Getting your baby into position for birth

The best position for your baby to be in for birth is head down and with their back towards your belly. This is what’s known as "occipito-anterior" position, or OA. This position is best because your baby fits snugly into the curve of your pelvis, so they can slip under your pubic bone. Those with babies in OA position tend to have shorter, less painful births.

But how do you know what position your baby is in? And what can you do to help your baby get into the best birthing position? Read on to find out.

What's the best position for my baby to be in before birth?

Labour is nearly always shorter and easier if your baby is in a head-down position, with the back of their head slightly towards the front of your tummy. This is called an anterior position. Most babies get into this position by the end of a pregnancy.

What are the advantages of the anterior position?

In an anterior position, your baby fits snugly into the curve of your pelvis, making it best for birth. During labour, your baby will curl their back over and tuck their chin into their chest. Your labour and birth should progress well if your baby is in this position, because:

• The top of your baby's head puts even pressure on the neck of your uterus (cervix) during contractions. This helps your cervix to widen and helps to produce the hormones you need for labour.
• At the pushing stage, your baby moves through your pelvis at an angle, so that the smallest bit of their head comes first. Try putting on a tight polo-neck top, without tucking in your chin, and you'll see how this works!
• When your baby gets to the bottom of your pelvis, they turn their head slightly so that the widest part of their head is in the widest part of your pelvis. The back of their head can then slip under your pubic bone. As baby is born, their face sweeps across the area between your vagina and back passage (the perineum).

What's a posterior position?

A posterior position is where your baby has their head down, but the back of their head is against your spine. By the time labour starts, about 1 baby in 10 is in this back-to-back or posterior position.

Most back-to-back babies are born vaginally, but this position can make labour harder for you, and even more so if your baby's chin is pushed up rather than tucked in. As a result:

• You may have backache as your baby's skull is pushing against your spine.
• Your labour may be longer and slower than most.
• You may feel like pushing before your cervix is fully dilated (Coates 2009).

When your baby gets to the bottom of your pelvis, they'll need to turn right round to get into the best position to be born.

This can take a while, or your baby may decide they're not going to turn at all! In this case, they will be born with their face looking up at you as they emerge. Baby might need help from forceps or a vacuum to get out.

Why are some babies posterior?

Your baby may be posterior because of the type and shape of pelvis that you have. Some people have a pelvis that is narrow and oval-shaped (an anthropoid pelvis) or wide and heart-shaped (an android pelvis), rather than round. You’re unlikely to know what shape your pelvis is, but doctors may tell you, if you end up having a pelvic X-ray for any reason.

If your pelvis is oval or heart-shaped rather than round, your baby is more likely to settle in a back-to-back position at the widest part of your pelvis. This is because they can rest their head more easily like that (Vance 2009).

Lifestyle may also be a factor. It seems that Western pregnant people are most likely to have posterior babies (Sutton 1996).

When you relax on an armchair watching TV, or work at a laptop for hours, your pelvis is tipped backwards. This encourages the heaviest part of your baby (the back of their head and their spine) to swing around to the back (Andrews 2004). In this position, baby ends up lying against your spine.

In the same way, if you do a lot of upright activities, your baby is more likely to go down into your pelvis in an anterior position, because your pelvis is often tipped forwards. Try to do some walking daily, and maybe some stair climbing if you can.

How do I know if my baby is in position for birth?

Your doctor or midwife can tell baby’s position in your womb quite easily. They will touch your belly to see if baby is head or bottom down, and whether or not they are anterior or posterior. If your baby is in a posterior position when labour starts, there’s every chance that they will turn by the time you give birth.

How can I help my baby into an anterior position?

"How can I help my baby get into birthing position?" is something a lot of parents ask themselves as they get close to their due date. You may have heard about a technique called optimal fetal positioning (OFP). This is a way of helping your baby into an anterior position by changing your posture, particularly when you're sitting down. Keep in mind that you're trying to tilt your pelvis forward rather than back. So, if you're sitting, check that your knees are always lower than your hips.

Try these things:

• Check that your sofa or armchair doesn't make your bottom go down and your knees come up. If it does, try turning the chair around, kneeling on the seat pad, and leaning forwards over the back of the chair.
• Scrub the floor! Our grannies used to say that washing the kitchen floor was a good way of preparing for labour. They were right! When you're on all fours, the back of your baby's head swings to the front of your belly.
• Take breaks and move around if your job involves a lot of sitting.
• Sit on a cushion in your car to lift up your bottom.
• Watch TV leaning forward over a birth ball.

Don't worry about the best sleeping position to get baby engaged. When you're lying down, your baby is not being pushed down into your pelvis. But lying on your side rather than on your back is best for sleep in late pregnancy.

Can I really make my baby get into the right position for birth?

There's nothing new about trying to get your baby into a good position for birth. Reports of "maternal posturing" go back to at least the 19th century (Andrews 2004). It's known today as optimal fetal positioning (OFP) because of a midwife called Jean Sutton, who publicized the technique in the 1990s. She advised pregnant persons to get into upright and forward-leaning postures as often as possible in later pregnancy (Sutton 1994, 1996).

Some doctors and midwives have questioned whether it really works, or just gives those who are pregnant something else to worry about (Walmesley 2000). So far, studies into OFP show that adopting a hands and knees position for 10 minutes, twice a day, towards the end of pregnancy, can help move your baby into an anterior position in late pregnancy.

But it doesn't seem to affect how your baby lies at birth. Sutton suggests trying to stay in upright or forward postures often in daily life, rather than for short bursts.

If you try OFP during pregnancy but your baby stays in a posterior position when labour starts, it may be because of the shape of your pelvis rather than due to your posture.

How can I improve my 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. It's common for babies to shift 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 (Lieberman et al 2005).

Sometimes, pregnant people have pains for a few days before labour really starts. This can be wearing, but the pain might be a sign that your baby is trying to turn. If you think you might be in labour, get in touch with your doctor or midwife. But if it turns out you’re not quite there yet, the best way to cope with the pains is to:

• try to get plenty of rest at night
• remain upright and active during the day
• lean forward during contractions
• eat and drink often to keep up your strength
• try to stay relaxed

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 (Hunter et al 2007) and hopefully helping them to turn, too.

When you're in labour, try to:

• Stay upright for as long as you can.
• Lean forward during your contractions – put your weight on a birth ball, a beanbag, your birth partner, or the bed.
• Ask someone to massage your back.
• Rock your pelvis during contractions to help your baby turn as they pass through the pelvis.
• Don't stay sitting in a chair or on a bed in a leaning-back position for too long.
• 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.

Read more in our article about positions for labour.