There certainly is an ideal way for baby to lie in the later stages of pregnancy. An optimal position for birthing is a baby who is lying with her head down, and her back towards your front or side. This is the position that is easiest for baby to make her decent during labour and delivery. When baby is lying with her back to yours (posterior), it can mean a longer and slower labour. If your baby is lying with her head up and her bottom down, she is considered to be breech, and your LMC will discuss your options for birthing her.
Just because your baby is breech during parts of your pregnancy, it doesn’t mean she will remain breech right up to the birth. Having said that though, as she gets bigger it does get harder for her to move, so your LMC will be keeping a close eye on your baby’s position over the last few weeks of your pregnancy. It’s often a mystery as to why babies lie in a breech position although there are some factors that make it a higher likelihood including previous breech birth, older maternal age, first time pregnancies and at times the position of the placenta. Suffice to say, it is nothing you have done wrong to cause this, and there is plenty you can do to encourage your baby into her best position for birthing.
Despite your baby’s increasingly cramped quarters, she can still manage some remarkably large movements in those last few weeks of pregnancy. Most babies end up head down by around 36 weeks, although some leave it even later to show which position they are going to settle into. There are plenty of recommendations you can follow to help baby move towards or settle into a good position, and you LMC will be a great source of information and encouragement with this.
The good news is there is a lot you can do to help your baby move, and using gravity is one of them! Be upright, walk and move on your feet and keep as active as you are able throughout your pregnancy. The combination of moving and gravity really helps baby to find her right position. Our current lives often include a lot of time sitting, and especially sitting with your knees higher than or parallel to your hips (think slouchy couches and desk based postures). What this does is tips your pelvis backwards making it less than an ideal angle for baby’s head to descend into, and also creates a greater curve in your lower back. Your baby’s back is quite heavy compared to her limbs, and she will often rest with her spine against yours if you sit like this a lot. This is known as a posterior position, and is also not an ideal birthing position. When you do sit, try and have your hips higher than your knees, and lean forward a little. Sitting on a back turned chair can be both helpful and comfortable right through to the end of pregnancy. Swiss balls can be a good option, but check the size of the ball that you are on – too often we see mothers who are diligently using a Swiss ball that is way too small for them, leaving their hips lower than their knees and poor posture through their lower back. More often than not, you will need a larger ball than you think, not to mention that it has to hold up a little more weight as your pregnancy progresses!
This is a question that is commonly asked by mothers whose baby is are not yet lying in the best position. The short answer in our opinion is no. A baby can become significantly distressed from an attempt to be turned, and in some mothers preterm labor can be initiated; neither of which can be appropriately managed in an osteopathic clinic. There is a good reason why this is considered as a significant medical procedure, and one that requires a high level of experience and monitoring.
The long answer is that osteopathic treatment may help to give baby more space to move freely herself, which may at times result in her moving to a head down position. Areas of tightness through the muscles and ligaments that surround the uterus may create small areas of pressure that is hard for baby to move past; lower rib restrictions limit the amount of space baby has under the ribcage, and pelvic bone alignment issues may create a less than perfect “bowl” for the baby to descend into. An osteopath skilled in pregnancy care can address all of these issues for you, and also give the right take home advice to support your baby to either change position or remain in a good position.
Unfortunately, it is true what they say about scrubbing floors! Spending time on your hands and knees allows for your baby to move away from your spine, and is particularly helpful in avoiding a posterior position for your baby (where their spine is up against yours).
There is a medical procedure known as ECV (External Cephalic Version). Essentially this means an experienced maternity care provider puts her hands on the outside of your belly (external) and attempts to turn the baby into a head down position (cephalic). Usually this is attempted as late as possible in the pregnancy to give baby a chance to turn herself, but not so late that baby has little space to maneuver (often around 37 weeks). More than half of ECVs are successful in turning baby to a head down position, and in doing so significantly reduce the rate of C-section (a common birthing choice for breech babies). ECVs do carry some risk, including distress to the baby, and as such it is performed with fetal monitoring before and after the procedure, and often with ultrasound guidance as well.
Absolutely. Those are all the right things to be doing. What you can’t do for yourself is relieve the tightness and tensions that may be surrounding your pelvis and contributing to baby’s position. Give us a call, we are happy to chat over the phone if you want to sound us out before deciding to come, or our reception team can make an appointment for you directly. We have late nights and Saturday to make things easier for you, and our reception staff are always happy to entertain any toddlers you have with you so you can focus on yourself for a few precious minutes.
This is a great website that has a wealth of information about helping your baby maintain a good position. Take your time to read and understand the ideas and before you know it you may be lying upside down on an ironing board! Spinningbabies.com
This is an article we wrote about how osteopathy can help expectant mothers and newborns, a piece featured in the OhBaby! Magazine. We come across a number of parents who mention they wished they had known about osteopathy earlier, so we wrote this with a view to helping parents know how and when an osteopath may be helpful.
