Monday, August 27, 2012

Mama Monday - Focus on Fetal Positioning for a Better Birth

Happy Mama Monday, Lovies!

For the fourth part of my series on Five Steps to a Better Birth, I would like to share tips on how to focus on optimal fetal positioning during your pregnancy. To catch up on where we are in the series, take a look at previous posts on the first three steps, Nutrition, Exercise, and Childbirth Education and Birth Plans for a better birth.

What Is Fetal Positioning?

Fetal Positioning describes the way your baby sits inside your uterus. There are basically five different positions the baby can be in before birth, with variations of each. They are described below:
  • Occiput Anterior - The occiput is the back of the baby's head and anterior describes the front of the mother's pelvis. So, if the back of the baby's head is facing the front of the mother's pelvis, baby is considered in the Occiput Anterior or OA position. This is the ideal position for your baby to be in for birth. When baby is OA, he or she is optimally aligned with the pelvis and birth canal and can best maneuver through it for a smooth birth.
  • Occiput Posterior - This is when the back of the baby's head faces mother's posterior, or the backside of her pelvis. This is commonly referred to as "Sunny Side Up," because the baby would be facing upward if the mother were lying on her back. This is considered a malposition because as the back of the baby's head bucks against the tailbone during a contraction, mother can experience painful and distracting "back labor." Persistent Occiput Posterior or OP fetal position can be cause for cesarean section in some cases because it can make it very difficult for the baby to descend into the pelvis and through the birth canal. This is especially the case for larger babies. That said, many babies begin the birth process in an OP position, and rotate to the optimal OA position before birth.
  • Transverse - Transverse refers to a side-lying position of the baby inside the uterus. Some transverse positions are still considered head down positions when the baby's head is pointing toward the mother's hip, and will likely rotate to a vertical position in order to successfully be birthed vaginally. A true transverse position after 29 weeks gestation is not ideal because it could turn into a breech position (requiring cesarean for most providers who no longer learn how to deliver breech babies vaginally), or remain transverse and therefore not have the ability to be birthed vaginally. It is very common for babies to be in a transverse position up to 26 weeks gestation, but by the third trimester it's ideal for your baby to be in a head down position. 
  • Oblique - A baby is considered in the oblique position when he or she is diagonal inside the uterus, facing mother's hip. While it's fine for a second twin to be in this position, it's not optimal for singleton babies.This can account for an unnecessarily long or painful labor, and if not managed well could lead to a surgical birth.
  • Breech - A breech baby has his or her buttocks downward in the pelvis, with the head at the top of the uterus. Though it's very possible, with a trained midwife, physician or obstetrician, to birth a breech baby vaginally, most care providers no longer learn the techniques to do so. In many cases, a woman whose baby is in a breech presentation in the third trimester of pregnancy will be encouraged to elect for a cesarean birth.
Image used with permission from Gail Tully

How to Promote Ideal Fetal Positioning:
  • Stay Healthy - As I've discussed in previous posts, prenatal nutrition and exercise in pregnancy can help ward off gestational diabetes, preeclampsia, excess weight gain and will ensure a smoother pregnancy and positive birth experience. Larger babies are more likely to get "stuck" in a certain position, and if they are OP early in pregnancy and become large due to gestational diabetes or genetics, it can be difficult for them to rotate into the optimal OA position closer to birth. If mother has not maintained her health during pregnancy nutritionally or has gained too much weight, she will likely move, rest and sleep in unfavorable positions during pregnancy, and be unable to move in ways during labor to help her baby maneuver into more favorable birthing positions.
  • Learn the Techniques - The most comprehensive source on the subject of fetal positioning currently available is through Spinning Babies. Take a look at their techniques for maintaining good positions and for helping to readjust babies who may have gotten itself in malposition.
  • Consider Professional Help - Acupuncturists, Acupressure Professionals, Midwives, Physicians, Chiropractors and Doulas can all be helpful in identifying malposition in babies and can suggest techniques or perform specific procedures to help reposition babies in the uterus.
  • Practice and Prepare Comfort Measures for Labor - Doulas and midwives have in their "bag of tricks" numerous non medical comfort measures for labor and birth that, in addition to easing pain, fear and stress in the laboring mother, can help promote optimal positioning for the baby to ease the birth process.
  • Assess Your Baby's Position - To assess whether or not your baby is in a good position while in utero, try a method called Belly Mapping. This combines feeling the outside of your belly with considering where you feel the baby's kicks, among other techniques, to determine how your baby is lying in your womb. Knowing how your baby sits inside your uterus as you approach late pregnancy will help you know how to accommodate your lifestyle to promote ideal fetal positioning for the birth experience.
  • Stay Upright and Forward - It is not recommended for pregnant women to lie flat on their backs beyond the first trimester of pregnancy because the weight of the uterus can constrict blood flow to the major blood vessel that runs to your heart, thus cutting blood supply to both you and your baby. It also promotes the OP (Occiput Posterior) and Breech positions. In addition to this, add slouching and reclining! When at rest, opt for side lying, and sitting in a straight backed chair or prop yourself with pillows on a soft couch. Compensate for any slouching or reclining with pelvic rocks and birth ball exercises several times a day.
Stay tuned next week for information on Perineal Massage for a Better Birth!


dnkdoss said...

Sometimes I wake up on my back (35 weeks preggie w/ 2nd). Makes me nervous that I've restricted blood flow to my baby girl! Do you know of a way to keep from sleeping on your back? Pillows? Or should I be super worried about an occasional waking up on back position?

Missy Rose said...

Don't worry too much about unintentially waking up on your back. You can place a body pillow or any other pillow behind you as you fall asleep to give yourself a little cushion in case you roll backwards, that way you're more likely to end up just tilted instead of completely on your back. Obviously you CAN'T control what you do while you're asleep so don't beat yourself up!


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