Getting your baby into position for birth

In an ideal world every baby would be in the best position for birth, making labour simpler. But sometimes, babies are lying in a way that can make birth a little more complex.

Most babies will move into the right position before they’re born, but some need a little help. There are some birthing positions you can use to try this.

Some babies may not turn. They might need to be born with assistance, or by caesarean.

What is the best position for my baby to be in?

The best position for your baby to be in is head-down (cephalic presentation), with the back of their head towards the front of your tummy (anterior position) (QH 2020). This is also called occipito-anterior.

In this position your baby fits snugly into the curve of your pelvis. During labour, your baby will curl their back over and tuck their chin into their chest. They will be born looking down, with their back facing your stomach.

Your labour and birth is more likely to progress smoothly if your baby is in this position. That’s because:

• The top of your baby's head puts rounded, even pressure on your cervix (the neck of your womb). During contractions, this pressure will help your cervix to widen. This will also help your body make the hormones you need for labour.
• In the pushing stage, your baby will travel through your pelvis at an angle, so the smallest part of their head will come first.
• When your baby gets to the bottom of your pelvis, they will turn their head slightly. This means the widest part of their head will be in the widest part of your pelvis.
• The back of your baby’s head can then slip under your pubic bone as they’re born.

All this has many benefits for you and your baby. If your baby is in an anterior position, you're more likely to:

• Give birth without needing a caesarean section or assisted birth (using forceps or ventouse) (DHAC 2019, Tempest et al 2019).
• Have a quicker and more straightforward labour and birth (Barrowclough et al 2020).
• Need less pain relief (Barrowclough et al 2020).

What's a back-to-back (occipito-posterior) position?

At the start of labour, some babies have their head down but are facing your front, so the back of their head is towards your back. This is called the occipito-posterior position (OP), or back-to-back. You might also hear it called ‘sunny side up’, as your baby can be born with their face looking up at you.

Most posterior babies are born vaginally, but this birth position can make labour harder. If your baby is occipito-posterior at the start of labour you may have more intense back pain, as your baby's skull will be pushing against your spine (Lee et al 2015). Your labour may also be longer and slower with a posterior baby (Barrowclough et al 2020).

The good news is that most posterior babies turn to an anterior position during labour. Only around five per cent of babies are born in this position (Dahlqvist 2017).

But some occipito-posterior babies do not end up turning. Birthing a posterior baby raises your chances of needing an episiotomy, which is a small cut that’s made to widen the entrance of the vagina, or an assisted birth (Tempest et al 2019).

Why are some babies posterior?

Your baby could be posterior because of the shape of your pelvis. Some women have a pelvis that's narrow and oval (anthropoid pelvis) or wide and heart-shaped (an android pelvis) (Betti 2021). In these women, the baby is more likely to settle in a back-to-back position, at the widest part of the pelvis (El-Mowafi 2016).

Your chances of having a posterior baby are also higher if:

• This is your first baby.
• You’re obese.
• You're African-American.
• You're 35 years old or older.
• Your baby is over 4kg in weight.
• Your pregnancy has lasted 42 weeks.
• You have an anterior placenta. (Blanc-Petitjean et al 2018)

Other birth positions for your baby

There are a few other positions your baby may be in before labour starts. These include:

Breech

If your baby is lying bottom or feet first, they are in a breech position. If they are still in that position by late pregnancy, your doctor may try to turn them up the other way, so they are head-down. This procedure is called external cephalic version (ECV). ECV has about a 50 per cent success rate (RANZCOG 2021).

Transverse lie

A transverse lie means your baby is lying straight across your uterus. It’s rare for babies to be in transverse lie by late pregnancy. If they don’t move into another position by birth, they will most likely be delivered by planned caesarean.

How can I help my baby into an anterior position before labour?

Some people believe that certain moves or exercises can help move your posterior baby into an anterior position. This is known as optimal fetal positioning (OFP). There is not much to suggest that OFP will help your baby turn (Guittier et al 2016). But many mums and midwives still feel it's worth a try.

At the least, research shows that some of the positions can help make you more comfortable. For example, spending time on your hands and knees has been found to help with back pain in late pregnancy (Guittier et al 2016).

An OFP tip is to try lying on your side when watching TV instead of slumping back in the chair. Or you can sit in a supported squat on a low stool or fit ball (QH 2020).

Do not worry about getting your baby into the right position when you lie down to sleep. The key thing is to focus on sleeping on your side. Side-sleeping (on either your left or your right) from 28 weeks reduces the risk of stillbirth compared to sleeping on your back (Cronin et al 2019).

Best birthing positions to help move your baby

Posterior babies often change position during labour on their own. Most get themselves into an anterior position, by the pushing stage (Barrowclough et al 2020).

But when you’re in labour, you can try to vary your birthing pose, to make you more comfy and help move your baby.

If you do not have an epidural, and are able to move around, these birthing positions may help:

• You may find that one of the best positions is on all fours. In this birth pose, your baby drops away from your spine, helping relieve back pain (Guittier et al 2016).
• You can lie on your left side, with your right leg bent and your left leg slightly bent. This is called the Sims position. This birthing pose has been shown to help move posterior babies to an anterior position in some cases (Bueno-Lopez et al 2018).
• Try a knees-to-chest position to help your baby move and ease your back pain. Get on your knees, with your head, shoulders and upper chest on the floor or mattress (Guittier et al 2016).
• Rock your pelvis during contractions, to help your baby turn as they pass through the pelvis. A birth ball is great for pelvic rocking (Zaky 2016).
• Walk or move about. This can help relieve pain, and move the labour along (Ondeck 2019).

Read more:

• The best positions for labour
• Can I tell how my baby’s lying, based on their movements?
• 16 birthing positions for labour