Fetal Positions : For Mummies

Why is the baby’s position during labor so important that most women spend weeks in preparation for their child to be delivered head-down?
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As the fetus grows, it starts to occupy most of the vacant space and can’t move around as much as it would when it was developing. In most cases (95%), around the 36th week most babies settle with their head down waiting to be delivered head-first through the birth canal. In other cases, babies are not in a position that would make for a safe delivery which can result in a risk of complications. Such babies are delivered via Cesarean section. Your doctor or midwife will inform you as to what position your baby is in and what you would need to do to prevent complications.

Fetal Positions
Healthcare providers and midwives can determine the position of a fetus manually or with the help of an ultrasound scan. Here is a list of fetal positions:
1. Head Down: This is the most ideal birthing position, where a baby’s head is facing the mother’s vagina. This position also has variations-
a. OA/ Occiput Anterior: The baby’s head will be directed downwards facing the mother’s rear, the chin is seen resting against it’s chest and legs are crossed. This fetal position is considered most favorable.
b. OP/ Occiput Posterior: The baby is head down facing the mother’s front. Babies usually rotate into an OA as the due date arrives but 5-6% of babies are born in this position. Also known as ‘sunny-side up’, this position may cause longer and more difficult labor.
c. OT/ Occiput Transverse: The baby is head down facing the mother’s side. If necessary, babies in this position are encouraged to rotate with the help of forceps or vacuum extraction. This fetal position is uncommon and may need a Cesarean section for delivery.
d. Face and Brow Presentations: The baby is head down but points it’s chin out instead of resting against it’s chest. The baby may enter the birth canal face-first or forehead-first. These are rare presentations and in some cases, may require a Cesarean section.
e. Compound Presentation: This position requires extra assistance and care during labor as the baby is head down along with a limb (usually an arm or hand). This presentation occurs less than once in every 400-1200 births and the limb will usually slides back during delivery.

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2. Breech: The baby’s head is facing upwards and buttocks face the birth canal. When labor begins, about 3-4% of babies are in the breech position. The variations of this presentation are:
a. Frank: legs straight up with feet near the baby’s face.
b. Complete: legs bent at the knees and crossed.
c. Footling/ Incomplete: One or both of the baby’s feet are facing the birth canal and will be the first to emerge.

3. Transverse/ Shoulder Presentation: Most fetuses lie sideways in the uterus at some point in the pregnancy. Babies that maintain this position until the due date are rare but there are 1 in every 200-400 births that have a transverse presentation. The baby lies sideways with shoulders resting against the maternal pelvis, which means, a Cesarean section must be performed.

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4. Umbilical Cord Presentation and Cord Prolapse: One in every few hundred births has the umbilical cord entering the birth canal before the baby’s body. This is dangerous as the baby’s head can block or add pressure on the cord (baby’s lifeline) while passing through the birth canal. Cord presentation- If the cord enters the birth canal before the water breaks (fetal membrane rupture), healthcare providers are given the gift of time to plan for a best case delivery. Cord Prolapse- If the cord enters the birth canal after the water breaks, the baby is at risk. This will be considered an emergency and will mostly require a Cesarean section.

Here is video that you might also find informative:

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Your midwife or healthcare provider will be able to determine the position of your baby but there are possibilities of inaccuracy in confirming the presentation during birth. There are several things you can do as a mother to encourage your baby to re-position itself into OA during your pregnancy, but through it all, you will just have to trust your instincts. Have faith in your baby and the process.

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