Which babies need the extra help for Optimal Fetal Positioning?
But which babies are those that need this extra help? How can we know if we are “watering the rain” or really doing something that helps the baby? As a midwife in a small practice, I am able to feel each woman’s baby through her abdomen at each prenatal throughout her prenatal check ups. Somewhere around 26 to 31 weeks I can usually tell the position of a baby’s head and tell which way the baby is facing.
By this continuity of care I notice which babies are held tightly into position by tight uterine ligaments or by low amniotic fluid levels (a less common reason). If the baby doesn’t shift around for comfort and stretching, if the baby feels locked in place and if this baby is on the right or directly posterior the chances of a difficult birth are higher. Even if we can’t get the baby to swing around to rest the back of their head in the mother’s left side, we can start to loosen up the ligaments and pelvic joints, help the chin to tuck and encourage the flexibility needed for labor contractions to do their part in fetal rotation. See The Long Labor That Wasn't in the Real Stories section of this website.
These situations are more likely to be among first time moms, older first time moms or women experiencing their first labors after previous cesareans without advanced labor in their past experience. When the baby is OP and the water breaks before contractions, she is at higher risk for surgery. If she has her water broke by a provider before the baby engages, rotates or descends she is also at higher risk for cesarean.
If the OP baby is not engaged (dropped) before labor begins she is at higher risk. Especially if she doesn't use the specific activities, many listed in Spinning Babies, to address the issues of her particular birth.