Optimal Foetal Positioning: How to Help Your Baby Get into the Best Position for Birth
If you've been told your baby is back to back, or if you're searching the internet at 36 weeks trying to find out what position your baby is in and whether it matters, I want to start by saying something that I hope will immediately reduce your anxiety…
A back to back baby is still normal physiology for birth.
I'm Melanie, a birth doula and hypnobirthing teacher who has supported women through labours with babies in all kinds of positions. The fear and worry that surrounds foetal positioning, particularly the occiput posterior position (OP / back to back), is frequently disproportionate to the reality. Let me give you the full picture.
Understanding baby's position — the basics
Your baby's position in the womb refers to how they are lying in relation to your pelvis. The most significant aspect for birth is the position of the back of their head, the occiput, in relation to the front or back of your pelvis.
Occiput anterior (OA) — the most common position
In an occiput anterior position, the lower back of your baby's head faces toward the front of your pelvis. This is often described as the optimal position for birth, and it is the most common — the majority of babies settle into an OA position in the weeks before labour.
In this position, your baby's back curves towards your abdomen, their chin is tucked, and the smallest diameter of their head is presenting first. Labour in an OA position tends to progress straightforwardly, though of course every labour is individual.
Occiput posterior (OP) — the back to back position
In an occiput posterior position, the lower back of your baby's head faces toward the back of your pelvis, your baby's back is against your back. This is what is commonly called a back to back baby.
And here is an interesting statistic for you:
Between 15 and 30 percent of babies begin labour in an occiput posterior position. Only around 5 percent of babies are born in that position. The vast majority rotate during labour often without the mother even knowing it has happened.
This means that if you are told your baby is back to back at 37 or 38 weeks, or even at the start of labour, the overwhelming likelihood is that they will rotate on their own. Your body and your baby know what they are doing.
Does baby position really matter?
An OP baby can sometimes mean a longer labour, more back pain during surges, and a slower early labour. This is because the presenting diameter of the baby's head is slightly larger in an OP position, and the baby may need more time and space to navigate the curves of your pelvis.
However, and this is important, many women labour through an OP birth without knowing their baby was in that position until afterwards. It is not a guarantee of a difficult birth. It’s a variation of normal that may require a little more time, a little more movement and a little more patience.
What helps most isn't worrying about it or being told what to do, it's freedom of movement. Freedom to move how you feel is right for you, that and trust from all who are supporting you. Trust in you and trust in your baby.
Is there anything that you can be doing before labour?
In the weeks before your due date, there are stretches and movements that may encourage your baby into an optimal anterior position and keep them there. These are worth doing daily from around 32 weeks, but they are not a guarantee and if your baby remains OP please remember the statistics above. This may simply be the most comfortable position for them.
Stay upright and forward-leaning
The most important thing you can do is simply spend more time in upright, forward-leaning positions. When you sit or lie back the heaviest part of your baby, their back and back of head, tends to roll toward your back. When you lean forward gravity encourages their back toward the front of your bump.
Sit on a birth ball rather than a big squishy sofa, lean slightly forward with your hips higher than your knees.
When sitting, lean forward onto a table or the back of a chair rather than reclining.
Rest on your left side if comfortable with a pillow between your knees — this opens the pelvis and encourages anterior positioning.
Avoid spending long periods semi-reclined on a sofa or in a bucket seat as these positions tip your pelvis backwards and encourage a posterior position.
Hands and knees
Spending time on your hands and knees whether rocking gently, doing cat-cow stretches, or simply watching television in this position is one of the most effective things you can do to encourage your baby to rotate. It also takes the pressure of your baby's weight off of your back and gives them space to move.
Even 20 minutes a day in this position can make a difference.
Walking
Regular walking helps engage your baby's head into the pelvis and encourages rotation through the natural alternating movement of your hips. The psoas muscle, the body's main hip flexor, can become tight and when this happens we lose pelvic mobility and this can create tension that blocks the pelvis from fully opening, which might in turn slow or stall labour. Walking is free, gentle, and genuinely effective exercise in pregnancy. Aim for a daily walk if you can.
Spinning Babies
The Spinning Babies approach developed by midwife Gail Tully, offers a comprehensive framework of balance exercises, positions and movements specifically designed to encourage optimal foetal positioning. Their website at spinningbabies.com has excellent, detailed guidance that is worth exploring from around 30 weeks. In fact I would highly recommend bookmarking it on your smartphone so that you can refer to it even during labour.
What to do during labour — movement is everything!
Whether your labour begins with your baby in an anterior or posterior position, the most important thing you can do during labour is move. This is not a simple suggestion I am making, it is the single most effective tool available to you for both comfort and progress.
The most important thing in labour is simply to keep moving and listen to what your body is telling you. Really listen and move how your body is asking Whether your baby starts in an OA or OP position, this is still normal physiology for birth.
Your body will often tell you exactly what it needs. The instinctive movements of labour... rocking, swaying, circling, getting onto all fours, leaning forward are not random. They are your body and your baby working together to find the best path through for birth.
Movement that helps during labour
Walking, even during active labour, short slow walks between surges help your baby navigate your pelvis.
Rocking and circling on a birth ball, the figure-of-eight hip movement is particularly effective for an OP baby.
Hands and knees, particularly useful during back labour (where most of the pain is felt in the lower back). It relieves pressure and gives your baby room to rotate.
Asymmetrical positions, lunging, placing one foot on a chair, stepping up onto a step. These movements open one side of the pelvis at a time and can help a baby navigate through.
Supported squat, using your birth partner, a birth bar, or a rope opens the pelvic outlet and uses gravity to help your baby descend.
Getting into the birth pool, this soothes both the body and the mind and allows you supported and weightless movement which can be an absolute game-changer.
For back labour specifically
If your baby is OP during labour you may experience significant back pain during your surges. A deep, persistent ache in the lower back rather than the more familiar abdominal tightening. This is because your baby's skull is pressing against your sacrum.
Counter-pressure on the sacrum, your birth partner pressing firmly with the heel of their hand or a fist against your lower back during each surge is one of the most effective natural pain relief techniques available. Warm water, whether in a pool or a shower directed at the lower back, also provides significant relief.
For birth partners: Ask where it hurts and press there firmly, steadily, throughout each surge. This is one of the most valuable things you can do in back labour and it makes an enormous difference. You can also get a hot water bottle (not so hot that it burns!) and hold this to the lower back, which I can tell you from experience is really appreciated by the mum to be.
What hypnobirthing gives you in the context of foetal positioning
Hypnobirthing prepares you for birth as it actually is, not as a fixed, predictable process, but as a journey that unfolds in its own way. The women I support who have prepared with hypnobirthing approach an OP labour very differently from women who haven't.
They know the statistics, that most OP babies rotate and they know to keep mobile. They know how to breathe through back labour. They know their birth partner is prepared to support them with counter-pressure. And they know that whatever position their baby is in, their body is capable of working with it.
That knowledge is its own form of pain relief.
Ready to prepare for birth — whatever position your baby is in?
The Better Birth Stories Online Hypnobirthing Course covers foetal positioning, movement in labour, birth partner support, and everything else you need to feel genuinely prepared. 94 lessons, 12 professional MP3s, £39, 30-day guarantee.
→ Explore the Online Hypnobirthing Course