Engaging Baby in Labor

Engagement of the baby into the pelvic inlet (brim) is important because to fit through the pelvis, baby has to get into the pelvis first. Engagement is when the widest part of baby’s head enters the true brim of the pelvis.

Figure 1. Diagram depicting the fetal head immediately prior to engagement. The straight black arrow depicts the scanning plane at the level of the pelvic inlet, utilized to depict the presence or absence of engagement of the fetal head, with the transabdominal transducer placed in a transverse fashion above the maternal symphysis pubis opposite the maternal sacral promontory. The curved black arrows depict various possible scanning planes, which may assist in depicting the fetal biparietal diameter either below or above the pelvic inlet (engaged or not engaged). The dashed lines indicate the scanning planes utilized in obtaining Figures 2a and 2b. Note the fetal head is in the left occiput transverse (LOT) position, correlating with Figure 2. (Modified from Norwitz et al.2). https://onlinelibrary.wiley.com/doi/10.1002/uog.102/full

Yes, but if baby doesn’t engage at 38-42 weeks, won’t baby engage in labor?

Many do.
One study, back in 1999, showed that only 14% of first time mothers went on to cesarean, but in that setting the cesarean rate was normally far lower. My, how times have changed.
Non engagement of the baby is one “flag” that tells us to pay attention to body balance and fetal position. After adding balance, many babies rotate and engage with labor contractions. Labor really is useful!

How can I tell if my baby is engaged?

Tips to tell if baby is engaged. Is baby in ideal starting position which support easier engagement (but doesn’t guarantee it, obviously). Does baby overlap the pubic bone in early labor or active labor? Is baby Occiput Posterior or Left Occiput Transverse?

How can I help baby to get engaged?

Things that help fetal flexion increase engagement.

Adding body balancing will help a long, free stride, walk in soft soled shoes engage baby.
Some people walk the stairs, sideways, holding the railing, up and down one side and then the other. Go both directions on both sides, to get the best pelvic movement.

Deb Lawrence’s Dip the Hip (Figure 8s) or otherwise, releasing the lower back muscles and ligaments to the pelvic crests at the back of the pelvis.

Contractions have not started yet, and/or

Membranes released (water broke) but no contractions yet

Circles on a firm birthing ball. Not so much the up and down bouncing… if the baby’s head is on the pubic bone, that is going to be tough on the baby. But flowing circles and figure 8s will also loosen up those pelvic attachments just mentioned and help your little egg drop into the cup of your pelvis.

Psoas Muscle Release (or resolve short psoas issues at www.coreawareness.com)

Will Breaking the Water help baby engage?

Yikes! Please no! Well, in some cases this may work really well. In many cases, its nearly the same as signing the cesarean permission form. That’s said pointedly. Add balance and then movement first if you can.

Adding body balance may help baby engage, because engagement is as nature intends, and adding balance returns your innate design closer to that which nature intended for you.

With contractions to help baby engage

Now we’re talking. The first task of contractions (other than the practice contractions of pregnancy) is to engage baby. Some babies must be rotated first, and we hope the first baby, or VBAC baby, enters the pelvis from mother’s left side. But flexion, chin tucking, is the most important indicator of vaginal birth. I believe that entering the pelvis from the left gives the first baby the most opportunity to tuck their chin.

There are techniques on Spinning Babies that have anecdotal claim of helping engagement.

The circles on the ball may be effective in engagement.

The next three techniques only work with contractions! They do not work in pregnancy.

Posterior pelvic tilt. Flatten your lower back so that your arm can’t fit in the space where your lower back curves if you flatten it against the wall. This would only be effective with contractions!

One favorite of mine is Janie King’s Abdominal Lift described in her book, “Back Labor No More.” I add a posterior pelvic tilt to the “belly lift” and find even greater success for babies that are still high once labor is active.

Walcher’s “Open The Brim” is specific to engaging babies at the inlet and has been studied. This is a common technique in Germany and other places in Europe. Its intense and often successful.

References for Engagement