38 weeks? Is baby engaged yet?
Engagement is when the widest part of the baby's presenting part (usually the head) enters the pelvic brim or inlet. A first baby usually engages two weeks before the due date, at 38 weeks gestation.
Baby has to get into the pelvis in order to go through the pelvis. Read more to find out why a baby may not engage, what's normal and what's concerning, and what to do about it.
Why does baby engage?
By 38 weeks, baby's head to lower into the pelvic brim deeply enough so that the parietal eminence in below the level of the pelvic inlet. As the broad ligament, wrapping the uterus, softens at the end of pregnancy the baby lowers in the abdomen. This softening encourages flexion. When tucked baby's head more easily lowers into the pelvic brim. Engagement happens when 4/5th of the baby's head is in the pelvis. The head is no longer ballotable, it can no longer be wiggled between the midwife or doctor's fingers.
A first time mother has a pear-shaped uterus, compared to an apple-shaped uterus of the experienced birther (Sutton).
An experienced mother's baby may not need to engage. If baby isn't posterior and earlier labors have gone well, don't worry about it. Labor will engage baby.
A mother who had to have her first baby by cesarean because baby remained high will be more likely to have a natural birth if her subsequent babies engage.
A breech baby may engage when the uterus allows the hips of the baby to lower beneath the level of the pelvic brim.
Why wouldn't a baby engage?
Many of the occiput posterior babies don't engage before labor starts. Some do, of course. When the baby hasn't engaged and the due date has come and gone, I've almost always found the baby to be in the posterior position. Helping this baby to tuck their chin may help them engage.
Some babies have to rotate so the back of their head is on the mother's left before they can engage in pregnancy or in labor.
Pelvic shape in relation to fetal position. Many women have a gynecoid pelvis, wider side to side than front to back. When baby is flexed and baby's back is on the left, the baby aims his or her crown into the brim. Few women have such a narrow front to back diameter (distance) from their pubic bone to their sacrum in the back of the pelvic inlet that baby must be on the left side to engage. Some women have a long front-to-back diameter with their anthropoid pelvis and then the direct posterior or direct anterior baby can engage.
Rarely, it might be due to a pelvis having too small an inlet to let the baby enter. This would be a case of CephaloPelvic Disporportion (CPD), or baby's too big. Rickets, injury or an actually too-big-baby may be the cause here. CPD is rare, but does exist.
Personally, I don't suspect CPD in pregnancy if baby isn't engaged until baby is LOA or LOT, or the woman has body work specific to aligning her pelvis and releasing her sacrum. Some women will need to release a tight psoas to let baby descend into the pelvis.
Many babies don't engage if they aren't 38 weeks gestation in a first time mother. This is normal. Check the dates.
It is not uncommon that a second, third or more baby to remain high and unengaged because the mother's uterus is now apple shaped instead of pear shaped. This is not usually a problem. We would decide to intervene if the first labor was difficult and this baby was posterior.
A woman whose sacrum is sharply angled may have hours of labor before her baby engages. This woman will have a "sacral bustle" or a "ledge" on the top of her bum. To describe this, I say she could set a glass of water on this ledge, which isn't really true, but gives the picture. Standing and leaning forward with contractions, in early to active labor is usually what these women do naturally and usually helps engagement. If not, a birthing stool or the abdominal lift and tuck usually brings the baby into the pelvis. From there, the labor proceeds usually rather quickly, as the mother's hormones are well primed by the long, strong early labor.
What happens if the baby doesn't engage before labor?
This depends on the reason and how easily it is to help baby engage.
Labor may also start before baby engages. When labor does start, contractions can be strong without much dilation and the baby remains high in the pelvis. Before the cervix opens well, we need to help baby come down into the pelvis well.
Some women are recommended to have an induction, even if their baby is not engaged. Get ready for an induction by increasing Balance of the maternal structures, by helping baby get chin flexion, if needed, and out of the posterior position, if possible, with Balancing activities. See more below.
Techniques to help a baby engage
Techniques to help baby engage will help open the brim, tuck the chin and rotate the baby to a left-sided presentation:
- Align the pelvic brim
- Align the sacrum which may be torqued on a vertical axis and distorting the lower uterine segment
- Relax the spasm out of the cervical ligaments (aka uterosacral or posterior ligaments, woman may have a history of retroverted cervix)
- Relax the psoas muscle pair (resolve chronic muscle tension in the illiopsoas)
- Help baby tuck the chin (flex the head)
- Helping a baby rotate to left occiput transverse (lateral), left occiput anterior, or occiput anterior
These engaging activities can be done before labor or during labor with body work.
Could there be another reason for babies not to engage?
It would be quite rare to have a placenta blocking baby's way and preventing engagement. The soft tissue issues of a twist in the lower uterine segment from the above list is more common. A tight psoas can be another cause. Sometimes a mother or a mother and her provider can do what is needed to help baby engage before or during labor. Sometimes a body worker is best for a particular situation.
If a baby doesn't engage, should we assume baby is posterior?
Beginning with Balancing techniques will not cause an anterior baby to turn posterior. So if gently suggested and gently done, it is a mother's choice. I would work on balancing the muscles, ligaments, pelvic joints, and resolving tight psoas issues.
Listen to the actual signs and symptoms in pregnancy of fetal position. A woman often feels little fingers wiggling between her pubic bone and her navel on both sides of her linea nigra when baby is posterior.
If baby hasn't engaged in a first time mother by 38 weeks we might check more carefully for either occiput posterior presentation or to be sure dating of the pregnancy is correct.
Can she walk briskly with free-swinging thighs? Sit on a birth ball and make circles? There are several things to do both by getting bodywork (a chiropractor can help align her pelvis) and by her own activities.
I'm working with a woman who is about to be induced and her baby is at -2 station, should I suggest Walcher's?
Walcher's position is only effective with contractions.
Begin instead with Balance. This is why Balance is the first principle before Gravity and Movement, which would include Walcher's.
Balance in this case means activities to help the mother's anatomy be more symmetrical on both sides as concerns tension and relaxation (or tone) of the muscles, ligaments, and alignment of the pelvic bones. These exercises can be begun now.
Once she has regular contractions, whether spontaneously or by induction, the Abdominal Lift and Tuck through 10 contractions may do the trick of lowering the baby into the pelvis, and if not, Walcher's through 3 contractions (and between because its so uncomfortable she won't likely go back to it a second time). Walcher's in the air (as opposed to the deep birthing tub version) is for when other ways of getting baby to engage don't work.
Babies naturally engage in the pelvis when the broad ligament is soft enough and the brim open enough. Fetal chin tucking and coming down from the mother’s left side helps more babies fit more mother’s inlets.
Generally, we hope for flexion and rotation before engagement. This is most important when we find baby in the posterior position and high after 38 weeks.
Work on Balance before working on rotation and descent. Though, sometimes we have a time issue, as when a woman's membranes have released and when her provider has a time limit for her labor. Descent from a non-optimal position may have additional challenges that may be met with maternal positioning and activities in labor.
Fetal engagement may help the onset of labor be more spontaneous.
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.