Saturday, August 29, 2015

Timeline for Fetal Position

Babies follow a natural progression to settle into the final birth position. Well, not exactly final. So I call it, the starting position for labor. It almost always changes for baby to rotate through the pelvis.
Oxorn and Foote, Obstetric text book authors, state that most babies are in position at 34 weeks gestation. This means that fewer babies will change position after 34 weeks.
We assume that the moms in obstetric studies were not balancing out their tight muscles and short ligaments. They weren't using Rest Smart positions themselves and they weren't going to get body work and Chiropractic/Osteopathic.
My doc isn't concerned about the position until 36 weeks. You have plenty of time for your baby to move. -- post on Glow


If you spend any time on this website you will know that I don't exactly agree with that statement. Baby's don't move at random. Their position matches the shape of the room within the uterus. This space is shaped by the abdominal and pelvic muscles, ligaments, and connective tissue (or fascia). The mobility and alignment of the pelvis also make a significant contribution.
So, will the baby move into an ideal starting position for labor at 36 weeks? Depends on the room in the womb, I believe.
Add balance and babies move in response to the room created by the release of tension or torsion in the soft tissues and joints. Tension comes from living in gravity. I don't necessarily mean emotional tension. I mean tightness in the muscle, a muscle, several muscles. This effects mobility and alignment.
We know that in the second trimester that babies are often laying sideways in a transverse lie. Some or oblique (diagonal).

Timeline for fetal position

26 weeks or so

Babies begin to move to a vertical lie, which means either head down or buttock down. A few more will wait to go vertical until 28 weeks and fewer at 30 weeks.
28-30 weeks, the breech (buttocks/pelvis coming into the mother's pelvis before the head does)  baby often flips head down.
A few more will move head down by 32 weeks.
Gentle balancing can be done throughout the pregnancy with the Daily and Weekly Activities listed on this site and other ways of moving in pregnancy.

28-30 weeks

You may like to get more active about body balancing if baby isn't head down.

By 32 weeks

If baby is breech or sideways I suggest getting serious about self care techniques, such as the

If you have a history of difficult pregnancies or births, cesarean or babies in positions that are challenging, then you might want to get serious earlier. Start early, even before pregnancy if you have a history of car accidents, sports accidents, or work and activities that twist you and make a jolt or sudden stop, like soccer, baseball, running, massage therapy, Chiropractic adjustments from the side, lifting patients, throwing bales of hay, that sort of thing...
If baby is breech at 32 weeks get started with flipping activities in earnest and add professional body work no later than 34 weeks. - unless of course, you don't know you should have done this because you've been told it doesn't matter until 36 weeks.
See the Breech Timeline of when to do what in the Breech Section under Baby Positions.
If baby is transverse at 32 weeks, read that article and do the activities listed there.

Left Occiput Anterior 

At 32-35 weeks

Many babies still switch sides. You may feel the weight and mass of the baby switch, but is it your womb leaning or is it baby changing positions?
Tell by where the baby kicks, if that changes, too, then baby changed positions. If baby doesn't switch sides to kick, then the womb and the baby inside it are simply leaning over. Ligaments around the womb are loose. Wear a pregnancy belt for walking and doing activity like house and yard work.
By 32-35 Weeks, if baby favors only your right, and kicks towards your left:
Don't panic, but don't ignore it. There is a gracious center of activity without stress. May we all find it.

By 36 weeks

We expect baby to settle in, change position once or twice a week if there is room, if not, we are hoping baby favors the left by now.
LeahJeff8mos

During the 38th week

Many first time mothers' babies engage. If balance and flexibility are well established this may be less important to have happen. If baby has fingers wiggling in front, add balance. The lack of engagement is an issue for the posterior baby in starting labor or keeping labor going.
At 40 weeks, take a lovely walk and bath. Do something unrelated to pregnancy. Enjoy yourself and don't worry about when the baby is coming. Give yourself a break.

At 41.5 weeks and more

Serious focus on fetal position and engagement takes up your day but again, be chill about it. Just be focused on 3 x a day doing the engagement activities. If baby is truly in a good position, and many providers say so without knowing much about fetal position in detail, then you only have to deal with the politics of labor onset and not likely the actual challenge of helping baby engage to start labor.
Walk and make love. Changes are a'coming.

