Maternal Positioning is a phrase for talking about posture and positions women use in pregnancy and in labor for comfort or labor ease. Maternal positioning uses the 2nd Principle of Spinning Babies: Gravity.
Sitting up on the sitz bones is better for your back.
Maternal positioning is thought to influence the fetal position during pregnancy and birth. There is some evidence both for and against this claim in the literature.
Le Boursier du Coudray, Abre’ge’ (1773) “counseled … that women sleep on one side so that the opening of her womb, a bit off kilter, would be pulled by gravity into alignment with the vagina.” -The King’s Midwife; A history and Mystery of Madame du Coudray by Nina Rattner Gelbart
Fetal Positioning is a phrase to talk about the baby’s position in the womb.
Babies change position in pregnancy and during the birth process. True! That’s nature’s design! But, I do not believe fetal position changes are random. I think the research lacks attention to several factors. I believe there are multiple factors that come together to affect the fetal position changes.
The most important reason, I believe is what I simply call “Balance.”
If a woman’s womb is relatively balanced, then getting into gravity-friendly positions during pregnancy can help a breech baby to flip head down or a posterior baby to scoot over to the mother’s left side and face her right hip.
Contractions of labor may help a posterior rotate to an anterior position with time. Time necessary for rotation may be shortened when a woman uses gravity-friendly maternal positions. Gravity-friendly positions are more likely to reposition baby if the womb is in balance. You see how they are connected?
Some helpful maternal positions in pregnancy are:
- Sitting with your hips higher than your knees
- Sitting with your back straight and your rib cage lifted off your middle
- Sitting on a firm exercise ball that allows your hips to be level with your knees or higher than your knees
- Laying with your navel aiming towards the bed, floor or couch/ sofa, if not directly on your belly, then so that eventually an imagined light-beam coming from your navel would eventually find the floor
- Brief Forward-Leaning Inversions, once a day
- Squatting or supported squatting with your back flat against the wall and your knees bent (work gradually up to where you can squat with your feet flat on the floor for 2-5 minutes)
- Holding your shoulders back, yet relaxed, while you walk briskly
Melissa stands and leans forward during contractions (Photo by Melissa Booth)
Some helpful maternal positions in labor are:
- All the same that are listed above, plus
- Standing and leaning forward with your knees “soft” (slightly bent)
- Standing and leaning back (straightening, even arching your back slightly)
- Standing and flattening your lower back against the wall while lifting your lower abdomen during the entire contraction (See Belly Lift)
- Kneeling and leaning forward on a bed or chair or exercise ball (hands and knees)
- Kneeling and lifting your arms to grip a shawl or rope or bar above you
- Kneeling and resting your elbows on the mattress or floor in front of you
- Kneeling and resting your shoulders on the floor or mattress in front of you
- In the deep birth tub, kneeling in a way that stretches your knees far away from your hips, so that your thighs are at a diagonal and your knees are further from your belly than your hips. This opens your pubic bone away from your spine and lets a posterior baby drop into the pelvis (engage). Do this only in active labor after you’ve tried to help baby rotate to the Left occiput transverse and that hasn’t been able to happen for whatever reason.
- Sitting on a birth stool
- Lifting your arms to grip a shawl (Rebozo) and standing with your knees “soft” (slightly bent)
Adding your instinctive movements is an excellent way to “tune in” to what your body needs to do to respond to your labor.
From Christine Kent, RN “..How our spine is is primary, but how the abdominal wall is is equally primary. We’re a whole tension-compression system. The whole thing works in harmony. There are really no parts in this system; it is a whole.
The “L” shaped abdominal wall wrapping underneath the body and holding the organs up above is a major part of the female pelvic organ support system.
So yes, our work is all about what I’m calling the natural shape of the female spine. And we come to that through posture. Exercise is fabulous, but its how we hold our body, as much as we can, through the course of the day….It becomes unconscious, pulling into this shape that we’ve trained ourselves to be in. It becomes effortless, and ultimately supportive of our abdominal and pelvic organs.”
Katy Bowman Says on her Facebook called Aligned and Well: “I’ve said this before, but it can’t be said too many times: Posture does not equal alignment. Posture is how something looks. Alignment is how something works. “Good posture” is cultural and is typically horrible alignment.”
Katy has got a lot to say, and you may learn a lot from visiting her website.
The living room couch may be the biggest contributor to unnecessary cesareans. Slouching on the sacrum is not helpful.
What positions to avoid resting in
There are times in pregnancy and labor when it is perfectly OK to lie on your back. During an exam, rolling over, doing exercises and getting body work, for example. But when you are resting, it’s better not to be on your back for the purposes of fetal positioning. You may feel comfortable on your back in the first half of pregnancy. Towards the end of pregnancy, your blood circulation will be better if you lay on your side than on your back. You can lay on your left or right as comfort directs you. Fetal positioning may be a concern of yours, however. For instance, you had a posterior labor previously or a cesarean for a long or stalling labor. Then, your resting position may matter as early as the end of the first trimester!
For some women, good maternal positioning includes not sitting and leaning back against the birthing tub. Lay on your side in the birthing tub, but don’t semi-sit if you have any history of a long or posterior labor, shoulder dystocia or are experiencing a long second stage (pushing). Most of the time the baby will come out fine anyway, but its best to avoid this position for any longer than 15 minutes and avoid being spine-down for birthing your first baby (first vaginal birth).
You can also lie on your right side. The directions to lie on your left side are not meant to be a prohibition against laying on your right side. You can favor your left if your care providers suggest you lay on your left. But once in a while, you need to roll over just to give your left shoulder some circulation! Somewhere, there is a woman who must lay in one particular position and will have to ignore this advice in preference to her caregiver’s advice. I acknowledge that and hope you do, too.
- Maternal position alone is not usually enough to ensure a good fetal position by the time labor begins.
- Balance in the uterus and pelvis precedes the success of using maternal positioning for changing fetal position.
- Maternal positioning is Spinning Babies Principle 2: Gravity.
Gravity-friendly positions are rarely enough. Add movement to increase flexibility and reduce pain. Before either, add balance to help both Gravity and Movement ease birth.