My premise here at Spinning Babies is that the position a baby starts labor in is determined mostly by uterine balance which then leads to availability of space in the lower uterine segment. Uterine shape is part genetics and partly due to the degree of balance of the womb. You can read more about this in The Three Principles.
The way a baby moves through the pelvis is called the cardinal movements.
Typically, these cardinal movements are discussed in 7 key, or cardinal, steps.
The wide part of baby’s head dips below the pelvic brim. Typically, for the first time mother, this occurs before labor, often at 38 weeks.
Baby’s chin touches the chest for full flexion.
The baby lowers, or comes down. Descent is actually happening inbetween every other cardinal movement repeatedly. In other words, the baby must descend to engage. Then the baby descends a bit more to flex. The baby descends again before extension and then again during extension before restitution. Finally, descent is the action of expulsion.
4. Internal rotation
The baby’s head rotates inside the pelvis. From whatever position the head was in when engagement occurred at the brim, the head next rotates on the pelvic floor to fit the midpelvis and after more descent rotates to the front and back diameter to fit out of the outlet.
After navigating the opening through the pelvic floor, the baby’s back extends pushing the head further through the outlet. Many books simply state that the head extends and misses the fact that the baby’s spine is the origin of extension.
6. Restitution (or external rotation)
The baby’s head is out, usually in the OA position while the baby’s chest is rotating in the pelvic floor. The baby’s head is then seen to rotate to follow the chest rotation. Some babies first rotate externally1/8th of the circle, and then another 1/8th, or seen to rotate ¼ of the circle to face the mother’s thigh.
The baby’s anterior shoulder presses on the firm tissue just under the pubis. A tiny bit of pale flesh of the anterior shoulder is seen in the front. The pressure of the anterior shoulder pivots the posterior shoulder down, allowing the posterior shoulder to swing out the arc of the sacrum. The posterior shoulder is then born first. This is assuming no one has grasped the baby and forced the anterior shoulder out first, a common habit.
The baby will continue to spiral out, and the hips may need to be lined up in the Anterior-posterior diameter with the opening of the pelvic floor for the large baby’s legs to emerge. But this is rarely noticeable.
Continue on to the Membership Section of SpinningBabies.com if you would like to examine the cardinal movements, including engagement variations amongst the four pelvic types. The Membership Section explores the Spinning Babies perspective in detail and offers more childbirth education resources. Visit the Membership Description page for more information.
The Cardinal Movements again in detail.
Engagement is when the parietal bones of the baby’s head dips below the pelvic brim. Typically, engagement occurs at 38 weeks gestation for a first time mother. For women who have already carried a baby through pregnancy, the time of engagement may wait until labor contractions bring descent of the baby into the pelvis. This can happen when the womb is softer, the apple-shape rather than the pear-shape of the first time mother.
The direction of baby’s head, the head position, engages according to pelvic shape.
A description of pelvic shape and engagement
Gynecoid (round) The baby in a gynecoid often engages while in the LOT position but can also be LOA and OA with equal success. Occasionally, the baby may begin labor in the ROA position, but this is less common than LOT, LOA, or even direct OA.
If posterior, the baby in a gynecoid pelvis is likely to be ROP, but may be LOP or occasionally direct OP. This pelvic shape gives the most options.
Anthropoid (oval front to back) The baby in an anthropoid pelvis will engage in either the direct OA or the direct OP position. If the mother’s pelvic cavity also has a steep brim (entrance), engagement may occur only after many contractions and standing or sitting on a birth stool or toilet in a strong “early” labor.
Android (triangular) The baby in an android pelvis is likely to engage in the LOA position, with an occasional baby in the ROA position. IF the baby is small comparatively to the mother’s pelvis, a direct OA or direct OP engagement is possible. If the baby is a bit larger, the direct OP baby will rest their forehead on the pubic bone waiting to engage until a clever mother or helper backs the baby up and helps rotation to LOA occur above the brim.
Platypelloid (longer side-to-side, but very narrow front-to-back) The baby hoping to enter the platypelloid pelvis will rotate above the brim to the LOT position and also tip their head to a posterior asynclitism to dip below the brim. Its good to help this happen between 36 and 38 weeks.
