Fetal Positions For Labor and Birth

Knowing your baby's position can you help ease pain and speed up labor.

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The Fetal Skull

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

In the last weeks of pregnancy, determining the position your baby is in can help you manage discomfort. Knowing your baby's position during early labor can help you manage pain and even speed up the process.

To understand how a baby maneuvers out of the pelvis, it's helpful to learn a bit about the fetal skull. The bones of a baby's skull are not fused. Instead, there are spaces between the bones. Suture lines on the skull indicate where these soft spots, called fontanelles, are located. The spaces allow the bones to overlap as the baby moves through the pelvis in late pregnancy and during labor.

Looking at where the baby's head is in the birth canal helps determine the position. The front of a baby's head is referred to as the anterior portion and the back is the posterior portion.

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Occiput Anterior (OA) and Left Occiput Anterior (LOA)

Left Occiput Anterior
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The Left Occiput Anterior (LOA) position is the most common in labor. In this position, the baby's head is slightly off center in the pelvis with the back of the head towards the mother's left thigh. In general, this position does not lead to problems or additional pain during labor or birth.

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Right Occiput Anterior (ROA)

The Right Occiput Anterior (ROA) presentation is also common in labor. In this position, the back of the baby is slightly off center in the pelvis with the back of the head towards the mother's right thigh. The ROA presentation generally doesn't cause problems or increased pain during labor or birth.

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Left Occiput Transverse (LOT)

When facing out toward 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. If the baby was previously in a posterior (in either direction) position, the LOT position indicates positive movement toward an anterior position.

When a baby is in the Left Occiput Transverse (LOT) position during labor, it may lead to more pain and a slower progression. There are several labor positions a mother can try to alleviate pain and encourage the baby to continue rotating toward an anterior position, including:

  • Lunging
  • Pelvic Tilts
  • Standing and Swaying

These positions open the pelvis and encourage the baby to move into a more favorable presentation for delivery. Your doula, labor nurse, midwife, or doctor may have other suggestions for positions.

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Right Occiput Transverse (ROT)

When the baby is facing outward toward the mother's left thigh, the baby is said to be Right Occiput Transverse (ROT). Like the previous presentation, ROT is halfway between a posterior and anterior position. If the baby was previously in a posterior position, ROT is a sign the baby is making a positive move toward an anterior position.

When a baby is in the ROT position, labor may be more painful and slow to progress. Several positions can help alleviate the pain a mother experiences during labor as well as encourage the baby to continue rotating to an anterior position.

Lunging, pelvic tilts, standing, and swaying are all positions the mother can try to open the pelvis and help the baby move into a more favorable presentation for delivery.

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Occiput Posterior (OP) and Left Occiput Posterior (LOP)

Occiput Posterior
Photo © Lauren Shavell / Design Pics / Getty Images

When facing forward, the baby is in the occiput posterior position. If the baby is facing forward and slightly to the left (looking toward the mother's right thigh) it is in the Left Occiput Posterior (LOP) position. This presentation can lead to more back pain (sometimes referred to as "back labor" and slow progression of labor.

To help prevent or decrease pain during labor and encourage the baby to move into a better position for delivery, mothers can try a variety of positions, including:

Mothers may try other comfort measures, including:

  • Counter pressure
  • Massage
  • Rice Socks (heat packs)
  • Cold packs
  • Bathtub or shower (water)
  • Movement (swaying, dancing, being on a birth ball)
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Right Occiput Posterior (ROP)

Fetal Positions in Labor
Photo © Elizabeth Livermore/Getty Images

In the Right Occiput Posterior position (ROP) the baby is facing forward and slightly to the right (looking toward the mother's left thigh). This presentation may slow labor and cause more pain.

Laboring mothers can try different positions, such as on their hands and knees, in a lunge, or rocking their pelvis, to relieve pain and encourage the baby to continue moving and rotating into a more favorable position for delivery.

Specific comfort measures for easing labor pain include:

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

Prenatal belly check
Photo © MartinPrescott/Getty Images

Leopold's Maneuvers is a series of hands-on examinations your doctor or midwife will use to help determine your baby's position. During the third trimester, the assessment will be done at most of your prenatal visits. Knowing the baby's position before labor begins can help you prepare for labor and delivery.

Once labor begins, a nurse, doctor, or midwife will be able to get a more accurate sense of your baby's position by performing a vaginal exam.

When your cervix is dilated enough, the practitioner will insert their fingers into the vagina and feel for the suture lines of the baby's skull as it moves down in the birth canal.

While practitioners vary in skill when it comes to using these techniques to assess position, it's important to ensure the baby is head down and moving in the right direction. Labor and delivery may be more complicated if the baby is not in a head-down position, such as in the case of a breech presentation.

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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

While exams by health practitioners are an important part of prenatal care as well as during labor and delivery, often the best person to assess a baby's position in the pelvis is the mother.

Mothers should pay close attention to how the baby moves and where different movements are felt.

A technique called Belly Mapping can help mothers ask questions to assess their baby's movement and get a sense of the position they are in as labor approaches.

For example, the position of your baby's legs can be determined by asking questions about the location and strength of the kicking you feel. The spots where you feel the strongest kicks are most likely where your baby's feet are.

Other landmarks you can feel for include:

  • A large, flat plane, which 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 may feel either:

  • a hard, round, shape (most likely your baby's head)
  • a soft curve (most likely to be your baby's bottom)
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