back to back presentation in labour

Pregnancy |
Labour and Birth

My baby is back to back – what do I do?

In the weeks leading up to your due date , your baby will be getting into position ready to make their way into the world. The best position for your baby to be in prior to birth is head-down (cephalic presentation), with the back of their head towards the front of your tummy (anterior position). But this isn't always the case. Sometimes babies present bottom first or with the back of their head towards your back (occipito-posterior). The latter is more commonly known as "back to back".

What is a "occipito-posterior" or "back-to-back" position?

A back-to-back position is where your baby's head is down, but the back of their head and their spine is against your spine. At least one in ten babies are back-to-back when labour starts.

Most back-to-back babies are born vaginally, but this position can make labour longer and more difficult.

Back-to-back baby symptoms

If your baby is back-to-back at the beginning of labour, you might feel some of the following things:

• Backache, as your baby's skull is pushing against your spine

• Long and slow labour, with contractions stopping and starting

What happens when you're in labour with a back-to-back baby?

Most back-to-back babies turn to the anterior position during labour. While you're giving birth, the majority of back-to-back babies turn almost 180 degrees when they reach your pelvis.

This can take time, or your baby might decide they don't want to turn around after all, which means they'll come out face-up. You might also need an episiotomy or an assisted birth with forceps or ventouse to help them out. If none of this works, you may possibly need a caesarean section .

Why are some babies back-to-back?

Your baby might be back to back because of the size and shape of your pelvis. If you have a narrow and oval-shaped (anthropoid) pelvis, or a wide and heart-shaped (android) pelvis, your baby is more likely to settle in a back-to-back position.

There is also some evidence to suggest that the way you sit and move during late pregnancy can cause your baby to settle in a back-to-back position. When you're sat down for long periods of time, your pelvis is tipped backwards, which can cause the back of your baby's head (the heaviest part) to swing round to the back due to gravity and they'll end up lying against your spine.

How do you help your baby get into the anterior position?

Some experts think that you can help your baby get out of back-to-back position by adopting certain movements before and during labour. This is known as optimal fetal positioning (OFP). There isn't a whole host of scientific evidence that this will work, but many midwives think it's worth a try and for some women, it works well.

If you'd like to try some OFP techniques, you can have a go at the below positions:

• Adopt a hands-and-knees position for 10 minutes, twice a day.

• Tilt your pelvis forward, rather than back, when you're sitting. Ensure your knees are always lower than your hips.

• Check that your favourite seat or car seat doesn't make your bottom go down and your knees come up. If it does, sit on a cushion to lift up your bottom.

• Move around if your job involves a lot of sitting, and take regular breaks.

• Watch TV leaning forward over a birth ball, or sitting on the ball. If you are sitting, make sure that your hips are higher than your knees.

Other tips from NCT include:

• Sit on a wedge cushion in the car, so your pelvis is tilted forwards

• Use yoga positions, like sitting with your back upright and the soles of the feet together, knees out to the sides

• Sleep on your side, not on your back

• Avoid: deep squats, crossing your legs, sitting with feet raised, leaning back into a sofa or armchair

Try getting used to these positions all the way through your pregnancy, so you'll be well practised for when labour starts.

Lifestyle and parenting blogger Eilidh Wells talks about her experiences having a back-to-back birth with her son Oliver. She hadn't been told that her baby was back-to-back until she was in labour, and she said it helped her to understand where the pain was coming from.

"It was so so painful, but because he was back-to-back I remember thinking this pain feels like somebody is hitting the bottom of my spine with a hammer," she says.

"At one point the pain changed, I still don't know what happened at this point and me and Andy [her partner] thought that maybe he'd turned...and it happened really suddenly," she also says.

How can I improve the chances of anterior position during labour?

You can use the above tips to help turn your baby, although there is little evidence to support the success of the movements, it might help relieve back pain caused by your baby being back-to-back.

You should also try to move around as much as possible, finding the most comfortable position for you. You might find that being on all fours helps, as this means your baby drops away from your spine, alleviating backache.

You could also try knees-to-chest positions, on your knees with your head, shoulders and upper chest on the floor or mattress and your bottom in the air. Lean forwards during your contractions by using a birth ball, beanbag, your partner, or the bed.

Rocking your pelvis during contractions can help your baby turn as they pass through the pelvis. Using a birthing ball is great for pelvic rocking.

Adopting lunge positions, either when standing on one foot, kneeling on one knee, or when you're lying on the bed can help give the baby more room to turn.

Walk or move every now and again. Don't stay sitting in a chair, or on a bed in a leaning-back position, for too long.

