How to Prevent
a Posterior Labor
Posterior labor happens when your baby’s head is face up to your belly button (face down aka anterior is the most common position) and the occiput (the back of baby’s head) is pressing against your spine. This can cause longer labor and severe back pain in labor, although this is not necessarily so!
Here are some ways to prevent a posterior labor…these exercises should encourage baby to rotate to anterior. They should be started at least 6 weeks before the due date for a first pregnancy and 3-4 weeks before the due date for second and subsequent pregnancies. Although don’t get discouraged if you are really close to your due date, it’s really never too late to start! Some babies turn right away with this amount of encouragement. It should be noted these exercises won’t turn an anterior baby posterior, so if you are not sure of position, do these anyway, since they can’t hurt!
Avoid all reclining positions. If you have a soft reclining seat or couch, best to put a pillow under your bum and tilt your pelvis forward.
Keep knees below your pelvis at all times, back straight. A large birth ball is the perfect ‘chair’ for this position. Those nifty office chairs with knee rests are also great. The goal is to keep the pelvis tilted forward at all times.
Keep active, walk as much as possible.
Practice pelvic rocks on your hands and knees every day for minimum 3 times a day for 20 minutes and/or;
Take up the knee-to-chest position (sometimes called the playful puppy pose…chest to the floor, bum up in the air) for an hour or so everyday. Some people prefer this because it will prevent a posterior baby from engaging until it is in a good position. (Once baby engages posterior, it’s much less likely s/he will turn.)
While this doesn’t sound like much fun, scrub your floors on your hands and knees regularly. Crawling around in this fashion is great for getting baby anterior.
Talk to your baby; ask him/her to turn to anterior (or better yet, ask him/her to turn to a position that will help labor…sometimes there is a good reason for baby to be posterior).
Visualize an anterior baby, preferably LOA (left occiput anterior) with baby’s bum in your front, but slightly to the left of your belly button.
Sleep on your left side, with your left leg straight and your right leg at a 90-degree angle supported by a pillow or two. This creates a ‘hammock’ for your belly and will encourage the baby to rotate.
Avoid squatting unless you are sure baby is now anterior…squatting can force a posterior baby into the pelvis before s/he rotates, making it much less likely s/he will turn anterior without being disengaged first.
Relaxing in a warm bath and telling your baby you are happy s/he is about to arrive can also make a world of difference! Doesn’t hurt to try it.
Sometimes these measures will still not work. Perhaps it could be because there’s a good reason your baby is posterior…maybe that is the only way s/he can enter the pelvis, or it's possible the placenta is in the way (for example, an anterior placenta may predispose you to a posterior baby). Talk to your baby, and ask your baby if you should take any extra measures to turn him/her. If you feel comfortable that there isn't any really good reason for baby to be posterior and the above measures tried for a couple of weeks have not worked, you might try the following in addition to the above exercises:
Lie down on your back and put a rolled towel in the small of your back to form an exaggerated arch. This will make a posterior baby hyperextend their necks and will usually make them turn.
If baby is deeply engaged posterior, you may try a slant board (as with a breech baby; a piece of wood or an ironing board is propped up on a couch or chair and the mother lays on it, on her back with her head pointing down) to try to disengage the baby in order to try the first set of exercises again. A relaxing tea, such as valerian or skullcap may also help before trying the slant board.
If you are certain of the baby’s position, assume the hands and knees position and ‘massage’ your baby or ‘encourage’ them into an anterior position. Do it very gently…do not force the baby. This may be better done with a midwife present, or someone to help monitor baby’s heartbeat.
Since babies tend to turn their backs toward warmth, an ice pack on the back with warm towels on the mother’s belly will sometimes encourage a baby to turn.
Homeopathic Pulsatilla has been known to help turn a baby. It apparently evens out the muscles in the uterus, allowing baby to fit into an optimal position
Sometimes a posterior position is caused by a lack of strength in your lower stomach muscles…in this case a belly support or belly binding (a large sheet or towel wrapped tightly around the belly for support) might help.
If it’s a cord preventing baby from turning, try perhaps rotating baby the opposite direction (for example, at night try sleeping on your right side instead of left). This can help ‘unwrap’ the baby and encourage him/her to turn.
chiropractic adjustments of the back and pelvis will be just what the baby
needs to rotate. A mother’s sacral area might be jammed or just tight,
and that, along with a misaligned tailbone, could force the baby to become
posterior. Chiropractic adjustments throughout pregnancy should avoid this
situation altogether. There is also a chiropractic technique called
"diaphragmatic release" and is supposed to turn posterior babies
every time. Ask your chiropractor about it.
What to do if you go into labor and baby is still posterior:
Don’t get too worried…the vast majority of posterior babies rotate during labor and those who don’t are often born "sunny-side-up". Some posteriors actually are born precipitously with no back labor, depending on how well flexed the head is. Babies come out!
First thing is to get into a knee-to-chest position and stay there for at least 45 minutes, or until baby turns. Be sure to have lots of pillows on hand so you can stay in this position comfortably for as long as is required.
Sometimes doing stairs 2 at a time between contractions (with a spotter on each side!) will jiggle the baby’s head enough for it to turn or move the pelvic bones enough for baby to turn.
Belly lifting is another technique for when baby won’t turn and dilation is slow. With someone supporting you from the back, lean back, arching your spine, and with both hands around your belly near the baby’s bum - pull up on it during a contraction. This realigns the vectors so that baby’s head will put more pressure on the cervix, helping it to dilate more quickly.
A big pool filled with water will relieve a lot of the back pain and will help baby to turn, so plan a waterbirth!
Have someone press on the upper part of your sacrum, to hopefully move the lower part away from baby’s head, lessening back pain and hopefully giving baby more room in the pelvis to turn.
Sometimes something called the 'double hip squeeze' can give baby more room in the outlet to come down if he/she is not descending. Have your partner, or 2 helpers, press on each side of your hips, with considerable force during each contraction. This should force open the outlet of the pelvis to help baby descend. This maneuver often lessens the pain for the mother considerably.
Things your caregiver can do to help you out.
Remember, however your birth turns out, even if it's not the labor or birth you want, it WILL be the labor and birth you need. :-)
For more information and some great pictures on fetal position and the knee-to-chest position try this link:
Other related links:
Midwife archives: Sub optimal Fetal Positions, Including Posterior
"Posterior Labor: A Pain in the Back" By Valerie El Halta
"My first 2 babies were posterior…will my third be as well?"
Understanding and Teaching Optimal Foetal Positioning by Jean Sutton and Pauline Scott
Heart and Hands by Elizabeth Davis
The VBAC Companion by Diana Korte