A ‘posterior baby,’ also known as ‘sunny-side up,’ is a fetal position where the baby is head-down, but its back aligns with the birthing person’s back, causing its face to look towards the abdomen. While many babies are born this way without complications, it can sometimes lead to a longer and more challenging labor. This article explores ways to encourage a baby to rotate into a more optimal position, both before and during labor.
Understanding Posterior Baby Position
The occiput posterior (OP) position differs from the more common occiput anterior (OA) position. In OA, the baby’s head is down with its face toward the birthing person’s spine, allowing easier passage. In OP, the baby’s face is toward the birthing person’s abdomen, meaning the wider part of the baby’s head may present first. This can lead to less efficient descent and increased pressure on the birthing person’s sacrum.
This position often results in prolonged labor and intense lower back pain, known as ‘back labor.’ While not all posterior babies cause significant issues, they can increase the likelihood of interventions. Signs of a posterior position include feeling kicks primarily at the front of the belly. Healthcare providers can identify this position through physical examination or ultrasound.
At-Home Techniques for Fetal Rotation
Non-medical strategies can encourage a baby to rotate from a posterior position by utilizing gravity and creating more pelvic space. The hands-and-knees position is widely recommended. This posture helps relieve pressure on the baby’s head, allowing its heavier back to rotate forward. Consistent practice, such as 20 minutes several times daily, can be beneficial.
Pelvic tilts, performed on hands and knees, involve gently rocking the pelvis, which can loosen joints and encourage fetal movement. Leaning forward over a birth ball, chair, or sofa also promotes optimal positioning by creating a ‘hammock’ for the baby. Avoiding reclining positions, like slouching on a couch or in a car seat, is advised, as these can encourage a posterior lie. Instead, maintain a forward-tilted pelvis, perhaps by sitting on a birth ball or backward on a kitchen chair.
The ‘forward-leaning inversion’ aims to create more space in the lower uterus by releasing uterine ligaments. This involves kneeling on an elevated surface and slowly lowering the upper body to the floor, allowing the head to hang freely. Hold this position for short durations, such as 30 seconds, with caution and ideally with assistance. Always consult a healthcare provider before attempting new techniques, especially with concerns or high-risk factors.
Medical Approaches for Fetal Repositioning
If at-home techniques are insufficient, medical or specialized bodywork approaches can be considered for fetal repositioning. The Webster Technique, a specific chiropractic adjustment, balances the birthing person’s pelvis and reduces tension in surrounding muscles and ligaments. This creates more optimal space for the baby to move, addressing musculoskeletal imbalances that might hinder optimal fetal positioning.
Pelvic floor physical therapy also addresses muscle imbalances and tension in the pelvic region. A physical therapist can provide targeted exercises and manual therapy to improve pelvic mobility and alignment, which may indirectly encourage the baby to rotate. These interventions are usually considered in late pregnancy if the baby persists in a posterior position. The decision to pursue any intervention is made in consultation with a healthcare provider, who assesses individual circumstances and recommends the most suitable course of action.
Navigating Labor with a Posterior Baby
Even if a baby remains in a posterior position during labor, vaginal birth is often possible, though the labor pattern may differ. Labor with a posterior baby can be longer, especially the first stage, and may involve intense back pain from the baby’s head pressing against the sacrum. Not all posterior labors result in severe back pain. Many babies spontaneously rotate to an anterior position during labor as contractions help them navigate the pelvis.
To manage discomfort and encourage rotation, frequent position changes are recommended. Moving, rocking, swaying, and walking are beneficial. Adopting hands-and-knees positions, leaning forward over a birth ball, or sitting backward on a chair can alleviate back pressure and create space for the baby to turn. Applying counterpressure to the lower back, hydrotherapy, and using heat or cold packs can also provide significant pain relief.
If the baby does not rotate, medical interventions may be considered. An obstetrician may attempt a manual rotation, gently turning the baby’s head to a more favorable position; this often requires an epidural. If labor progress stalls or there are concerns for the baby’s well-being, instrumental delivery using forceps or a vacuum may be necessary. In some cases, if other methods are unsuccessful and labor does not progress, a cesarean section may be recommended for a safe delivery.