No one can predict birth, and that's one of the things that is so humbling about it. We can prepare, we can get educated, we can stretch, we can breathe, but at the end of the day, we never know what will happen. As my midwife once put it, "birth is crazy, and crazy shit happens." With that said, there are absolutely things that we know will positively impact the labor process.

So what helps in birth?

A provider whose philosophy matches your own
A provider who practices evidence-based care
A strong support team
Feeling safe and comfortable in your birthing space
Having all the information so that you can give informed consent to any proposed interventions or plans of care

From a physical perspective, we can hone in on five things:

Ensuring baby is in an optimal position and has the best space possible to work with
Ensuring the birthing body is balanced and in alignment
A strong core
A yielding pelvic floor
Freedom of movement prenatally and in labour

For the purposes of this post, we're going to focus on the first bullet point: ensuring the baby is in an optimal position with the best possible space to work with. To learn more about getting your body prepared for labour, delivery, and postpartum, check out this blog post or preparing your pelvic floor for birth or contact us for a prenatal pelvic floor evaluation.

Depending on where you live and the prevalence of providers trained in breech delivery, for most birthers a head-down baby is a necessary component for a vaginal birth. But just being head down is not enough. Due to slight asymmetry in the uterus and the shape of the pelvis, where baby's head is facing when they're head down can greatly impact their ability to rotate and descend, which in turn can affect the speed and ease of labour and delivery.

Consider the spread of reasons for a birther's first cesarean delivery. As noted in the chart below, malpresentation (baby's head is in another position than head down) accounts for 17% of first-time cesareans, while "labor arrest" accounts for 34%. Stalls in labor are often the result of a poorly positioned baby, so really, positioning accounts for just over 50% of first-time cesareans. That's not nothing!

Image created by Allie Malinovich, CD(DONA), data from ACOG

For most pelvises, the optimal fetal position is known as occiput anterior or OA, which means baby is:

Head down
Facing your back
With their back on one side of the front of your tummy
Tucking their chin
With the smallest part of their head (crown) applied to the cervix

Funky fetal positioning can:

Slow the progression of labor
Cause painful back labor
Cause stalls or irregular labor patterns such as stop/start contractions, coupled or double peak contractions
Cause frequent and very intense contractions with no correlated cervical dilation
Impede baby's descent during the push phase

In labor, we want the smallest diameter of baby's head (their crown) to present first. Babies not in an optimal position have trouble tucking their chin, which can result in them coming down forehead-first, which is a much greater diameter that needs to pass through the pelvis.

The good news is that babies are smart. In general, they will settle in the position that is best for them with the space they have. The bad news is that sometimes our bodies are out of whack for whatever reason (extended time sitting at computers, previous injuries, Gollum posture, etc) and baby can’t necessarily get to that good position. Fret not!

There are things you can do now to give baby the best space possible, encourage great positioning, and take steps toward an easier labor. Here are 12 ways to promote optimal fetal positioning for labor:

1. Get a pelvic floor evaluation and begin to address any tension or weakness

2. Familiarize yourself with Spinning Babies® and their Three Principles and check out spinningbabies.com for an incredible wealth of information on fetal positioning

3. If baby is breech at 30-32 weeks, begin to follow the Spinning Babies breech protocol and check out their ebook on flipping a breech baby

Daily activities (can be started at 20 weeks gestation):

4. Walk every day (Gail Tully, founder of Spinning Babies, recommends working up to 3 miles daily in an upright position, however I recommend listening to your body)

5. Forward-leaning inversion for 30 seconds daily

6. Stretches like cat/cow, heel lifts, windmills, forward lunges, deep yoga squats

7. Hula hoop circles standing or sitting on a birth ball

8. Rest smart

Guiding principles of posture and positioning to keep in mind:

9. Avoid recliners -- think of your belly as a hammock, and you want to always position yourself so that baby's back will be resting in the hammock

10. When possible, sit on a birth ball instead of chair, or roll up a towel and sit on it to find a more neutral pelvis position

11. Lean forward when possible -- another way to visualize the best posture for the birther is to think of the belly button as a flashlight, and always have that flashlight be pointing down or forward, not up.

12. Keep moving! Check out this video for a great visual on why movement prenatally and in labor is so important to help baby get into a good position

I also want to include a note about fetal size and position. As a doula, I hear over and over again that birthers are scared they'll have a big baby that "won't fit." While that of course does happen occasionally, more often than not it's the position, and not necessarily the size, of the baby that will impede labor and delivery (see the above chart -- only 4% of first-time cesareans are due to macrosomia, or big babies). A big baby that is in a great position can slide on out while a little peanut of a baby in a wonky position will struggle to come down. This is part of the reason why it's so important to have a provider who trusts your body, encourages movement in labor, and will allow your body the time it needs to labor effectively to rotate baby and bring baby down.

Last, a moment of #ShamelessSelfPromotion for hiring a doula: Doulas are trained in understanding common labor and positioning challenges and can suggest and encourage positions for the birther to try that can help mitigate or relieve those challenges. Believe it or not, we're not shaking your booty all the time for the fun of it. Evidence also shows a significant reduction in the risk of a cesarean birth with the continuous support of a trained labor support person. Your partner will be awesome emotional support and your best friend might do a terrific job of keeping the atmosphere lighthearted and keep the oxytocin flowing, but unless they know how to position your legs to increase the size of pelvic outlet while you're pushing, you might want to consider hiring professional labor support to help you achieve your birth goals!

Take the steps now to prepare your body as much as possible and give baby the space to settle into a favorable position with a pelvic floor evaluation with one of our incredible PTs who specialize in pregnancy and postpartum or check out our birth preparation course to learn more.