The term “sunny side up” describes the Occiput Posterior (OP) fetal presentation. This occurs when the baby is head-down, but the back of the head faces the mother’s abdomen instead of the ideal position, which is facing the mother’s spine. While many babies turn spontaneously, the OP position can complicate labor by increasing the length of contractions and pushing time. Understanding the OP position and applying specific strategies can help the baby rotate into a more favorable alignment.
Understanding Occiput Posterior Position
Occiput Posterior (OP) means the baby’s head is positioned toward the mother’s back, causing the baby to face forward. The optimal position, Occiput Anterior, involves the baby facing the mother’s spine, which allows the smallest diameter of the head to engage the pelvis. When the baby remains OP, the largest part of the head attempts to fit through the pelvic inlet, leading to inefficient descent and rotation.
This presentation is a common cause of “back labor,” where the baby’s skull presses against the mother’s sacrum, causing intense low back pain. Labor often becomes prolonged, and the pushing stage may take longer than expected. Persistent OP position increases the likelihood of requiring an instrumental delivery or a Cesarean section if the baby fails to rotate.
Techniques for Encouraging Rotation Before Labor
Before active labor, techniques can be used during the third trimester to encourage the baby to shift. The goal of these movements is to create more space in the pelvis and soften surrounding ligaments. Regularly adopting a hands-and-knees position, often called “all fours,” uses gravity to gently encourage the baby’s back to swing forward toward the mother’s abdomen.
Avoiding deep recline is important, as slouching or sitting with the knees higher than the hips can inadvertently encourage the baby to settle into the posterior position. Instead, sit upright with the hips elevated above the knees to help tilt the pelvis forward.
Forward-leaning inversions are a specific technique where the mother briefly positions her head lower than her hips. This uses gravity to temporarily move the baby up and away from the pelvis, giving them space to reorient. This should be done only for short periods, such as three full breaths, and should be discussed with a healthcare provider. Gentle pelvic tilts while on hands and knees can also help align the pelvis, making the space more accommodating for rotation.
Positional Strategies During Active Labor
Once active labor starts, positional changes utilize contractions and gravity to achieve rotation. Frequent movement is encouraged, as staying active promotes the spontaneous rotation that occurs in most OP cases. Positions that involve leaning forward, such as draping the upper body over a birth ball or the back of a chair, help open the pelvic inlet and encourage the baby to move.
The knee-chest position or a modified semi-prone side-lying position is often recommended during contractions to encourage a shift away from the posterior alignment. Lying on one side with the top leg draped over a peanut ball helps open one side of the pelvis, allowing the baby’s head to move into a better angle. Sustained forward lunges can also be used during a contraction to change the shape of the pelvic outlet and create room for rotation and descent. Upright and forward-leaning positions can increase the rate of spontaneous rotation and vaginal delivery while reducing the duration of active labor.
When Professional Intervention is Needed
If the OP position persists despite positional efforts, medical professionals may intervene to ensure a safe delivery. If a baby remains posterior during the second stage of labor, a provider may attempt a manual rotation. This procedure involves the obstetrician or midwife inserting a hand into the vagina and gently turning the baby’s head to the anterior position.
A period of expectant management is often allowed, as some babies spontaneously rotate even late in the second stage of labor. However, if labor stalls or the position cannot be corrected, assisted delivery may be necessary. This involves using vacuum extraction or forceps to guide the baby through the birth canal. If the baby remains persistently posterior and unengaged, or if there is concern for maternal or fetal distress, a Cesarean section becomes the safest delivery method.