Recently I had a conversation with a doula about fetal positioning. She and many of her doula colleagues have noticed an increase in clients that struggle during labor due to posterior positioning of the fetus. Posterior occiput position is when the baby's head is down and facing mom's belly. A normal presentation is when the head is down and the baby's head is facing the mom's sacrum as in the picture to the left. I would like to share some information from the workshop I presented to our Salt Lake Birth Circle group.
Incidence and consequences of Occiput Posterior (OP):
Incidence and consequences of Occiput Posterior (OP):
- 15-30% present posterior at onset of labor
- 5% presentation at delivery
- 5.5% of OP accounts for 12% of all cesarean deliveries for lack of progress or dystocia
- 7 fold increase in the incidence of 3-4th degree perineal tears (into anal sphincter)
Why are babies malpositioned?
Penny Simkin, PT and author of The Labor Progress Handbook attributes fetal malposition to cultural habits and trauma.
Cultural Habits:
Cultural Habits:
- Slouching
- Crossing legs
- Sitting too much, driving
- Standing with pelvis imbalanced
- Too little or too much exercise
- Sport injuries/falls
- Motor vehicle accidents
- Assault
- Fears
What can we do about it?
- Stand & Sit in alignment
- Release tension in your hip flexors and pelvic floor
- Walk 3-5 miles a day
Stand and Sit Alignment
 Stand in alignment. If we had a plumb line coming down from her shoulder, you can see that her shoulder, hip, knee and ankle are stacked up in a line. The pelvis is neutral in this position and the load is transmitted through the legs. The ribcage is stacked over the pelvis, so the core is able to engage and support. The muscles of the pelvic floor are in a more optimal position to generate force.  Sit in alignment. Sit on your ischial tuberosities, not your sacrum. Avoid sitting slumped on cozy couches, and driving in bucket seats. For a demonstration see video to the right. |  Poor standing alignment. If we had a plumb line coming down from her shoulder, there wouldn't be any joint stacked underneath. The load is being transmitted to the front of her abdominal wall (which can create abdominal separation), to the front of her pelvis (which can create pubic symphysis pain) and to her low back and SI joints. The ribcage is not stacked over the pelvis which interferes with the optimal function of the core: diaphragm, pelvic floor and deep abdominal muscles. |
Release Tension in your Hip Flexors and Pelvic Floor
 Attaching superiorly at the spine (to the transverse processes and lateral surface of thoracic vertebra 12 to the last lumbar vertebra and corresponding discs) and traversing down and forward through the pelvis to attach to the inside of the upper leg (lesser trochanter). Tension in the psoas can limit the fetal space as the baby descends into the pelvic inlet. |  Psoas release Place the bolster near the bottom of the shoulder blades. Make sure that the ribs remain relaxed and flush with your abdominal wall. Extend the legs. Make sure that the back of your thighs fully touch the floor. If they don’t, you need to bolster up higher. Relax here for 5-10 min. Allow your legs and torso to relax. Practice breathing. Focus on allowing the pelvic floor muscles to relax on the inhale. Tension in the pelvic floor can pull on the sacrum, limiting sacral mobility that is necessary to widen the pelvic outlet. |
If you are in the Salt Lake area you can learn about the topics introduced in this blog and more, in my prenatal workshop, Birth Mechanics: Get Your Body Tuned up for Delivery.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT. Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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