In labor

Labor wants baby engaged before labor will open the cervix. Since engagement is a result of fetal flexion and fit in the brim and an aligned brim makes engagement easier, balance and engagement activities are useful in early labor. A start and stop labor pattern is a clear sign that engagement help is needed.
Flexibility and softness helps gravity be more effective. Once a series of balancing activities have been done, gravity helps labor progress.
In a fast labor, just hang on and try to relax. You don't likely need to concern yourself with baby positions. You may want to get low to the ground if baby is coming so fast that you aren't prepared with someone there to catch!
In  a long labor, its all about softening the way and moving the pelvis at the level where baby waits to pass by. Using techniques randomly gets random results.
When baby needs helping engaging, Abdominal Lift and Tuck is specific.
When baby needs help turning from facing the side to face the back, and get lower than 0 Station, or half way, then Sidelying Release and the standing lunge or a lunge in bed or resting the leg over a peanut ball.
When baby needs help at the outlet, the nurse or midwife sees a bit of the head, but labor isn't bringing the baby lower very fast, open the outlet with a squat, an anterior pelvic tilt or put your knees closer together and your feet further apart and push in that position. Please consider the birth stool!

Lots of Labor lore and techniques are discussed in Spinning Babies; Parent Class. Stream it to your device, download, or buy the DVD before labor starts so you can get familiar with it.

Enjoy your labor! Its amazing to open up and let a brand new human being into the world!

Wednesday, August 12, 2015

You can tell if your baby is engaged

Engaged or not?
Sometimes the posterior baby's head seems low in the pelvis when checked by vaginal exam. The nurse, doctor, or midwife feels the dome of the head and it doesn't wiggle. So, they think, the head is not ballottable, and that equals engaged. Therefore, the head is engaged.

But that estimation is wrong when baby's facing the front with her or his forehead on the pelvic brim. If the forehead isn't in the pelvis we can't claim engagement.



Ask, Is baby overlapping the pubic bone?
Lay down and feel for your own pubic bone. Now feel just above your pelvic bone. Is there  a little bump, or ledge touching it? Does this object stick out further from your spine than your pubic bone or do you have to reach into your belly skin to feel the firmness of the head?
Pregnant Women can tell if the baby is resting on the pubic bone. Midwives can help them determine whether the head is overlapping or not. They may need to have the possibility of an overlapping head pointed out to them. Its not in the text books. Its only here, at Spinning Babies!

Is baby Occiput Posterior and unable to engage?
If the mother feels little hands wiggling on either side of her center line (the linea nigra of pregnancy) then she can be pretty sure she has a posterior baby and that any bump on the pubes that is not her is, indeed, her baby's forehead.
Compare OP babies 
Is the baby in an ideal position and simply waiting to engage?
Sometimes a woman has a very steep inlet with a pelvic cavity that sweeps back in a 90 degree turn from the inlet. Then a Left Occiput Transverse baby will slightly ride on the pubic bone. The hands will not be felt on the same side as this baby's back. She will have a little ledge at the top of her sacrum which seems to make the buttocks rounder. They rise higher due to the tilt of the sacum. This normal variation can make early labor longer. The tip below can help make engaging baby easier.
Remember, most first babies engage by 38-39 weeks. Engagement seems, practically speaking, like it may be easier for baby if the pelvis is aligned.  A long walk in flat, soft soled shoes helps engage babies. Walk regularly in pregnancy.

Once labor contractions begin, engagement has a friend
Uterine contractions seem to want to help baby engage. That's more important than dilation until engagement occurs. Even if you don't know baby's position, doing a series of posterior pelvic tilts with abdominal lifts during ten contractions
is a technique that is likely to help, http://spinningbabies.com/learn-more/techniques/other-techniques/abdominal-lift/.

  • The OP baby may rotate and then engage
  • The LOT baby engages for the mom with a steep brim
Learn more about engaging babies in the previous two posts on this blog.

References

Debby A Clinical significance of the floating fetal head in nulliparous women in labor.  2003 Jan;48(1):37-40.

D. M. Sherer* and O. Abulafia Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations Volume 21, Issue 5, pages 430–436, May 2003


Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.