the firewood if you have a fire place-some people still do!

In order to rotate your baby to an anterior position or OA (Occipito Anterior) position as it is referred to, so that your baby may enter the pelvis with more ease, it is so important that from thirty weeks in your pregnancy, you avoid laying on your modular couch that has the ‘chase’, or reclining chair such as a La-Z-Boy, as this really does interfere with what optimal foetal positioning is about. I know this can be very difficult and tempting when you are pregnant and feeling tired and heavy, and nowadays we have such comfortable furniture that looks like a bed and beckons us to come and lay on it in the dreaded reclined position. Avoid doing so at all costs—I really can’t stress this enough! Ban yourself from lying down on this furniture for this very short time in your life.

I know personally that all you really want to do is lay on that couch at the end of a day and rest, however laying on your back can rotate your baby into a posterior position which is not really conducive to a straightforward and easy birth. Labour with a posterior baby position is hard work, make no mistake about that. Women can birth a baby in a posterior position however, it is harder on the woman due to the intense back ache that does not go away when the contraction is on and off, and often the labour can be very long and hard. Women who do labour with a posterior positioned baby need a medal for being so strong with incredible endurance.

Having a baby in a posterior position may cause the following:
Labour pain in your back/constant intent back ache that does not go away
Pain deep in the pelvis and hips on one or both sides
The baby cannot enter the pelvis as easily in this position (it is often referred to as the ‘Military position’ where the baby is straight from head to bottom spine to spine with Mum- causing baby’s head to be rigid presenting widest part of head circumference)
Continuous pain that does not go away when in between contractions
A longer labour Irregular contractions More interventions (like induction to get labour started)
The baby decides to turn in labour to the anterior position You go over your estimated date of birth
The need for your baby to be rotated at the end of the labour with the head in the birth canal using forceps or vacuum or both
The need for assistance to birth your baby using forceps or vacuum

Having an anterior position baby may mean: Labour being shorter Less pain associated with labour You will receive rest periods in-between contractions Baby may be born closer to estimated dates Less need for pain relief Less likely to need interventions at the end of labour due to your baby being in a better position In order to assist with optimal foetal positioning, try to avoid at all costs:
Laying back in a semi-reclined position on furniture and in bed Long car trips with a bucket type seat
Sitting with the legs crossed on any type of chair
Squatting— should not be attempted unless your baby is head down or in an OA position
If you are still working up until your estimated date of birth try not to slouch on your chair at your desk—try to use an ergonomic chair that tilts forward or sit on a fitball

Below are some practical ideas that I encourage women to do to get the baby down into the pelvis. Ball Time Ball time is about getting on a fitball every day once you know your baby is in an anterior position to encourage your baby to head down and into the pelvis rim. If you don’t have a fitball, go out and buy one as you can use it to labour on as well. Make sure when you sit on your ball that your knees are lower than your pelvis. Once your baby is in the anterior position, you have less chance of your baby deciding to rotate into an OP position or worse still, deciding to go breech!

Ball time is about sitting on your fitball for twenty minutes or more a day, while swinging and rocking your pelvis forward and back, side to side, doing big round circles one way and back the other way. Then I often suggest you pretend to write your name on the floor with your vagina in cursive writing (this is always interesting and very entertaining in a class!) You can finish with your pelvic floor strengthening exercises (squeezing your pelvic floor muscles up to the 1st floor, 2nd floor and 3rd floor and holding for the count of six, and then letting it down slowly. This can be repeated eight times over, having a minute’s rest and repeating two more times. All up, you are doing three sets of eight exercises)

If you are having bad problems with peeing when laughing, sneezing, chasing your toddlers around or jumping up and down when exercising then you will need to do three sets of eight three times per day to really get these muscles to engage and become strong once again. The more you do the exercises the stronger your muscles will become the less likely you are to leak urine and have a little accident. Remember if you go into labour with strong pelvic floor muscles your recovery after will be so much better and some women actually have great strength straight away post birth because of all the effort they put in prior to birth.

The thing to ask yourself is how strong are my pelvic floor muscles and how open is my pelvis?

Many women I work with have terrible pelvic floor muscles and very tight ligaments around the pelvis even though they have the wonderful ‘relaxin’ hormone in their body that should be assisting with ligament laxity in their pelvis. As for the pelvic floor muscles, women seem to think that the stronger the pelvic floor muscles, the harder it is to push a baby out. This is completely wrong and contrary to popular belief is in fact the opposite. The stronger the pelvic floor muscles, the easier and more dynamic the pushing can be, hence the pushing/birth phase of a labour can go very quickly. Sitting on a fitball doing ‘ball time’ can open up your pelvis I love this following story as it highlights just how the pelvis can and does open regardless of the size of a baby and the size of the woman and the biased opinions that are out there that are taught to midwives, obstetric care providers and women who then project them onto other women making them doubtful of themselves and their body and it ability to fit a baby through the pelvis. If you wish to read this story you will have to purchase book. It is a fantastic story by Gloria Lemay in that it highlights how women can birth any size baby through their pelvis and how Pelvimetry does not actually exist in the real world. It is so worth a read!