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Info Centre - 'Best' baby positions for birth

The way in which your baby lies in your pelvis is important; it can affect how smoothly your labour progresses. In the last few weeks of your pregnancy, it’s a good idea to stand and sit as much as possible in ways that will encourage your baby into the best position, prior to birth.  

Why it makes a difference

The best position for your baby to be in for birth is head down, with his back against your belly, facing your back. This way, he can fit through your pelvis as easily as possible. He can ‘flex’ his head and neck, tucking his chin into his chest, so that the narrowest part of his head (the back) is pressing on your cervix, helping it to dilate. The flexible joints in the baby’s skull allow the head to change shape and negotiate the birth canal during birth.

This position is know as ‘occiput anterior’ (OA), meaning that the back of the baby’s head, or ‘occiput’, is at the front, or ‘anterior’. The majority of babies lie this way and it may be written in your notes as LOA (‘left occiput anterior’) if the baby is lying to your left or, less commonly, ROA (‘right occiput anterior’) if he is lying to your right.

Positions for birth is one of the topics covered in NCT antenatal classes where you can find out more about labour and meet other parents in your area.

Back-to-back babies

Some babies lie with their back against their mother’s back, which is know as an ‘occiput posterior’ (OP) position. Labour tends to take longer if the baby is in this position because he can’t tuck in his chin very well and getting through the pelvis is more awkward. If a baby is lying OP, this often causes backache during labour.

Lounging on sofas and sitting in cars, may make babies more likely to lie in a posterior position. Because the back of your baby’s body is heavier than the front, his back will tend to roll toward the direction you’re leaning in. So if you’re leaning backward or reclining (as on a sofa), his back may roll toward your back – so he will be in a posterior position.

If you’re leaning forward, however, his back may roll toward your front – an anterior position. Leaning forward is therefore better than leaning backward. Also, if you’re in a position in which your knees are below your hips, this creates more space for the baby’s head to lie in the front of your pelvis. Some babies, however, will not shift their position.

Back or front facing – can you tell?

It’s not always easy for you to know which way round your baby is lying, but your midwife should be able to tell you. There are also some signs that you can look for. If your baby is lying OP or ‘back to your back’, your bump may feel squashy and you may feel (and see) kicks in the middle of your belly. Another particular tell-tale sign of the baby facing forward is a dip around your belly button.

Helping your baby into a good position

To help your baby to get into a good position, spend as much time as you can in positions in which you can lean forward and where your hips are above your knees, particularly from 34 weeks onward if it’s your first baby, or 37 weeks if it isn’t. Evidence that ‘re-positioning’ your baby works, however, is mainly anecdotal.

Positions you can try

  • Sit the wrong way round on an upright chair and lean over the back
  • Sit on an upright chair, with your feet flat on the floor, and lean forward so that your belly hangs between your knees
  • Sit on a birthing ball
  • If you sit a lot at work, take regular breaks to stand up and move around. If necessary, sit on a couple of cushions to keep your hips raised up above your knees
  • Kneel forward over a pile of pillows, a beanbag, or a birthing ball, with your knees apart and your bottom down; watch TV in this position
  • Get onto all-fours and move around
  • Put a cushion under your bottom if you’re travelling by car
  • Lie on your left side, with your right leg over and in front of your left leg (with a cushion or pillow between your knees)
  • Swim or float on your front (avoid breast-stroke leg actions if you have any pelvic pain).

Positions to avoid

  • Sitting leaning back on a squashy sofa or chair
  • Sitting with your legs crossed
  • Squatting deeply.

Breech babies

Although most babies turn head-down towards the end of pregnancy, about three to four per cent of babies will be breech at full term. This means the baby’s head stays uppermost in the womb with his bottom or feet positioned to come out first. It’s perfectly possible for a breech baby to be born naturally, although a head-first position makes the birth easier.

Can a breech baby be turned?

If your baby is breech before 34 weeks into your pregnancy, it’s quite likely that he will turn head down by himself.

If he’s still breech after 34 weeks, you can try to encourage him to turn by using ‘bottom-in-the-air’ positions. Either kneel with your forearms on the floor, your head down, and your bottom up, or lie on your back with your feet on the floor, your knees bent up, and three or four pillows under your bottom, for 10-15 minutes two or three times a day. There is currently insufficient research evidence to say how effective these positions are.

If your baby is still breech at 37 weeks and your pregnancy is otherwise straightforward, your midwife or doctor should offer you the opportunity to have external cephalic version.

Why are some babies breech?

Most babies are breech for no obvious reason. Premature babies are often breech and in about 40 per cent of twin pregnancies, one baby is in the breech position. Other possible conditions that make it difficult for the baby to settle head down include:

  • A uterus that has a divider, or ‘septum’, running down the middle
  • A tumour or fibroid low in the pelvis
  • Placenta praevia (placenta in the lower half of the uterus, instead of the upper). See “Low-lying placenta” for more information.
  • Too much amniotic fluid.

Birthing a breech baby

Results of an international trial of over 2,000 women around the world giving birth to babies in breech positions were published in 2000. Conclusions drawn in the study were that it is best for a breech baby to be born by caesarean section as the risk to the baby was higher with a vaginal birth. However, the trial methodology has been criticised. The balance of benefits and risks is uncertain, particularly for women who may have another pregnancy. There are, for example, more obstetric complications in future pregnancies following surgery, and a small increased risk of reduced fertility and stillbirth.

Mothers who plan to give birth vaginally to their breech baby will need to make sure they receive care from a midwife experienced in natural breech births. Ask to talk to the consultant midwife or a supervisor of midwives at your local hospital or discuss with an independent midwife. See “Breech baby” for more information.

Tranverse and oblique positions

Nobody knows what influences a baby to move into the best position for birth, or why some babies are more contrary than others and don’t. But when a baby is lying awkwardly, the natural process of labour cannot work so efficiently.

About one in 200 babies lies ‘tranverse’, or across the uterus, and about one baby in 75 may lie ‘oblique’, or diagonally across the uterus. Babies who are lying in the oblique position usually straighten up before birth. If your baby is lying tranverse and stays that way, then he will need to be delivered by caesarean.

Twin presentations

Your twins may be both head down (also known as ‘cephalic’ or ‘vertex’) – the presentation likely to be the easiest – or both breech (feet or bottom down) or one head down and one breech. Sometimes, when the first twin has been born, the second twin turns around spontaneously, as a result of the extra space in the uterus.

Twin birth

It is very unusual for a twin pregnancy to last more than 40 weeks (in fact term for twins is usually considered to be 37 weeks rather than 40) and many obstetricians advise induction of labour at 38 weeks.

The birth will be influenced by the way the twins are lying in the uterus. If the first twin is in a cephalic presentation (head down) labour is usually able to continue to a normal birth, but if the first twin is presenting in any other way, an elective caesarean is usually recommended. Discuss the options fully with your midwife and obstetrician.

Page lasted updated 2010.