Your Pregnancy

Month 9: Ready to go

Most babies line up on the runway with no problems, but for those who do struggle, we offer some advice.

- BY MIDWIFE TINA OTTE

There are five things that influence how you’ll labour on the day. Often referred to as the five P’s, they are: passage, passenger, powers, psyche and position.

YOUR POSITION

The way your baby is positioned in your body can affect labour and birth more than you realise.

Towards the end of pregnancy, your internal structure, muscles, ligaments and joints in the abdomen and pelvis can affect how your baby lies.

Your posture and your choices in movement could decide the course of labour. You can help yourself and your baby during labour by adopting appropriat­e positions that’ll facilitate the descent of your baby, open the pelvis and cause the cervix to dilate.

One thing is for sure – lying down on a bed and not moving isn’t a position that will assist with this. In fact, lying down can hinder the process and may even cause labour to become longer and be more painful. Studies comparing labouring upright with labouring lying down have shown that women who’re upright need fewer painkiller­s and labour-inducing drugs to stimulate contractio­ns. Epidurals were also less common in the ”upright” women compared to the women who were lying down.

BABY’S POSITION

The ideal position for a baby to be in as labour starts is to lie with the back of his

head against his mother’s hip along the left side of her abdomen between her hip and her navel. This is known as left occipito anterior (LOA) position. In this position, baby can turn his head through 45 degrees towards the mother’s front.

Not all babies adopt this position before birth. Pelvises are unique, with different shapes. Some are wider at the top, narrowing in the middle and towards the outlet; others are narrow at the brim and have deeper curves and angles at the sacrum. The ability of the baby’s skull bones to move over one another (moulding) as well as the “give” of the mother’s pelvic ligaments and the position she adopts in labour can add or subtract centimetre­s to certain diameters that could make a difference to the way a baby enters the pelvis and moves through it. This will have an impact on how labour progresses and on the outcome of the birth.

The good news is that at the start of labour, about 75 percent of babies are in the LOA position or its direct opposite (when the baby lies on the mother’s right side between her right hip and her navel). These are great positions for the baby to be in and promise a better chance of an easier labour.

The occipito posterior (OP) position occurs in about 25 percent of women. This is when the baby’s back lies directly against the mother back or slightly to the left or right of her spine. This makes the baby’s head seem bigger when moving through the pelvis. If a baby starts labour with his back on the right, or along the mother’s own spine, labour may be longer and might even necessitat­e more interventi­on. These labours are known for the back pressure they bring and they’re usually longer. If your baby is in this position, you’re advised to stay as upright and mobile as you can during your labour.

WHAT YOU CAN DO

In the last six weeks of pregnancy, try adopting upright and forward-leaning positions as often as possible. When the pelvis tilts forward, it allows more space for the broader diameter of the baby’s head to move easily into the pelvis. Modern sitting (deep couches and car seats) forces the pelvis to tip backward rather than forward, and this prevents the baby from entering the pelvis in the anterior position. Sit on straight-backed chairs, on a birth ball or on the backless chairs designed for computer work, where the knees are supported in the front and the pelvis is tipped forward, easing lowerback strain.

Rocking your pelvis back and forth several times a day may also help.

This can be done while standing, crouching in an all-fours position or sitting on a birth ball. When sleeping or resting, lie on your side with pillows behind your back with your top leg and knee resting forward on the mattress. Swimming, yoga and prenatal exercise classes where crawling and ball work is done will also help.

From early on in pregnancy, start

spending some time in an all-fours position. It will encourage your baby to turn. In the latter part of pregnancy, the importance of this position can’t be overemphas­ised, both for helping babies to settle into the anterior position, and for the sake of your own back and abdominal muscles. Doing it from early on in pregnancy means the baby is much less likely to settle into the OP position.

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