Not so long ago, treating women through their pregnancy and into parenthood was an academic interest of ours, a specialty area of practice that we enjoyed. Then I injured my pelvis late in my first pregnancy (moral of the story is not to jump puddles when one is 8 months pregnant) and it became much more real. The pain was intense, at times debilitating, and to be honest a bit frightening about how I would give birth when I could barely get myself out of bed. I always knew I would have osteopathic treatment to help, I just wanted to try regular maternity services first to see how they worked for me. My Lead Maternity Carer (LMC) gave me a support belt which succeeded in making me hot and uncomfortable, probably more than a little grumpy, but most importantly it didn’t change my pain. What fixed it was a few sessions of osteopathy combined with someone else telling me to slow down, some home exercises and stretches and a lot of frozen peas. This experience changed our academic interest in pregnancy related problems to a real passion. Textbook knowledge of how debilitating SPD can be is very different to being on the end of it, or living with someone with it for that matter!
SPD stands for Symphysis Pubis Dysfunction – quite a mouthful and hence it is usually referred to by its abbreviation. Essentially, it describes some kind of dysfunction or injury to the joint at the front of your pelvis. What it doesn’t do is describe what type of dysfunction or injury has occurred, and therefore a diagnosis of SPD doesn’t in itself tell you what sort of treatment will be helpful. A SPD issue for example that stems from very tight inner thigh muscles that occur as your body adapts to pregnancy, will need a very different approach than a true joint separation and again will be different to a ligament strain of the symphysis itself from a twisting and lifting injury.
Wearing a support belt can be a limited and sometimes completely unhelpful treatment approach for SPD. Where it has its most value, is if the Symphysis Pubis (SP) joint is undergoing true separation due to advancing pregnancy changes, but this only applies to a small percentage of SPD sufferers. The SP joint can twist, strain, develop swelling and inflammation at the muscle attachment sites, be pushed out of alignment by issues at the back of the pelvis, as well as undergo true separation. So a one size fits all solution of wearing a support belt for all forms of SPD simply doesn’t work- the SP can become sore for many reasons and therefore there are many ways of treating this condition. Make sure you don’t settle for a support belt if it isn’t helping, or if it isn’t helping enough. Seek out a practitioner who works regularly with pregnant women, and understands how important it is to help recovery of the SPD not only to reduce daily levels of pain, but to allow for comfortable sleep and birth readiness.
One of the reasons osteopathy is so successful with SPD, is that we check for all the different reasons and areas that can cause SPD, and then treat only the ones that are problematic. To understand this better, it would be worth knowing a little about the anatomy we are talking about. Here is the SP, the front join of your pelvis. Your pain may be centered here, or it may be in your groin, pelvic floor, hips, lower back or in your thighs. There is a little cartilaginous disc in between the bones, ligaments that run above and below the joint, and muscles that attach into the top and bottom surfaces of the joint. It’s important to remember too that the SP joint is only part of the pelvis, and with the two Sacroiliac joints at the back they together make up the pelvic ring. Any shifts or injuries to those joints around the back of the pelvis can cause pain in the SP region that strictly speaking comes from the sacroiliac joints. So you can see that simply adding a tight support belt around your pelvis doesn’t fix all of these issues. For you to get better, you need to have treatment focused on your particular problem and the reason that your SP is in pain.
There are some exercises that are more important than others, and at this point in your pregnancy combined with having SPD, you want to be really picky about which ones you choose to do. There is not normally much energy to spare at this point in the game! A good rule of thumb to stick to is “what feels good is good, and what feels bad is bad.” Please don’t keep doing an exercise that hurts, even if you have read that it is good for you, and equally, trust your body that if you are comfortable lying a certain way or doing a certain exercise then it is ok for you to do. On top of that, DO keep your legs together wherever possible (getting out of bed, sitting to get dressed, swimming freestyle rather than breaststroke), DO engage your abdominal muscles (check with your osteo for help with this if you need), and DO sleep with a pillow between your legs. DON’T squat, run, jump or stride it out when you are walking. And extra pelvic floor exercises is a MAYBE – there are good reasons to improve your pelvic floor control but sometimes this can irritate SPD so please be guided by pain on this one.
Firstly, going in to your upcoming birth without pre-existing pain and disability (how long can you stand, what positions can you labor in etc) is a great start. We want all cards on your side! Secondly, we know that general advice for SPD is to keep your legs together, so it is helpful to get far enough along in your recovery that you can comfortably use all birthing and laboring positions. The other thing to think about is that the SP forms part of the pelvic ring, as we talked about earlier, through which your baby will descend during his or her birth. Any misalignment or swelling from inflammation in the area could potentially reduce the overall size of the pelvic outlet, and its ability to move and stretch as your baby descends.
SPD is very treatable, and successful treatment can make a remarkable difference to your levels of comfort and ability to continue with normal activities. If you have had unsuccessful treatment elsewhere or in previous pregnancies, it does not mean you cannot be helped. Once we work out exactly what is causing the pain for you, then we know how to treat you effectively and what to advise you regarding home exercise and care. We know it can be tricky choosing your treatment providers when you are pregnant; somehow it seems like a much bigger decision when you are growing another wee human!
We take a limited number of new patients each week, and our experienced team would love to help you with SPD and all the other physical complaints that may come with pregnancy.
Try this article of ours featured in OhBaby Magazine for an in-depth look at how and when osteopathy can help you and your growing baby.