That “just-right” fit
Toward the end of pregnancy, as your minds turns to giving
birth, one thing you may wonder about is “Is my baby in the
right place for birth?” We’ll be checking for fetal position
throughout your pregnancy, and about 28 to 32 weeks, we’ll
begin to really pay attention to whether or not your little
one is head-down. Be picturing your baby in a head-down
position, head pointed to the exit, from the beginning of
your pregnancy to help you and
your baby get used to the idea!
There are a number of workable
positions for giving birth, but the
easiest is called “Left Occipital
Anterior,” or LOA2,4. This means
that your baby’s head is down,
that her or his face is toward your
back, and his or her spine is on
your left, front side, between your
(Mama Natural, 2018) left hip and belly button.
Of course, that’s “optimal,” if everything is 100% perfect.
There are other positions your baby can be born in with little
enough fuss. The main ones that providers become
concerned about are “breech”—when the baby’s bottom is
in your pelvis and their head is up; and transverse—when
the baby is lying across your pelvis with their head and
bottom on your left and right. There are a couple of others
that are a cause for concern as well, but let’s don’t borrow
more trouble than already is before us.
When these situations come
up, it is important for you and your
baby that we learn if there’s a
specific reason for these unusual
positions1,2 5. This usually means that
you will be asked to have an ultrasound to determine
possible reasons for other-than-optimal positioning. This
could be things like a cyst somewhere in your pelvis; your
placenta may be in an unusual place; their umbilical cord
might be looped unusually; or it could be nothing more than
that your baby forgot to turn over before he or she grew so
big1,2 5!
What next?
When your ultrasound comes back showing there is a
“mechanical” blockage to your baby turning head-down, we
have a couple of options. We will talk about the possibility
of a referral to a partner physician or certified nurse midwife
if the need is there. Also, because we start thinking about
position a little earlier than is common among medical
practitioners (this is often put off until 37 weeks1), we’ll
suggest stretches, poses, exercises and sometimes even
homeopathic remedies to help your baby get moving in a
downward direction2.
An excellent resource for addressing your
baby’s position from the beginning of your
pregnancy is “Spinning Babies.” This organization is
dedicated to promoting Optimal Fetal Positioning from as
early in your pregnancy as possible. Check out their website:
https://spinningbabies.com/

What if baby doesn’t go head-down on their
own?
If baby doesn’t turn head-down on his or her own, one
option to consider is an External Version. External Version
can be done by your midwife as early as 26 weeks2, but can
also be done by an obstetrician, although they often wait
until 37 weeks to attempt this1. This is a procedure where
we will attempt to coax your baby into a head-down position
manually, by pressing on your belly. An External Version
usually only takes a few minutes to accomplish, and can be
done at a regular clinic visit. The earliest we would attempt
this is 32 weeks. Experienced midwives have found that this
is a good time for External Version because baby is not
finished growing allowing for more room for baby to move;
also, there is still a good deal of amniotic fluid present,
which makes the procedure somewhat easier2. Like all
procedures, there is some risk. A provider may cause
bruising on your abdomen; there is a some risk of causing a
placental abruption if your placenta is at the front of your
uterus (another important reason to have an ultrasound); it
is also possible to cause cord entanglement that can lead to
other troubles later1,2. These things are not common, but
they are possible and should be taken into consideration
before you consent to an External Version.
In general, the External Version looks like this:
(Hanafi, 2011)
As you can see in Figure D, the baby can be turned either
forward or backward; this is done at the midwife’s
discretion, based on the best information available from
palpation, the pregnant person’s perception of movement
of hands and feet, and if readily available, an ultrasound.
Before the External Version, the midwife will listen to fetal
heart tones to establish the baby’s baseline heartrate.
During the procedure, your baby’s heartrate will be checked
several times to ensure she or he is responding to the
procedure well. If at anytime your baby’s heartrate becomes
erratic, your midwife will stop, and allow the baby’s
heartrate to return to within normal limits, and then begin
the procedure again. Once your baby is in the head-down
position, the midwife will observe the baby’s heartrate a few
times to ensure that your baby has responded positively to
his or her new position.
What if my baby flips back?
It is not at all unusual for the baby to turn part or even all
the way back to the position she or he was in to begin
with1,2,5,6. Don’t worry! The baby can be turned again as
needed, so long as she or he responded well to the External
Version the first time, there is no reason to not attempt
again2,5,6.
You can help your baby not to turn back to the wrong
position by spending time in positions suggested on
Spinningbabies.com and MamaNatural.com. Also, keep
visualizing your baby head-down; talk to your baby and
encourage him her to be head-down so she or he can be
born more easily! Your partner can encourage the baby as
well, talking to the baby through your belly, telling the baby
that the easiest way for him or her to be born is head down,
you and your partner can both gently massage your belly
between your left hip and belly button and tell baby that his
or her back should be in that place2,6. Believe in your body
and baby’s instincts. This hurdle can be overcome!
References:
1. American College of Obstetricians and Gynecologists. (2017, May 1).
ACOG guidelines at a glance: External cephalic version.
Retrieved from http://www.contemporaryobgyn.net/editors-
choice-cog/acog-guidelines-glance-external-cephalic-version
2. Frye, A. (2013). Holistic midwifery: A comprehensive textbook for
midwives in homebirth practice (2nd ed.). Portland, OR:
Labrys Press.
3. Hanafi, M. (2011). malpresentation [drawing]. Retrieved from
https://www.mamanatural.com/fetal-position/
4. Howland, G. (2018, October 29). Is your baby in this "ideal" fetal
position? Retrieved from
https://www.mamanatural.com/fetal-position/
5. Mama Natural. (2018). [drawing]. Retrieved from
https://www.mamanatural.com/wp-content/uploads/Baby-
Fetal-Position-Left-occiput-anterior-LOA-Mama-Natural-
1480x1906.jpg
6. Sutton, J. (n.d.). Optimal foetal positioning | Babies know how to be
born. Retrieved from http://optimal-foetal-positioning.co.nz/