Try not to have an epidural or strong labour pain relief too early on in labour if you can, as epidurals may increase the chance of your baby being in a posterior position at birth. Epidurals also increase the likelihood of you having an assisted birth.

My baby's not back to back, but I've got an anterior placenta, should I be worried?

It shouldn't be a worry if your placenta is in the anterior position, it will still nourish your baby, but you might not be able to feel your baby kick as much as you would if your placenta was in a different position.

This is because the placenta provides a cushion between your baby and your stomach. This might also make it more difficult for you to hear your baby's heartbeat.

There can be potential complications with an anterior placenta, although it's not normally a cause for concern. Sometimes if you have an anterior placenta, your placenta can grow down instead of up, towards your cervix.

This could possibly block baby’s way on delivery day and cause bleeding. This condition is known as placenta previa. If the placenta blocks all or a portion of your cervix during labour, a cesarean delivery, commonly known as a C-section, is required.

Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Fetal Positions for Labor and Birth

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

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

Right or Left Occiput Anterior

Illustration by JR Bee, Verywell

Looking at where the baby's head is in the birth canal helps determine the fetal position.The front of a baby's head is referred to as the anterior portion and the back is the posterior portion. There are two different positions called occiput anterior (OA) positions that may occur.

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 toward the mother's left thigh.

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 toward the mother's right thigh.

In general, OA positions do not lead to problems or additional pain during labor or birth.

Right or Left Occiput Transverse

Illustration by JR Bee, Verywell

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 position (in either direction), the LOT position indicates positive movement toward an anterior position.

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 left occiput transverse position (LOT) or right occiput transverse (ROT) position during labor, it may lead to more pain and a slower progression.

Tips to Reduce Discomfort

There are several labor positions a mother can try to alleviate pain and encourage the baby to continue rotating toward an anterior position, including:

Pelvic tilts
Standing and swaying

A doula , labor nurse, midwife , or doctor may have other suggestions for positions.

Right or Left Occiput Posterior

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.

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.

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:

Hands and knees
Pelvic rocking

Mothers may try other comfort measures, including:

Bathtub or shower (water)
Counter pressure
Movement (swaying, dancing, sitting on a birth ball )
Rice socks (heat packs)

How a Doctor Determines Baby's Position

Leopold's maneuvers are 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. 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.

How You Can Determine Baby's Position

While exams by health practitioners are an important part of your care, from the prenatal period through labor and delivery, often the best person to assess a baby's position in the pelvis is you. 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 of themselves 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) or a soft curve (most likely to be your baby's bottom).

Guittier M, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial . BJOG: An International Journal of Obstetrics & Gynaecology . 2016;123(13):2199-2207. doi:10.1111/1471-0528.13855

Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli G. Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy . Biomed Res Int . 2014;2014:1-7. doi:10.1155/2014/638093

Ahmad A, Webb S, Early B, Sitch A, Khan K, MacArthur C. Association between fetal position at onset of labor and mode of delivery: a prospective cohort study . Ultrasound in Obstetrics & Gynecology . 2014;43(2):176-182. doi:10.1002/uog.13189

Nishikawa M, Sakakibara H. Effect of nursing intervention program using abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment . Reprod Health . 2013;10(1). doi:10.1186/1742-4755-10-12

Choi S, Park Y, Lee D, Ko H, Park I, Shin J. Sonographic assessment of fetal occiput position during labor for the prediction of labor dystocia and perinatal outcomes . The Journal of Maternal-Fetal & Neonatal Medicine . 2016;29(24):3988-3992. doi:10.3109/14767058.2016.1152250

Bamberg C, Deprest J, Sindhwani N et al. Evaluating fetal head dimension changes during labor using open magnetic resonance imaging . J Perinat Med . 2017;45(3). doi:10.1515/jpm-2016-0005

Gabbe S, Niebyl J, Simpson J et al. Obstetrics . Philadelphia, Pa.: Elsevier; 2012.

By Robin Elise Weiss, PhD, MPH Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

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Mothers' positions in labour when baby is lying 'back-to-back'

What is the issue?

Malposition is when the back of the baby's head lies towards the mother's back. As a result, labour and birth can be long and difficult, sometimes resulting in an operative birth (where the baby is delivered by caesarean section or with special tools to help the baby through the birth canal) and more perineal trauma (damage to the pelvic floor). The baby may be more likely to go to a neonatal care unit. Also, women may experience stress or disappointment with the birth experience.

Why is this important?

The way a pregnant woman is positioned during labour may help rotate a baby so that the back of the baby's head lies towards the front of the mother's abdomen. This improved position may help the mother and baby have a more normal labour and birth. However, it is not yet known which posture, if any, is effective and when is the best time to use it.

