How to encourage your baby into an optimal position for birth

‘Optimal foetal positioning’ refers to the position a baby adopts in the last few weeks of pregnancy, with some positions considered better or best for an easier labour & birth, and possible ways to encourage a baby to settle into these.

What’s the best baby position for labour & birth?

The most ‘optimal position’ is deemed to be when baby lies with their head down in alignment with the pelvis, and their spine against their mum’s belly, anywhere between mum’s left hip and belly button (this is referred to OA - Occiput Anterior - or LOA - Left Occiput Anterior, in maternity care, for example in positional scans reports). It is deemed ‘optimal’ as it is thought to be the position where baby will have to rotate the least amount during labour, meaning a possibly shorter labour.

Other positions, such as baby lying to the right-hand side of mum’s belly (ROA) and ‘back-to-back’ (OP - Occiput Posterior) are considered less optimal, with ‘back-to-back’ often presented as problematic / needing to be addressed before labour begins, as it might cause a more lengthy or painful labour. However, what research tells us is that about 50% of babies start labour in the OP position, and that it is not necessarily an issue. Rather, presenting this fact as a potential issue/ risk factor of a more challenging labour can create stress and fear in the expecting mother.
Labours where babies start in the ‘back-to-back’ position also tend to unfold along a different pattern and rhythm to labours where baby is facing the other way (for example, women tend to feel an earlier urge to push, or labour seems to not progress for hours and then progress really fast) which can often cause questioning or intervention from health care providers, although it is necessarily needed. For more insightful information on this big topic, you can have a read of former midwife & researcher Rachel Reed’s fantastic post on OP babies.

One last type of position is breech, i.e. a baby presenting with their bottom, knees or feet first, which warrants a whole other post for itself! However, it is worth mentioning here that a baby shouldn’t really be categorised as ‘breech’ until at least 34 weeks/36 weeks for a first pregnancy, and 38 weeks in subsequent pregnancies. Before then, there is still plenty of room and amniotic fluid for the baby to change positions. By the time labour begins, about 96 per cent of babies are in a head-down position.

Can I encourage my baby into a good / better position for birth?

What is worth remembering that your baby is active in the lead up to and during the birth process. They will work hard to get themselves in the best position available ahead of birth, and during birth, in response to the space available in the labouring woman’s pelvis, facilitated by her instinctive movements, the tone of her tissues/muscles, and the alignment of her joints & ligaments.

So while the focus for years has been on focusing on what the baby is doing, it might actually more helpful to think about optimal maternal positioning, i.e. how a pregnant women can promote/create more space and balance in her body, both during pregnancy and during birth, to support her baby’s progress through the pelvis, but also increase and improve her comfort levels in pregnancy, which is so deeply important.

So what can you do?

1/ Move your body

The most helpful and effective thing you can do throughout your pregnancy is to keep gently moving your body, equally focusing on stabilising and releasing. Practicing specifically designed pregnancy yoga right up till birth is a deeply suitable - and enjoyable! - way to keep your body moving, stay as tension-free as possible, and also bring up to the surface potential imbalances and restrictions in the body which you can then look to address, helping to make it easier for your baby to move and align themselves with the first opening of your pelvis.

Whilst there is a huge variety of movements and postures to help with that, the 2 practices below are some of my (and pregnant women’s) favourites to practice throughout pregnancy.

‘Scrub the floor’ stretch

From an all fours positions, slide one arm forward along the floor, letting your chest release down, and sending your sit-bones towards the back of the room. This stretch makes more space in the chest, and gently stretches the ligaments of the pelvis as well as the perineum. Stay for a few breaths then change sides. You can also flow the arm up towards the ceiling into a gentle open twist and flow back down to the floor in front of you.

Hula Hoop stretch

Another good stretch to release tension in the torso and hips, release the back and encourage deeper breathing.
From an all fours positions, imagine there is a hula hoop around your torso/waist, then in turns round and release your torso as if you wanted to make the hoop go around. Keep the elbows and hips soft and move slowly with the breath. Then hula in the other direction.

2/ Watch your posture

How you use and position your body day in day out, your postural habits while standing, sitting and resting, is what influences most the tension we experience in our bodies and the space available for our babies.

In our sedentary modern life, most of us spend a huge amount of time sitting with poor posture at desks, in cars (which encourage us to lean slightly backwards) or lounging on squishy sofas, reclining and resting onto the back part of the pelvis (on the sacrum and tailbone) rather than sitting upright on our sitbones. This ‘bucketing’ (tilting under) of the pelvis might be a reason why many babies start labour in the OP position, as this position might encourage the weight of their spine to turn towards the back of our body. It also contributes to a lot of lower back/pelvic pain and pelvic floor tension.

Taking the habit to sit upright whenever we can - trying to spread the weight evenly between our left and right sides, is a great habit to take throughout pregnancy. Sitting on a birth/exercise ball is a great way to achieve this - have a look at my blog for ideas of how best to choose and use a birth ball.

How your position yourself while resting & sleeping is also very important - I cover this in great detail in my free webinar on 3 pregnancy yoga tools for an easier pregnancy & birth (watch here)

The position below is a great way to counteract hours spent sitting (maybe not optimally) at the end of the day.

Forward Leaning Supported Rest

This is a very comfortable position to release lower back pain, undo tension in the pelvic floor, and reclaim move space by encouraging baby to lie towards the front of your belly.
Take your knees as far apart as you need to make space for your bump, and don’t hesitate to use a cushion for support if your bum doesn’t touch your heels. You can rest your chest against a chair, or your birthing ball.

3/ Biomechanics for birth

As it name implies, biomechanics for birth is all about helping you understand & support how your body works physically - mechanically - in birth, and how better balance and function can be encouraged or promoted, once again during pregnancy and during labour & birth.

Along with exploring the role of posture and movement as explored above, birth biomechanics also covers very specific stretches and practices (such as the Forward Leaning Inversion) can help create balance and more space in the body, and more specifically in the pelvis, pelvic floor, uterus and breathing diaphragm.

These can be extremely supportive to address aches and pains in pregnancy, help turn a breech baby or a baby lying transverse (or ‘floating baby’) and assist with the progress of a medicalised labour, especially with an epidural and/or during induction. This is why this is one of the key components of my birth doula support, and of my Practical Birth Skills workshop.