Fetal Positions For Labor and Birth

1
The Fetal Skull

Fetal Skull
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

The position that your baby is in during the last weeks of pregnancy and the early part of labor will give you a lot of information on how to best handle your discomforts and pain as well as how to speed labor once the time comes.

The begin to understand how the baby maneuvers out of the pelvis you will need to know a bit about the fetal skull. The bones of your baby's head are not yet fused, this allows the bones to overlap as your baby makes it's way through the pelvis at the end of pregnancy and labor. The lines are called suture lines and also show the fontanelles or soft spots of the baby's skull. The front of the baby's head is the anterior portion and the back is the posterior portion.

2
Left Occiput Anterior (LOA)

Left Occiput Anterior (LOA)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

The Left Occiput Anterior (LOA) position is the most common in labor. It general represents no problems or additional pain during labor or birth. Here the back of the baby's head is slightly off center in the pelvis with the back of the head towards the mother's left thigh.

3
Left Occiput Transverse (LOT)

Left Occiput Transverse (LOT)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

When the baby is facing out the mother's right thigh, the baby is said to be Left Occiput Transverse (LOT). This position is halfway between a posterior and anterior position. It can indicate positive movements towards an anterior position if the baby has previously been known to be posterior (in either direction).

However, with a baby in the Left Occiput Transverse (LOT) position in the pelvis labor may be a bit more painful and slower. To alleviate pain and encourage the baby to continue its rotation towards the anterior positions, you can use several positions in labor:

  • Lunging
  • Pelvic Tilts
  • Standing and Swaying

These positions encourage the baby to move into a more favorable position by opening the pelvis more and providing a bit of help in moving. Ask your doula, labor nurse, midwife or doctor for more suggestions.

4
Left Occiput Posterior (LOP)

Left Occiput Posterior (LOP)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

When your baby is lying in the pelvis facing forward and slightly to the left, so that the baby would be looking out the right thigh, it is said to be in the Left Occiput Posterior (LOP) position. This presentation can lead to more back pain and a slower labor.

To help prevent this pain, decrease pain or to help encourage your baby into a better position for delivery, you can use a variety of positions, including:

In addition to moving the baby, specific comfort measures can include:

This position is sometimes the cause of back labor.

5
Right Occiput Anterior (ROA)

Right Occiput Anterior (ROA)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

The Right Occiput Anterior (ROA) position is common in labor. It generally represents no problems or additional pain during labor or birth. Here the back of the baby's head is slightly off center in the pelvis with the back of the head towards the mother's right thigh.

6
Right Occiput Transverse (ROT)

Right Occiput Transverse (ROT)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

When the baby is facing out the mother's left thigh, the baby is said to be Right Occiput Transverse (ROT). This position is half way between a posterior and anterior position. It can indicate positive movements towards an anterior position if the baby has previously been known to be posterior (in either direction).

However, with a baby in the Right Occiput Transverse (ROT) position in the pelvis labor may be a bit more painful and slower. To alleviate pain and encourage the baby to continue its rotation towards the anterior positions, you can use several positions in labor:

  • Lunging
  • Pelvic Tilts
  • Standing and Swaying

These positions encourage the baby to move into a more favorable position by opening the pelvis more and providing a bit of help in moving. Ask your doula, labor nurse, midwife or doctor for more suggestions.

7
Right Occiput Posterior (ROP)

Right Occiput Posterior (ROP)
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

When your baby is lying in the pelvis facing forward and slightly to the right, so that the baby would be looking out the left thigh, it is said to be in the Right Occiput Posterior (ROP) position. This presentation can lead to more back pain and a slower labor.

To help prevent this pain, decrease pain or to help encourage your baby into a better position for delivery, you can use a variety of positions, including:

In addition to moving the baby, specific comfort measures can include:

This position is sometimes the cause of back labor.

8
How to Tell Where Your Baby Is Located - Leopold's Maneuvers

Leopold's Maneuvers
LifeART (and/or) MediClip image copyright 2008. Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

Leopold's Maneuvers is a series of hands-on positions that your doctor or midwife will use to help determine the position of your baby. This is generally done at the majority of your prenatal visits in the third trimester. When your practitioner does this, be sure to ask where the baby is located. This can give you some time to start working on getting baby into the best position possible.

During labor, your labor nurse or practitioner can also tell with slightly more accuracy by doing a vaginal exam and feeling for the suture lines of your baby's skull. The cervix will have to be dilated enough to allow this to happen. It is worth noting that some practitioners are more skilled in this technique, both before and during labor, abdominally and vaginally, than others. Sometimes the best information that you can get is whether or not your baby is head down or breech.

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How You Can Tell Where Your Baby is Positioned

Doctor palpates a pregnant woman's abdomen to tell the position of the baby
Photo © Vicky Kasala Productions/Getty Images

One thing that many moms forget is that they are often the best person to assess where their baby is laying in the pelvis. All you need to do is to pay attention to how your baby moves and where you feel what.

For example, are you feeling lots of good kicks? Where do you usually feel them? Where you feel the good kicks, that's where your baby's legs are located.

Now ask yourself do you feel a large, flat plane? This is most likely your baby's back. Sometimes you can feel the baby arching his or her back.

At the top or bottom of the flat plane you will feel either a hard ball, most likely your baby's head or a softer curve that is likely to be your baby's bottom.

This process is also known as Belly Mapping.

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