Anterior Placenta

What is the effect of an anterior placenta on fetal positioning? 

An anterior placenta means that the placenta is located on the front of the uterus. Most of the baby will be hidden behind it. 

It is a common belief that the anterior placement of the placenta causes the baby to be posterior. The fact that this is sometimes true doesn't mean it is always true. Babies can be anterior with an anterior placenta. Abdominal tone, when loosened, can allow the baby to turn away from the placenta and face the mother's back.

Palpation around the anterior placenta (a hands-on exam through the skin) can be more difficult when the placenta hides most of the baby, but with time, the person palpating, be it parent or provider, will notice the firm back or bottom, and occasionally a limb will extend beyond the borders of the placenta. To be accurate an ultrasound can determine the baby's position easily, though with exposure to ultrasound.

 

In 1994, Gardberg studied the relationship between the placenta being located on the anterior wall of the uterus and the position of the baby near the due date.

Journal:  Acta Obstetricia et Gynecologica Scandinavica  1994, Vol. 73, No. 2, Pages 151-152

Title:  Anterior placental location predisposes for occiput posterior presentation near term

Authors:  Mikael Gardberg and Marketta Tuppurainen

Location:  Department of Obstetrics and Gynecology, Vaasa Central Hospital, Vaasa, Finland

 

325 sonographies [Ultrasound] were performed in singleton pregnancies past 36 weeks with the fetus in a vertex position [head down] in order to examine a possible association between placental localization and occiput posterior presentation (OP). OP was found in 11.6% of all cases. The distribution of the placental locations in the OP group differed significantly from the occiput anterior (OA) group. Also, an anterior placental location was seen significantly more often in the OP group.

Gail's thoughts: Notice, however, that Occiput Posterior occurred a little more than one in ten. This study was unlikely to have considered that babies in the Right Occiput Transverse presentation are likely to rotate to the OP position under usual labor "management."

An anterior placenta can contribute to a baby's posterior position. However, babies can also be anterior with an anterior placenta.

 


“Hi, Gail,
 

I was told at 18 weeks [gestation] that I had an anterior placenta.

The midwife I saw last week told me bub was probably posterior, and the heartbeat was low on my left hand side. The head was down which made me happy...

I have been feeling most movements on the right hand side, just under my ribs, but also some lower on the left hand side (below my belly button, towards the left). This seemed to me to fit with your description of LOT, which I gather is much more favorable than a true posterior presentation. I wonder what your opinion is?

I have been spending time lying on my tummy supported by pillows, and kneeling with my tummy over the gym ball, since I saw the midwife last week, and I always sleep predominantly on my left side. Do you have any other suggestions for postures or exercises I should be adopting in order to achieve/maintain the best possible foetal position? Hope you can help with some suggestions for me, as I am feeling a little lost...

Thanks, Wendy

 

My opinion? Follow the 3 Principles of Spinning Babies!A posterior placenta and an anterior baby

 

First Principle, Balance your uterus.


To do this, you may the Daily and Weekly Activities. See also Techniques.

Most first time mothers will find that the inversion helps to relax the uterine tone.

By releasing the chronic tension caused by sitting in chairs in school and at the computer, old falls, accidents, etc.,  you can relax your broad and round ligaments to let the baby rotate past them in labor. You and a friend can do the myofascial releases under the Techniques menu link, look for the titles with the word "release" in them.

Some women may need a professional body worker, someone who knows myofascial release.

If you've given birth before, and labor went well, its likely to go well again. If it was hard, then these techniques may make a wonderful difference.

Labor contractions also help reposition your baby by softening the lower uterine segment over time. Changing your positions in labor can be quite helpful.

See Professionals in the Techniques section to see what other help is available. If doing the daily and weekly activiites hasn't worked within three weeks, than seek professional assistance. Sooner if you are due within the month.

 

Second Principle, apply gravity using Maternal Positioning.


When your uterine tone is made flexible the maternal positioning techniques you are using will be much more effective.

In labor, kneeling and leaning over a ball is a good choice. Let your knees remain further from your belly rather than folded up near the ball and your belly, if you can follow that description. Don't worry about lying mostly on your left side, the right side is good, too, unless your providers tells you otherwise. Changing your position every 30 minutes to 2 hours is best. (Let a sleeping woman snore. (Doulas and Dads, don’t wake a woman to have her change position unless it is medically necessary.)

There are descriptions of what to do to help labor progress in the category "In Labor" under the menu link, "Start."

 

Third, Movement (of the Mother).


When the baby is active it is a good time to get down on your hands and knees and do 40 pelvic rocks. It may even be a good time to do the inversion (though not shortly after eating a meal!)

Swimming in deep warm water is helpful, too, since a submerged belly is easier for baby to adjust position in. It would be hard to time this to baby’s active time unless you noticed a daily pattern with a reliable active time. Driving to the pool may put baby back to sleep, however!

The baby can use the pelvic mobility to rotate to LOT and then LOA as descent occurs. This is what I see work.

If the baby doesn't change position in pregnancy, doing these things will help the pelvis be more mobile in labor so baby can rotate more easily by the action of the contractions.
 

A home remedy to make more fluid for baby to wiggle around in:

Drink 3 quarts of fluid (not counting milk since milk turns to cheese during digestion) every day. Drinking adequate fluid will increase your amniotic fluid and support movement of the baby.

 

An Email from a VBAC mom

Dear Gail,

...first labour ended in c-section, no real support, baby in Posterior Position... She had a big and was big... second pregnancy am told I have an anterior placenta....a good chance I will get another Posterior baby. I seem to have big babies. I have a midwife this time but not sure if there is something I can do to help the baby position better. I am only 20 weeks.  Thanks for your help.

Gail's reply:

Congratulations on your upcoming natural birth.

Having all the body work appropriate to balance your pelvis and release your broad ligament and round ligaments is a good choice for a VBAC mom with an anterior placenta.
Doing these things now is a good idea! You mention you are 20 weeks, that's a good time to get going with your situation: VBAC, Anterior placenta. 

Daily inversions, stretching, pelvic floor exercises, gentle prenatal yoga, psoas exercises, brisk walking, swimming - all these are good. As are the Rest Smart positions now in the 2nd trimester.

Here are some recommendations for professional help:
Myofascial release is good for relaxing the broad ligament.
Standing sacral release.
And the Webster Maneuver with Chiropractic helps with the SI joint (and should be done on both sides rather than the pure Webster approach) and the round ligaments. Have the symphysis aligned.
Release the Psoas.

I'm going to leave it to you to research these techniques. Some are on my site, some are not.

Print this and take it to body workers with you after you review it with your midwife.
Happiness,
Gail