There are many different things that influence how your labour will unfold.
Your state of mind, your personal health, the support you receive, and your birth environment all have an effect.
But a very important determining factor in the length and progression of labour is how your baby is positioned.
This seemingly unimportant detail can make a huge difference in the way your labour unfolds.
What Is Baby Positioning?
Essentially, the position of the baby relates to where he is in the uterus; specifically, where his head is, in relation to your cervix.
At some stage in the third trimester, it is expected your baby will assume a head down position, with the crown of his head above your cervix.
His face is expected to be directed toward your spine, with his chin tucked into his chest. This is called the occiput anterior position.
Most babies will be in this position by about 36 weeks, and will stay there.
This is called the optimal position for birth. It’s considered optimal because the baby is lined up to move through your pelvis with the least resistance. You can read more about this here.
However, there are times when, for a number of reasons, babies will be in different positions during labour. Although this is often just a variation of normal, it can have an impact on how labour progresses.
It’s also important to remember care providers might not pick up all position changes before labour begins. Likewise, the way your labour is progressing might not be identified as being linked to the position your baby is in.
Here are 8 signs that indicate your baby isn’t in the optimal fetal position during labour:
#1: Stop-Start Early Labour
Prodromal or early labour is the stage before active labour begins, when the cervix is thinning. Contractions might be mild and might even stop, but will continue to pick up over time.
Stop-start labour patterns tend to be very erratic. Contractions can be strong enough to feel like the real deal, but then they stop. This can happen day after day (or more likely night after night).
Stop-start labour can happen for a number of reasons but one of the most common is the baby hasn’t engaged. He might have his chin up, rather than tucked down, for example, and this is interfering with his ability to rotate into the pelvic brim.
#2: Contractions Aren’t Regular Or Consistent
In early labour, contractions might be well spaced apart but, over time, will become stronger and occur closer together.
If baby’s position is having an impact on labour, your contractions might be affected.
They might be:
- Regular, but some are intense and some weak
- Irregular, never occurring at the same time intervals
- Mild and close together, then slowing down
- Strong and close together, then slowing down
During labour your uterus contracts, first to dilate the cervix and then to push the baby out. As the uterus contracts during dilation, the pressure running down the muscles acts on the baby, helping him to rotate and move down into the pelvic brim.
If the baby isn’t in a good position to move down, these contractions can be weakened or stalled.
#3: Increased Back Pain
Tight ligaments, tight or weak muscles, and your baby’s position can all be reasons for back pain during labour.
Most commonly back pain is caused by a baby who is in what’s known as the posterior position, which is facing forward with his back aligned to the mother’s back.
Another reason for back pain is baby’s head isn’t at the right angle.
#4: Pain In Other Places
In a straightforward labour, the pain of contractions is felt at the front, low down where the cervix is. For most women, this is caused by the physical dilation of the cervix and will subside between each contraction.
In labour when baby’s position is having an influence, pain might be in the buttocks, upper thighs or hips. This can be transient, meaning it moves around, or is felt consistently on one side, in one place, often with no breaks.
#5: Feeling ‘Pushy’ Early
For many women, a pushing feeling can come on when the cervix is thinned, but before they are fully dilated. This can occur at about 8cm and pushing now will often bring the baby onto the cervix and complete dilation.
However, feeling pushy before this stage, or when the cervix is still thinning, means the uterus is moving the baby down before he is in the best position to rotate and move through the pelvis. This usually happens when the baby is in the posterior position. This can result in feeling pushy long before your body is actually able to respond and push your baby out.
#6: Active Labour Is Long
Most first time mothers will expect the active or dilating stage of labour to be about 12-24 hours. It is the average expected length; it can be shorter, or even longer.
When a baby is in a less favourable position for birth, a woman’s body will wait, and work with that situation. This increases the length of active labour, as the baby rotates or moves into the best position. If mama is coping and baby isn’t in distress, there’s no cause for concern.
#7: Longer Pushing Stage
Pushing, or the second stage of labour, can last from a few minutes to an hour or two. Depending on the position of the baby, the pushing stage is usually a time of great energy and progress, as the baby moves down through the vagina and is born.
When a baby is still high or in an awkward position, it can take more time to push the baby out.
Pushing can help resolve these position changes, as the strong muscles of the uterus encourage the baby to move into a more favourable position.
#8: Swollen Cervix And Labour Stall
During labour, there might be a time lapse, when contractions slow down or peter out. If you are checked, it might be discovered your cervix has developed some swelling.
The cause of the swelling might be the position of your baby, particularly if he is in the occiput posterior position. In this position, the hardest part of the baby’s head is pushing down unevenly on the cervix. When the cervix begins to swell, it can stall dilation or prevent the baby from descending far enough to be pushed out.
Remember, optimal fetal positioning is considered ‘optimal’ or ideal because it is generally accepted as allowing labour to progress in what is considered the normal way.
There are many variations of normal, however, and it’s easy to be caught up in the idea there is something ‘wrong’ if your baby’s position isn’t ‘ideal’.
There are several ways you can work with your body and your baby to resolve this, and go on to have a positive and empowering birth.