In the final weeks, your doctor will check to see whether your baby has moved into the ideal setup for delivery—the “anterior position,” in which her head is down near the birth canal and facing your back. Most babies instinctively settle themselves this way, but about 1 in 25 full-term births present as breech, when the butt or feet are positioned to be delivered first. And at the beginning of labor, up to one-third are posterior (head down but facing your abdomen, sometimes called “sunny side up” or “OP,” which is short for occipital posterior position). While it’s not always necessary, research shows that it’s safer for a breech baby to be delivered by cesarean section. A posterior baby often turns around during labor; if not, your doctor or midwife may be able to make the adjustment. However, if the baby doesn’t change position, a C-section will be unavoidable.
But don’t assume you’re destined for surgery quite yet: When your baby is in the wrong position, there’s a lot you can do to get her to move into the right one—or to cope if she doesn’t turn at all. Experts share three smart strategies.
At 37 weeks, if your baby is breech, your doctor should suggest an external cephalic version (a “version”), in which she applies pressure to your abdomen with her hands to try to get your baby to turn. “Almost every patient who has a baby in the breech position should be offered this option, unless there’s another contraindication to vaginal delivery,” says Andrew S. Gardner, M.D., clinical assistant professor of obstetrics and gynecology at New York University Langone Medical Center. A typical version has more than a 50 percent success rate. The risks of a serious complication, such as premature rupture of membranes, are low, but it should be done in an acute-care facility in case you need a cesarean. Kerstin Guba, of San Diego, was nervous about the procedure when she was pregnant with her son but found that it felt like a deep-tissue massage.
Taking walks and stretching your calves can help loosen the ligaments and connective tissue that support the uterus and pelvis. This can create more space so that a posterior baby may rotate her body and tuck her chin to ease birth, says Gail Tully, a midwife in Minneapolis and founder of Spinning Babies, an organization that helps women move their baby into a better birth position. As long as you have your doctor’s approval, doing squats may help the baby descend properly. With your back straight, feet shoulder-width apart, and heels on the floor, bend your knees until they’re over your toes. Hold for 10 to 30 seconds, then slowly stand back up. Do five reps and work up to more.
You might also tweak the way you lounge. “I encourage clients with a posterior baby to avoid leaning back in big comfy furniture and instead to sit forward with their back straight,” says Andrea Shandri, owner of the Iowa Doula Agency in Des Moines.
Posterior babies are more likely than anterior babies to press into your tailbone during labor, causing intense lower-back pain known as “back labor.” Know how to combat this discomfort: Swaying, sitting on a birthing ball, laboring on your hands and knees, and having counterpressure applied to your hips bring relief. Staying upright until you’re at least 6 centimeters dilated can also help labor progress.
Fortunately, only about 8 percent of babies are still posterior when it’s time to push, especially if an early epidural is avoided, says George Mussalli, M.D., director of MaternalFetal Medicine at Bronx-Lebanon Hospital Center, in New York City. If you opt for an epidural, try lying in a variety of positions—including on the side opposite your baby’s back—as you dilate. It’s also smart to let your water break on its own, if you can. One study found that when membranes are ruptured artificially to induce labor, posterior babies are more likely to stay posterior.