Generally, babies get into the proper position for birth without any assistance. In fact, many pregnant people give little thought to baby’s position unless baby is breech. However, as a doula, you can help your client understand baby’s positioning should their provider express any concerns.
There are several in between positions from breech to optimal fetal positioning. Understanding the terms and how to support optimal positioning is an important way you can help your clients prepare for birth.
What Are Different Fetal Positions?
Nearly everyone knows that head down and feet up is the ideal positioning for a baby. However, there are more positions than simply head up or head down.
Fetal positions include:
- Occiput anterior (OA) – Baby’s head down with face towards pregnant person’s spine
- Occiput posterior (OP) – Baby’s head down with face forward, back of head is facing spine
- Breech – Baby is feet or buttocks first
- Oblique – Baby is laying diagonally in uterus, a rare position
- Transverse – Baby is laying horizontally across the uterus
There are additional fetal positions. These include left or right anterior and posterior, asynclitic, face presentation, compound presentation (along with any of the other positions), and left or right transverse. There are also different breech positions.
Is There an Ideal Fetal Position For Birth?
There are many ways a baby can safely make its way through the birth canal. However, some positions make the process easier for both baby and birther.
The optimal fetal position is Left Occiput Anterior (LOA). In this position, baby is head down, with their back on the birther’s left side, with face towards birther’s back between the right hip and the spine of the birther.
In this position, baby is angled to easily navigate the birth canal. They are less likely to change positions to a more difficult one once in LOA.
That said, while LOA is ideal, there are many other positions baby can still safely navigate the birth canal.
Can A Breech Baby Be Born Vaginally?
As a doula, you are likely to have clients concerned about breech presentation. Many may wonder if a c-section is the only option. The shortest answer, yes, a breech baby can be born vaginally. The complete answer is more complex.
The safety of a breech birth often depends on the type of breech. Breech positions include:
- Frank breech – Baby’s hips are flexed with their feet up by their ears. Around 65-70% of breech presentations are frank. This position increases the risk of an umbilical cord prolapse.
- Complete breech – Baby is buttocks first like frank breech, however, their legs appear as if they are sitting crisscrossed.
- Footling breech – In this aptly named presentation, baby’s feet are coming first.
- Footling – frank breech – Baby is buttocks first with one leg bent with the foot presenting first along with the buttocks.
A few other variations also exist in breech presentation. In many locations, birthing facilities and providers automatically book a c-section for all breech presentations. While breech presentation can carry risks, c-section births are not without risks either.
As a doula, you can encourage your clients dealing with a breech presentation to:
- Look into Spinning Babies
- Search for a Webster Certified chiropractor
- Discuss an external cephalic version (ECV) with their provider (also applicable to transverse and oblique)
- Read evidence regarding vaginal breech birth versus c-section
- Discuss the option of a vaginal birth with their provider or a new provider
- Look into family-centered c-sections for a positive surgical birth experience
How Do We Help Babies Get Into An Optimal Fetal Position?
Generally, you do not need to do anything. Most babies will naturally get into the best position. However, if a client has been told baby is not in an ideal position, or they are concerned, there are some things which can help. One can use these things prenatally or during labor.
To help encourage baby to get into a good position some find the following helpful:
- Walking with asymmetrical hips
- Being on all fours
- Walking stairs sideways
- Sitting and rocking on a yoga ball
- Rebozo used by a trained professional
- Miles circuit
- Overall good posture
- Stay active and upright during early and active labor
- Use a variety of Spinning Babies exercises
As a doula, you can reassure clients that babies frequently get into the ideal position with little to no assistance. However, if they have concerns or labor is not beginning or progressing, using some of the above can help. As a doula, you can provide reassurance and resources.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...