A systematic review of studies of positions (postures) used by women in labour with a baby in a malposition can provide answers on whether the postures improve birth and other health outcomes for mothers and babies. The summary of this review can be used to update clinical practice guidelines.

A Cochrane Review in 2007 reported that the use of the 'hands and knees' posture in labour was ineffective for malposition, but it did reduce labouring women's backache. Since then, more trials have been conducted, some using other postures; these need evaluating to see if those postures work.

What evidence did we find?

We searched for evidence (published to 13 July 2021) and identified eight studies in nine different countries involving 1766 women and their babies. Women in the included studies were either first-time mothers or mothers who had birthed before. All the women's pregnancies were at least at 36 weeks.

The trials compared use of 'hands and knees' posture or 'side-lying' (lateral) postures (lying on the same side as the baby, lying on the opposite side to the baby, and lying semi-prone) to other postures (free posture, lying on back, leaning back, lying on the same side as the baby).

For both the hands and knees posture and side-lying positions during labour, there may be little or no difference in the numbers of operative births, haemorrhage (profuse bleeding of the mother), severe perineal trauma, and women's satisfaction with their labour and delivery, but there was insufficient evidence to be sure. Many of our outcomes of interest were not reported in the included studies.

Overall, we have little to no confidence in the evidence, mainly because there were too few women and babies in the studies, and some studies used unclear methods.

What does this mean?

Overall, it is uncertain whether hands and knees or side-lying positions in labour improve the health of mother and baby when a baby is in a malposition. However, if women find the use of hands and knees, side-lying, or other postures in labour comfortable, there is no reason why they should not choose to use them.

Further research is needed to enable optimal fetal positioning. In particular, further research is needed on variations in the postures, the impact of longer use of these postures during labour, and on long-term outcomes for women and their babies.

We found low- and very low-certainty evidence which indicated that the use of hands and knees posture or lateral postures in women in labour with a fetal malposition may have little or no effect on health outcomes of the mother or her infant. If a woman finds the use of hands and knees or lateral postures in labour comfortable there is no reason why they should not choose to use them. Further research is needed on the use of hands and knees and lateral postures for women with a malposition in labour. Trials should include further assessment of semi-prone postures, same-side-as-fetus lateral postures with or without hip hyperflexion, or both, and consider interventions of longer duration or that involve the early second stage of labour.

Fetal malposition (occipito-posterior and persistent occipito-transverse) in labour is associated with adverse maternal and infant outcomes. Whether use of maternal postures can improve these outcomes is unclear. This Cochrane Review of maternal posture in labour is one of two new reviews replacing a 2007 review of maternal postures in pregnancy and labour.

To assess the effect of specified maternal postures for women with fetal malposition in labour on maternal and infant morbidity compared to other postures.

We searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov , the World Health Organization (WHO) International Clinical Trials Registry Platform ( ICTRP ) (13 July 2021), and reference lists of retrieved studies.

We included randomised controlled trials (RCTs) or cluster-RCTs conducted among labouring women with a fetal malposition confirmed by ultrasound or clinical examination, comparing a specified maternal posture with another posture. Quasi-RCTs and cross-over trials were not eligible for inclusion.

Two review authors independently assessed trials for inclusion, risk of bias, and performed data extraction. We used mean difference (MD) for continuous variables, and risk ratios (RRs) for dichotomous variables, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

We included eight eligible studies with 1766 women.

All studies reported some form of random sequence generation but were at high risk of performance bias due to lack of blinding. There was a high risk of selection bias in one study, detection bias in two studies, attrition bias in two studies, and reporting bias in two studies.

Hands and knees

The use of hands and knees posture may have little to no effect on operative birth (average RR 1.14, 95% CI 0.87 to 1.50; 3 trials, 721 women; low-certainty evidence) and caesarean section (RR 1.34, 95% CI 0.96 to 1.87; 3 trials, 721 women; low-certainty evidence) but the evidence is uncertain; and very uncertain for epidural use (average RR 0.74, 95% CI 0.41 to 1.31; 2 trials, 282 women; very low-certainty evidence), instrumental vaginal birth (average RR 1.04, 95% CI 0.57 to 1.90; 3 trials, 721 women; very low-certainty evidence), severe perineal tears (average RR 0.88, 95% CI 0.03 to 22.30; 2 trials, 586 women; very low-certainty evidence), maternal satisfaction (average RR 1.02, 95% CI 0.68 to 1.54; 3 trials, 350 women; very low-certainty evidence), and Apgar scores less than seven at five minutes (RR 0.71, 95% CI 0.21 to 2.34; 2 trials, 586 babies; very low-certainty evidence).