Flexion is curling forward. The natural fetal posture is to curl. At the end of pregnancy as the baby slips lower in the softening abdomen, the baby on the left flexes well. The chin comes to the chest and the crown of the head comes over the brim. After engagement, the baby flexes more and this reduces the size of the baby’s diameter.
The movement downward is descent. The baby’s first obvious descent is “lightening” or engagment. The next dramatic and reassuring descent movement is when the head comes down on the pelvic floor opening. This allows for the fourth cardinal movement.
Uterine contractions will also try to move the baby into changing positions at each level of the pelvis to help the head fit.
4. Internal rotation
Internal rotation is nearly always necessary for fetal rotation, but a few babies do not have to rotate. These babies may be smaller babies, their mother’s may have a pelvis that is longer front to back (anthropoid pelvis) than side-to-side (gynecoid or platypelloid).
Childbirth education books describe extension as a movement of the baby’s head. However, back in the 1950’s Borrell and Fernstrom made a radiological motion picture of the baby’s cardinal movements, published in ACTA. They saw the babies extend their spine which presses the still flexed head down through the perineum. The head extends somewhat as the chin comes over the perineum.
6. Restitution (or external rotation)
Most of the time the baby’s head comes out direct OA. There is often a natural pause before the next contraction brings the shoulders out. The chest is in the pelvic floor rotating through the midpelvis. When the chest rotates, the head rotates to match the turn. This can occur by 1/8ths or by a 1/4 turn, depending on whether the chest waits in the oblique or continues to the Anterior-posterior diameter (front-to-back).
When the baby’s head emerges in the direct occiput posterior the baby may not need to restitute. But sometimes the OP baby can’t get out without turning 180 degrees to fit through the tuberosities in the OA position yet the body remains OP. In this case, you see the forehead and pareitals emerge OA, the head turn to the thigh and after the chin is out the head restitutes back to direct OP. It happens fast, so it is easiest seen on the film afterwards.
The baby continues to spiral out. The hips enter the brim in the transverse diameter after the shoulders emerge. Then the hips rotate to the A-P diameter to come through the pelvic floor and midpelvis. As soon as the thighs are seen the baby continues spiraling to face the mother. If she were kneeling, the baby would slip out on the ground in front of her (perhaps on clean, soft padding). She may then catch her breath and while she does so the baby’s blood is pumped out of the placenta back into the baby. By the time the mother opens her eyes and registers that her baby is before her, she can reach under the baby’s arms to lift baby to her breast (as cord length allows). In this way, baby comes to breast in the vertical position that organizes brain function and allows for the trunk and neck muscles to gradually work the head to mother’s nipple. We are designed for being born and women are designed for giving birth.
Maternal Positioning is a term used for talking about the posture and positions women use in pregnancy and in labor for comfort and labor progress. The 2nd Principle of Spinning Babies is Gravity. Maternal positioning uses the 2nd Principle of Spinning Babies: Gravity.
Childbirth educator Pauline Scott coined the phrase Optimal Fetal Positioning to describe the work of Midwife Jean Sutton. These two women published Understanding and Teaching Optimal Fetal Positioning in 1996. Two facts will help you to understand why fetal position is important:
- Baby's rotate through the pelvis to emerge from the womb.
- Fetal position effects the relative ease of fetal rotation and descent.
Get the back ground on Midwife Jean Sutton's approach with OFP :
Mom's job is to dilate, but baby' s job is to rotate. If we can help baby's job be easier, we can make labor easier for the mother as well. The 3 Principles, Balance, Gravity, and Movement can be applied to any childbirth method, whether managed or physiological to empower today's childbearing women.
How do you know whether your labor will be hard or easy?
Birth offers a spectrum of possibilities. The unusual variations are on either end of a bell-shaped statistical curve. For instance, its unusual to have a super-easy posterior or to truly need a cesarean for a posterior baby.
Most posterior babies rotate in labor (Lieberman, Gardberg). Yet, too many women are given cesareans for a posterior baby because no one there knew what to do to help the baby rotate.
