After giving birth, it’s common for women to be told they needed intervention or a c-section because their baby was “stuck” and couldn’t be born vaginally.
Do so many babies really get stuck during labour?
After all, some countries such as Australia and the United States have c-section rates of over 30%.
If you’re concerned about your baby getting stuck during labour, rest assured that it’s very unlikely to happen.
There are certain situations where babies are unable to navigate the pelvis and do get stuck. This may be due to having an irregular shaped pelvis or have had a pelvic injury. Your baby may have adopted a position which won’t allow his head to pass through the pelvis, or rarely the head is too large to fit (called cephalic pelvic disproportion).
It’s important to remember babies getting stuck during labour is a rare occurrence and if it’s a result of the issues mentioned above, is likely to have happened regardless of what you do during pregnancy and labour.
5 ways babies get stuck during labour
Here are five ways your baby can get ‘stuck’ and how to you may be able to prevent it.
Stuck During Labour #1: Baby’s presentation (position)
During late pregnancy, babies tend to assume a head down, tucked up position, with their backs facing to the front (usually slightly left), and chin tucked into their chest.
This is known as the occiput anterior position.
This position means the smallest part of the baby’s head is ready to lead the way through a dilated cervix and through the pelvic opening.
During labour, this is the most effective position for a baby to rotate through the pelvis to be born.
If your baby’s head isn’t in the optimal position when labour begins, you may feel concerned it will cause your baby to become stuck. Care providers checking fetal position at every appointment can cause unnecessary worry when baby isn’t engaged or is in breech position (bottom down) – even though you have weeks to go before your due date.
Find out more about breech babies during pregnancy.
While it’s ideal for babies to be in the optimal fetal position, it doesn’t necessarily mean they can’t be born in other positions.
Babies often change position during labour, going from posterior (baby’s spine against mother’s spine) to anterior, or breech to vertex (head down). Rarely, a baby’s head is tilted to the side (asynclitic presentation).
In most cases, babies will find their own way to get into a better position for labour. If your baby is persistently in a position which isn’t optimal for birth, a c-section may be the safest option.
If the mother is able to move freely or uses techniques to create more space in the pelvis, this can help encourage her baby to shift into an optimal position.
When a woman is experiencing irregular contractions due to malpositioning of the baby, care providers may suggest labour isn’t progressing. They may want to administer artificial oxytocin (Syntocinon or Pitocin) to increase the strength and consistency of contractions.
Unfortunately, this can cause the baby to be pushed into the pelvis in the position that they’re in. The strong contractions from an induction with artificial oxytocin can prevent baby from shifting positions and they can get stuck, requiring interventions such as episiotomy (cut to the perineum) and forceps, or a c-section.
Stuck During Labour #2: Maternal position
The positions a woman chooses during labour and birth plays an important role in how quickly and effectively her labour progresses.
Effective positioning can speed labour and help a baby to align properly.
Upright positions such as standing, squatting or hands and knees can open the pelvis by up to 30%.
Movement such as rocking, swaying, walking, hands and knees crawling can all provide comfort to the mother as her baby moves into the best position for birth.
Needless to say, an active birth is very important.
Unfortunately, in many hospitals, women end up on hospital beds, lying down in a supine (flat on their back) or semi-reclining position, sitting on their tailbone. These positions restrict the woman’s ability to work with her body and baby. They also increase the risk the baby will become distressed, due to compression of maternal blood vessels or compression of the umbilical cord.
Stuck During Labour #3: Epidural use
When having an epidural, a local anaesthetic is injected into the epidural space – the space around the tough coverings protecting the spinal cord.
Epidurals block nerve signals from both the sensory and motor nerves. This provides pain relief for the mother-to-be but numbs the lower part of the body.
Epidurals interfere with normal labour and have many side effects, including increased risk of augmentation (with synthetic oxytocin – similarly to being induced), c-section, instrumental delivery, tearing or the perineum and malpositioning of baby.
Women who have an epidural in place are unable to move without support and are unable to use their legs, as their body is numb from the spine down. This means they’re unable to move freely during labour, adopting positions that help their baby to find a good position for birth.
Care providers should be helping women with epidurals to achieve positive movements and positions to help the baby to move through the pelvis. However, this sort of support is rare in hospital settings as resources are often overstretched.
A doula can be a great help in this and many other instances.
Epidurals are by far the most commonly used pain relief, with 75% of women in the US using them during labour. This is a significant statistic – three out of four birthing women are confined to a bed during labour, which means many labours have the potential for increased complications.
Stuck During Labour #4: Big baby and shoulder dystocia
One of the most common reasons why women are induced before 40 weeks is due to a suspected big baby (macrosomia).
The main concern with a big baby is the possibility of shoulder dystocia, which occurs when the baby’s shoulders become stuck in the pelvis.
While true shoulder dystocia is an emergency, it’s a rare event, occurring between 0.5 % and 1.5% of births. The exact incidence of shoulder dystocia is very dependent upon how it’s defined and reported, which varies depending on care providers.
Size and weight of babies can’t be accurately diagnosed before the birth. Many women are told they have a big baby and need to be induced to prevent shoulder dystocia occurring.
Yet, induction may in fact cause babies to become stuck due to the strong and relentless contractions preventing them from being able to slowly ease through the pelvis.
Stuck During Labour #5: Problems with the pelvis
Many care providers believe babies get stuck because the woman’s pelvis is the wrong shape or isn’t big enough.
While most women have the most ‘desirable’ pelvis shape (gynecoid) for birth, some women have pelvises that may have less room in certain parts (anthropoid, android, platypelloid).
This has the potential to cause the baby to assume a less than optimal position or slow progress through the pelvis, but it does not automatically mean vaginal birth is impossible.
When a baby can’t fit through the pelvis, this is called cephalopelvic disproportion (CPD).
True CPD is very rare and is not diagnosed before labour has begun unless it’s known the mother has a pelvic injury or congenital abnormality. Women who have been told their pelvis is too small or the wrong shape in the absence of known pelvic problems have gone on to birth vaginally without any problems.
Unfortunately, CPD is often diagnosed when labour isn’t progressing. Care providers will suggest the baby is too big to fit through the birth canal, attempt to strengthen contractions and speed up labour by artificial means. This in turn causes a cascade of interventions which may lead to fetal distress and c-section as the outcome.
How to prevent a baby from getting unnecessarily stuck
The best way to encourage your baby into the optimal position for birth is to watch your own posture during pregnancy. Avoid reclining back and stick to gravity friendly positions, which will allow the baby to have plenty of space and encouragement to get into a good position.
Regular bodywork such as osteopathic, stretching or pregnancy yoga helps to align muscles that hold your skeletal system together. Ensuring your body is aligned allows plenty of space for your baby to find the right position for birth.
If your baby is persistently in a position which is not optimal for birth, avoid thinking it’s abnormal. Most babies move into the more optimal positions just before or even during labour. You can enlist the services of a number of therapists to support you if baby’s position is a concern.
Check out the Spinning Babies website for more information about techniques to improve maternal-fetal positioning.
Choose a care provider who supports natural birth, and truly appreciates the fact labour is unique for every woman and baby. If your doctor is worried about your baby’s size or position, be aware they may not be opting for best practice if they suggest an early induction.
If you need an epidural or request one during labour, request your birth team is on hand to help you move into positive labour and birth positions.