No data were reported for the hands and knees comparisons for postpartum haemorrhage, serious neonatal morbidity, death (stillbirth or death of liveborn infant), admission to neonatal intensive care, neonatal encephalopathy, need for respiratory support, and neonatal jaundice requiring phototherapy.

Lateral postures

The use of lateral postures may have little to no effect on reducing operative birth (average RR 0.72, 95% CI 0.43 to 1.19; 4 trials, 871 women; low-certainty evidence), caesarean section (average RR 0.78, 95% CI 0.44 to 1.39; 4 trials, 871 women; low-certainty evidence), instrumental vaginal birth (average RR 0.73, 95% CI 0.39 to 1.36; 4 trials, 871 women; low-certainty evidence), and maternal satisfaction (RR 0.96, 95% CI 0.84 to 1.09; 2 trials, 451 women; low-certainty evidence), but the evidence is uncertain. The evidence is very uncertain about the effect of lateral postures on severe perineal tears (RR 0.66, 95% CI 0.17 to 2.48; 3 trials, 609 women; very low-certainty evidence), postpartum haemorrhage (RR 0.90, 95% CI 0.48 to 1.70; 1 trial, 322 women; very low-certainty evidence), serious neonatal morbidity (RR 1.41, 95% CI 0.64 to 3.12; 3 trials, 752 babies; very low-certainty evidence), Apgar scores less than seven at five minutes (RR 0.25, 95% CI 0.03 to 2.24; 1 trial, 322 babies; very low-certainty evidence), admissions to neonatal intensive care (RR 1.41, 95% CI 0.64 to 3.12; 2 trials, 542 babies; very low-certainty evidence) and neonatal death (stillbirth or death of liveborn) (1 trial, 210 women and their babies; no events).

For the lateral posture comparisons, no data were reported for epidural use, neonatal encephalopathy, need for respiratory support, and neonatal jaundice requiring phototherapy. We were not able to estimate the outcome death (stillbirth or death of liveborn infant) due to no events (1 trial, 210 participants).

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Tips: how to get your back-to-back baby into position for birth

Read time 3 minutes

If your midwife’s said your baby is back-to-back, there’s still a big chance that they’ll move. In the meantime, here are some ideas to help them shift…

While there’s definitely no right or wrong position for your baby to hang out in in your womb, labour’s definitely easier if they’re facing a certain way. That’s head down, with their tummy facing your back.

Some babies though will lie with their back against your back, known as being in the ‘occiput posterior’ (OP) position.

"If they’re in that position, giving birth tends to take longer – words no-one wants to hear. It’s because your baby can’t tuck their chin in so easily and that makes getting through the pelvis more awkward."

Giving birth to a back-to-back baby can also give you backache while you’re in labour (Simpkin, 2010; RCM, 2012) .

Here are some tips to help during pregnancy.

1. Lean forward

Forward-leaning positions, like getting on all fours, have often been recommended. There’s no evidence that this can help turn your baby but it can reduce any backache that you’re suffering because of the baby’s position (Hunter et al, 2007) . So it’s definitely worth a go.

It can also be helpful in the first stages of labour to ease backache (Guittier et al, 2016) .

2. Don’t panic

In the end, your baby is very likely to end up in the occiput anterior position – one of the best positions. Only five to eight of every 100 babies end up back-to-back with you anyway (Tommy’s, 2016) . So try not to worry too much.

3. Get into positions where your pelvis and belly tilt forwards

Some ways to do that are:

Sit upright on a chair making sure your knees are lower than your pelvis and your torso is slightly tilted forwards.
Sit on a swiss ball.
Watch your favourite Netflix show while kneeling on the floor, over a beanbag or cushion or sit on a dining chair.
Use yoga positions, like sitting with your back upright and the soles of the feet together, knees out to the sides.
Sit on a wedge cushion in the car, so your pelvis is tilted forwards.
Sleep on your side, not on your back.
Swim with your belly downwards.
Any exercises that you do on all fours can be helpful too.

(Sutton and Scott, 1996; Andrew, 2010)

4. Avoid certain positions:

Sometimes you won’t be able to but if you can, ditch:

deep squats
crossing your legs
sitting with feet raised
leaning back into a sofa or armchair.

This page was last reviewed in August 2018.

Further information.

