Understanding the Position
A “sunny side up” baby is in the occiput posterior (OP) position: head down, face towards the parent’s abdomen. This contrasts with the more common occiput anterior (OA) position, where the baby’s face points towards the parent’s spine. In OP, the baby’s occiput (back of the head) is towards the parent’s back, influencing labor progression.
The term “sunny side up” informally describes the baby’s facial orientation during birth, similar to a fried egg. In the OP position, the widest part of the baby’s head may engage less ideally in the pelvis, slowing descent. This means the baby’s forehead or top of their head, not the smaller crown, might navigate the birth canal first.
Recognizing the Signs
Pregnant individuals might experience subjective indicators of an occiput posterior position. A prominent sign is intense, persistent back labor, with pain concentrated in the lower back. This pain may not subside between contractions and can feel constant or radiating, caused by the baby’s head pressing against the sacrum.
Labor progression might be prolonged or stalled, with regular contractions but slow cervical dilation or fetal descent. The baby may not engage deeply in the pelvis, or descent through the birth canal might take an extended period.
Some individuals report rectal pressure or an intense urge to push before full cervical dilation. The abdomen might also appear flattened or less rounded, as the baby’s back is not prominently positioned towards the front.
It can be challenging to feel the baby’s back through the abdomen during palpation, as it is oriented towards the parent’s spine; instead, limbs might be more easily felt towards the front. While these signs suggest an OP position, they are not definitive diagnostic tools, as many factors influence labor progression and pain.
Professional Diagnosis
Healthcare professionals confirm a baby’s position using several methods. Abdominal palpation (Leopold’s maneuvers) involves systematically feeling the pregnant abdomen to determine the baby’s lie, presentation, and position. During these maneuvers, a provider can identify the baby’s head, back, and limbs, helping deduce if the back faces the parent’s spine.
A vaginal examination provides specific information about the baby’s head position within the pelvis. During this, the provider feels for bony landmarks on the baby’s head, such as fontanelles and sutures. In an OP position, the posterior fontanelle may be felt towards the front of the pelvis, indicating the baby’s face is anterior.
Ultrasound imaging offers precise visual confirmation of fetal position. This technique allows the provider to clearly see the baby’s orientation in relation to the parent’s pelvis and spine. Ultrasound accurately identifies the occiput (back of the baby’s head) and its relationship to the parent’s sacrum, confirming an occiput posterior position.
Impact on Labor and Delivery
The occiput posterior position can influence labor and delivery. Labor duration is often longer than with occiput anterior births, due to less efficient engagement and descent of the baby’s head. This prolonged labor can lead to increased fatigue.
Intense back pain is common in OP labor, resulting from the baby’s head pressing directly against the sacrum. This pressure can make it challenging to find comfortable positions or rest. The need for pain management, including epidural anesthesia, may be higher.
The likelihood of medical interventions may increase with an OP presentation. This includes a higher chance of instrumental delivery (forceps or vacuum extractor) to assist in the baby’s rotation and descent. If the baby does not rotate or descend adequately, or if there are signs of fetal distress, a cesarean section may become necessary. While many babies in the OP position rotate spontaneously during labor, a significant percentage may not, potentially leading to these outcomes.
Encouraging Optimal Positioning
Several non-medical approaches can encourage a baby to rotate from an occiput posterior to an occiput anterior position, either before or during labor. Spending time on hands and knees is a suggested technique, as this position uses gravity to shift the baby’s back away from the parent’s spine. Maintaining this posture daily may provide a gentle gravitational assist.
Using a birthing ball can be beneficial, as sitting on it encourages an upright posture and promotes pelvic mobility. Rocking or gently bouncing on the ball can help open the pelvis and create space, allowing the baby to rotate. An upright and forward-leaning posture, such as sitting on a chair with knees lower than hips or kneeling with support, encourages optimal fetal alignment.
Avoiding recliners or semi-reclined positions for extended periods is advised, particularly in later pregnancy. These positions can encourage the baby to settle into an OP position by making the back of the parent’s body the most dependent area. Movement and an upright stance, like walking or gentle swaying, contribute to favorable conditions for the baby to turn.