Spinning Babies has a plan for moving women towards the easier side of the bell curve. Spinning Babies may just be the rainbow in the storm of confusing labor challenges. Let's look at the spectrum and where you might find yourself on it.
Spinning Babies Website is a project of Gail Tully's.
Gail is a midwife in
Minneapolis, Minnesota, USA
in the Central Time Zone (6 hours before Greenich)
Tel: (612) 817-3144
Gail gets more emails than to which she can politely or fully respond. And really must reduce time answering emails, which is heart breaking for her. An option is to have scheduled phone consultations for women who want to discuss an upcoming or previous birth.
Please resist sending general emails that say, "I'm pregnant and want to know what to do." I will say, "Honey, this site is for you! Enjoy exploring Spinning Babies."
Extremely Important: By emailing Gail, you are agreeing that the content of your email may be used publicly on her site. Names will Not be posted unless you grant permission in your email. I am looking for concise stories that tell how using maternal positioning and techniques resolved a stuck or long labor, or helped achieve an "easier" labor.
Email: Either, gail at SpinningBabies (dot) com; or speebee at gmail dot com fix it, you know what to do.
I don't answer Facebook messages or posts or blog posts very often. Use email if you need a fast response. Call for an immediate response (late pregnancy or labor only please).
Tell Gail your city (or nearest big city), which # baby this is for you, and how far along you are in pregnancy or labor.
I do want to celebrate your journey and desire for an emotionally nurturing birth for you and your baby, of course! I just don't have much time for emails. The website is for ALL of you. You, too!
Do share your stories that tell how using these techniques resolved helped achieve an "easier" labor. And if these techniques didn't work, share which ones they were and how frequent you did them and at what gestational age, that would be helpful, too. They don't always work, even when the "right" technique supposedly matches the issue. Its important that we don't pretend these always work. Let's tell the stories in Real Stories
About Gail Tully, CPM
After 20 years with a small homebirth practice and organizing active community doula program development in hospitals and non-profits in Minneapolis/St. Paul, Gail is now devoted to developing Spinning Babies and her other areas such as Belly Mapping and Resolving Shoulder Dystocia. Gail became a CPM in 2000 and still enjoys being called in to stalled labors and breech births when her support might be helpful.
Gail's related published works include
- This Spinning Babies website (2002 to the present)
- "First Twin: Breech" Midwifery Today Issue Number 106 (Summer 2013) Breech Birth Issue
"Identifying and Resolving Obstructed Breech Birth: When to Touch and When to Be Hands-free"
Midwifery Today Issue Number 106 (Summer 2013) Breech Birth Issue
- “Arm Behind the Back: A shoulder dystocia complication” Midwifery Today Autumn 2012 Issue 103. P18-19, 69. (2012)
- “FlipFLOP: Four Steps to Remember” Midwifery Today Autumn 2012 Issue 103. p. 9-11. (2012)
- “Opening the Pelvic Brim with the Trochanter Roll”Midwifery Today Issue 96 (Spring 2011)
- Belly Mapping, Midwifery Today Issue 96. (Winter 2010/2011)
- Resolving Shoulder Dystocia DVD, Maternity House Publishing (2010);
- Belly Mapping Workbook, Maternity House Publishing (2009);
- Belly Mapping How Kicks and Wiggles Reveal Your Baby’s Position. International Doula Vol. 12. Issue 4 (Fall 2004);
- “Shoulder Dystocia; The basics” Midwifery Today (Summer 2003).
Her unpublished paper, Perspectives in Breech Birth (1994) helped to preserve breech options in Minnesota Traditional Midwifery law (1999).
Find Gail at
Is your question about which techniques are right for you? Please check here and in FAQs (frequently asked questions) before emailing. Whatever your question, Gail is going to begin with "Balance," the first Principle. Simply reading The 3 Principles articles will answer most questions - in other words, start with balance and the rest usually works itself out.
Did Spinning Babies help your birth journey?
I'm in this to change the world, but I could use a bit of the world's change.