Chin tucking to engage
Flexion into the brim of pelvis helps the baby fit through the pelvis. Flexion refers to the tucking of the baby’s chin, often the first step to engagement of the head and the start of labor.
Flexion, or chin tucking, is more important than starting labor with an anterior head position!
Many posterior babies can be born with natural labor, or just a bit of Pitocin, when they begin active labor with their heads tucked. Learn about both flexion and engagement here.
Chin Tucking Helps engagement
A tucked chin means that the baby is aiming the crown of the head into the pelvis first. This helps engagement, or dipping under the brim of the pelvis. The first baby engages about two weeks before birth, typically.
When the chin is tucked molding is easier. The crown molds more easily than the top of the head. And yet the top of the head can mold, and does so better, sometimes, than the side (asynclitic) or the forehead.
Whether a baby with her chin lifted fits depends on pelvic size, pelvic floor relaxation, strength of contractions and patience!
Pelvic tilts, walking briskly, and doing hula hooping motion while sitting on a birthing (exercise) ball in late pregnancy may help to tuck the baby's chin.
Regular pelvic rocking seems to help the pelvic tendons loosen and thereby help descent during active labor contractions.
Labor is easier when the baby's chin is tucked (flexed).
Left, chin tucked to chest, crown aiming into the pelvis.
Right, head engaged and applied to cervix.
When the head is applied to the cervix, the cervix has an easier time to thin and open.
Head application can happen in pregnancy or wait until labor. There is a risk that the head won't fit in the pelvis if the chin is up.
Problems can occur when the chin is up
Having the chin up is also called deflexion or extension.
When the baby's chin is up the top of the head enters the pelvis first, making the head seem bigger. The head may or may not fit the pelvis. Usually labor helps tuck the chin, but it may take time and lots of maternal movement. Once in a while, its no problem at all. Usually, there is a challenge of labor taking longer.
The baby with an extended head isn't able to help with rotation or descent as easily as when the chin is tucked. Sometimes, a baby who has his chin is extended is not able to even get onto the cervix and open the cervix. Other times, a lip remains on the cervix for some time when pushing is about to start or is in full force. Focusing on pushing the lip away is besides the point. The problem isn't the cervix, its the angle of the head. Help the chin tuck and labor will proceed.
What to do about an extended chin
Forward-leaning inversions repeatedly throughout pregnancy
Pelvic adjustments by a Chiropractor (replaces some of the missing inversions when a woman didn't know to do them)
Balancing the lower uterine segment
Diaphragmatic Release, also called Abdominal Release
Hula hooping or belly dancing movements
The same great hip circling movements while sitting an a somewhat firm exercise ball (hips as high or higher than knees, sit safely!)
Do all the same things listed under the preceeding list for tucking the chin in pregnancy. Especially the Abdominal Release.
When contractions are regular enough to predict the start of the next contraction, begin a series of ten Abdominal Lift and Tucks.
Wait and let the chin tuck by changing the mother's position and letting her rest if the cervical lip is tight and anterior. (The entire rim being tight may be emotional or from cervical biopsy. Resting in a deep, warm tub may help that cervix relax.)
Hula hoops (belly dancing) on the birth ball, and the Dangle are other ways to help labor progress with an extended chin and the larger diameter such a deflexed head presents.
At any point in active labor, get into Walcher's position and remain there for three strong contractions in a row. Have help to get into this position and help to relax into it. It will open the pelvic brim and let baby engage. Its good to have baby engage in the LOT or LOA or OA fetal position, but sometimes you just have to get engagement to happen after rotational attempts aren't working (usually that means an android pelvis).
When Walcher's is successful, I recommend that you push with your own back extended and not curled. This straight back pushing - no matter where you are, bed or birthing stool or birthing pool - will help progress and may even help avoid a stuck shoulder in those cases where the brim is the issue.
You should consider whether you want a posterior head to engage into the pelvic brim. Help baby to rotate first. Get your pelvis adjusted first. If baby engages while still posterior, then you will do vertical positions in labor to help him through the pelvis. If he gets stuck, try the forward-leaning inversion from a very steep angle for 3 contractions in a row and in between. Have a "spotter" or helper and see the video first.
Here is an email about the issues of engagement:
"My first child was in the head down position and didn`t dip down into the pelvic brim. 6 days after my due date the doctor suggested that the safest thing to do was to perform a c-section. At the time I went along with her expertise. I hadn`t had contractions until the day the c-section was performed I had tiny insignificant ones and the doctor told me that she noticed meconium in the sac with the baby and was grateful that we hadn`t tried to induce me which might have stressed the baby out more.
I now find myself one day overdue with baby number two. I have been seeing a midwife who`s been performing acupuncture on me. I am scheduled for my fourth and final appointment tomorrow. I have avoided the couch and have forced myself to sit up straight on a chair to encourage the baby to be in a good position. I saw my doctor today and the baby and I seemed fine so she suggested waiting three more days (she will be gone for the weekend and so she suggested a C-section Thursday morning if there is no labour before then-she will not induce me with any medicine).
I am not sure what I am asking you for. Information or perhaps an exercise I can do this late in pregnancy? I am just really discouraged and I realize that sometimes we can`t control everthing especially our babies and our body. Thanks for your time in reading this message."
Is baby number two engaged?
I have articles on helping get baby into the pelvis,
and finding out whether baby will fit.
And on why simply doing gravity positions doesn't work for many women.
When you and baby are healthy and not stressed (medically), its worth waiting a bit longer and getting body work, doing the excersizes and seeing if you can A.) Go into labor on your own before 42 weeks and continue for a vaginal birth, or B.) Go into labor before 42 weeks and go to the hospital for a cesarean if the baby doesn't engage after 4 hrs of strong, close contractions, or C.) have a cesarean when it seems right to you (and your providers) to do so.
Some midwives and physicians continue to help mothers labor after 42 weeks gestation when their health looks really good. However, a lack of engagement is something to work on. Engagement is not usually an issue for women who've birthed vaginally before without a posterior baby or cesarean. But, in your situation, the chances of vaginal birth are highly increased if your baby engages before labor.
The goals are to get baby to an LOT (LOL) or LOA position before labor and then to have baby engage.
But some babies will engage in other positions first and then rotate (or not!) in active labor or during pushing. Then descent becomes the focus. Read about the Abdominal Lift and Tuck, Hula Hooping on a birthing ball and Walcher's.
I've helped many women in your situation and while not all have had vaginal births, many many have! The most important thing is love. Be kind to yourself, love your little one with compassion and know that he or she would engage and rotate if he or she were able to. Then see if you can attend to the balance needs of your pelvis and womb and take it from there.
I want you to look back at this time and feel you've done what you feel satisfied to have tried to the full extent.
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