Optimal Fetal Positioning- Spinning Babies

Having just returned from New Hampshire after a long car ride and warm beautiful days filled with foliage and midwives, I ameager to share what I learned at Spinning Babies workshop. “Spinning Babies is a n approach to labor progress through Optimal Fetal Positioning and Body Balancing. You might say that Spinning Babies is a branch of the Active Birth Movement” with additional influences from  midwives, doulas, and body workers. Gail Tully is a doula and midwife who began her quest called Spinning Babies after 19-24 years of attending births. She offered this training and additionally has an outstanding website called Spinning Babies which outlines this information in detail.

Optimal Fetal Positioning is a phrase coined by Jean Sutton , “who found that the mother’s position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. Many difficult labours result from ‘malpresentation’, where the baby’s position makes it hard for the head to move through the pelvis, so changing the way the baby lies could make birth easier for mother and child.

The ‘occiput anterior’ position is ideal for birth – it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby’s head is easily ‘flexed’, ie his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. The diameter of his head which has to fit through the pelvis is approximately 9.5 cm, and the circumference approximately 27.5cm. The position is usually ‘Left Occiput Anterior’ or LOA – occasionally the baby may be Right Occiput Anterior or ROA.

The ‘occiput posterior’ (OP) position is not so good. This means the baby is still head down, but facing your tummy. Mothers of babies in the ‘posterior’ position are more likely to have long and painful labours as the baby usually has to turn all the way round to facing the back in order to be born. He cannot fully flex his head in this position, and diameter of his head which has to enter the pelvis is approximately 11.5cm, circumference 35.5cm.

If your baby is in the occiput posterior position in late pregnancy, he may not engage (descend into the pelvis) before labour starts. The fact that he doesn’t engage means that it’s harder for labour to start naturally, so your baby are more likely to be ‘late’. Braxton-Hicks contractions before labour starts may be especially painful, with lots of pressure on the bladder, as the baby tries to rotate while it is entering the pelvis. Be aware that if you accept induction on the basis of being postdates, and your baby is in a suboptimal position, you may have a tough haul ahead of you. ”

I like the explanation that is given here. For me it explains a few things. I have often wondered why women go “post dates” or past your due date. As a doula it is often one of the first hurdles a mother and I work to clear especially when working towards a natural birth. It’s easy to say trust that your body and baby know how and when to be born and much harder to put into practice especially as the days wear on after your due date. It also explains that just causing the body to have contractions wether stimulated to do so with herbs or pitocin does not always mean that birth will be swift or in some cases even vaginally.  The work of labor is aligning the baby in the pelvis,  dilating the cervix, and pushing the baby down. Clearly this takes longer for some women than for others. What I hadn’t really thought about was what position the baby was in while all of this was happening and what I as a doula could do to help the baby tuck his chin (flexion) and align himself in the pelvis to facilitate an easier decent and theoretically easier labor. That’s what this workshop was all about! Thinking about the position of the baby  before even considering induction seems logical and a more holistic view of why the body isn’t going into labor. My experience with some models of care is that often the position of the baby is never discussed before inducing labor. As expectant mothers and care givers that assist women, knowing the position of the baby before going into labor is a great tool to not only feel empowered and knowledgable about our own bodies but also informed and educated so that we can make the best decisions for the birth of our babies.

The first tool in learning about optimal fetal positioning is learning how to map your belly. This means learning to tell where in your uterus your baby is. The technique will help know your baby’s position and enable you to pick up a baby doll and lay it on your belly in the same position that your baby is in.  The things to remember while belly mapping is that the baby will move around! Early in pregnancy there is much more room for a baby to move. It is not uncommon for the baby to be in any number of positions up until the last two months of pregnancy and he will continue to move up until the time the baby is born. However, there is work that can be done to first get the baby head down and then help him align with the pelvic outlet for birth. Once we get to about the 7th month of pregnancy, it is easier to find the baby and help assist in his positioning. The way to map your belly is taught, but perhaps not called belly mapping, to caregivers. It has been my experience that midwives and doctors  are asking for this information when the palpate you. As expectant mamas this is a natural time to ask your care giver  to show you what they are feeling and ask them to explain the baby’s position while being palpated, or see if you can figure it out using the techniques of belly mapping. I think it is amazing that as expectant mamas we spend every moment of our baby’s life in utero carrying them around and often aren’t aware of their position. Taking time to get to know your body and your baby is the first step to help you learn more about yourself and helps you become the expert on your body. If you are not sure about your outcome, try again, and certainly ask for help. As a doula I can’t diagnose but can help you determine what you are feeling as a mama.

to be continued…..