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

Andrew CG. (2010) Considering non-optimal fetal positioning and pelvic girdle dysfunction in pregnancy: increasing the available space. Journal of Clinical Chiropractic Pediatrics. 11(2):783-788. Available from: http://jccponline.com/jccp_v11_n2.pdf [Accessed 13th August 2018]

Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. (2016) Maternal positioning to correct occiput posterior position during the first stage of labour: a randomised controlled trial. BJOG. 123;2199-2207. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132127/ [Accessed 13th August 2018]

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev.(4):CD001063. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001063.pub3/full [Accessed 13th August 2018]

RCM. (2012) Evidence based guidelines for midwifery-led care in labour: persistent lateral and posterior fetal positions at the onset of labour. Available from: https://www.rcm.org.uk/sites/default/files/Persistent Lateral and Posterior Fetal Positions at the Onset of Labour.pdf [Accessed 13th August 2018]

Simkin P. (2010) The fetal occiput position: state of the science and a new perspective. Birth. 37(1):61-71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20402724 [Accessed 13th August 2018]

Sutton J, Scott P. (1996) Understanding and teaching optimal foetal positioning. Tauranga: New Zealand.

Tommy’s (2016) Getting your baby into the best birth position. Available from: https://www.tommys.org/pregnancy/labour-birth/baby-best-position-birth [Accessed 13th August 2018]

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All of our articles have been thoroughly researched and are based on the latest evidence from reputable and robust sources. We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities.

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What to know about baby’s position at birth

Having a baby is an exciting time, but it’s common to have some worries about labor and delivery. One thing that often causes mums-to-be concern is what position their baby will be in when the time comes for them to be born.

For a vaginal delivery, the baby must descend through the birth canal, passing through your pelvis to reach the vaginal opening. The position of the baby - or presentation of the fetus as it is also known - affects how quickly and easily the baby can be born. Some positions allow the baby to tuck their chin, and re-position and rotate their head to make their journey easier.

Here’s a guide to help you understand the language used to describe the position of babies and some tips for helping them into the ideal position for birth.

Position of the baby before birth

During pregnancy your baby has room to move about in your uterus or womb - twisting, turning, rolling, stretching and getting in some kicks. As your pregnancy progresses and they grow bigger there’s less room for them to move, but your baby should still move regularly until they are born, even during labor.

Sometime between 32 and 38 weeks of pregnancy, but usually around week 36, babies tend to move into a head down position. This allows their head to come out of your vagina first when they are born. Only about 3 to 4 percent of babies do not move into a head-first or cephalic presentation before birth.

What’s the ideal position of a baby for birth?

Occiput anterior is the ideal presentation for your baby to be in for a vaginal delivery.

Occiput anterior is a type of head-first or cephalic presentation for delivery of a baby. About 95 to 97 percent of babies position themselves in a cephalic presentation for delivery, often with the crown or top of their head - which is also known as the vertex - entering the birth canal first.

Usually when a baby is being born in a vertex presentation the back of the baby’s head, which is called the occiput, is towards the front or anterior of your pelvis and their back is towards your belly. Their chin is also typically in a flexed position, tucked into their chest.

Occiput anterior is the best and safest position for a baby to be born by a vaginal birth. It allows the smallest diameter of a baby’s head to descend into the birth canal first, making it easier for the baby to fit through your pelvis.

What other positions are babies born in?

Sometimes babies don’t position themselves in the ideal position for birth. These other positions are called abnormal positions. Listed below are the abnormal positions or presentations that some babies are born in.

Occiput posterior or back-to-back presentation

Occiput posterior position or back-to-back presentation occurs when the occiput - back of a baby’s head - is positioned towards your tailbone or back during delivery. Sometimes this presentation is also called “sunny side up” because babies born in this position enter the world facing up. About 5 percent of babies are delivered in the occiput posterior position.

Babies presenting in the occiput posterior position find it harder to make their way through the birth canal, which can lead to a longer labor. This presentation is three times more likely to end in a cesarean section (c-section) compared with babies presenting in the ideal, occiput anterior presentation.

Breech presentation

A breech presentation occurs when your baby’s buttock, feet or both are set to come out first at birth. About 3 to 4 percent of full-term babies are born in a breech position.

There are three types of breech presentation including:

Frank breech. Frank breech is the most common breech presentation, occurring in 50 to 70 percent of breech births. Babies in the Frank breech position have their hips flexed and their knees extended so that their legs are folded flat against their head. Their bottom is closest to the birth canal.
Footling or incomplete breech. Footling or incomplete breeches occur in 10 to 30 percent of breech births. An incomplete breech presentation is where just one of the baby’s knees is bent up. Their other foot and bottom are closest to the birth canal. In a footling breech presentation, one or both feet may be delivered first.
Complete breech. A complete breech presentation is less common, occurring in 5 to 10 percent of breech births. Babies in a complete breech position have both knees bent and their feet and bottom are closest to the birth canal.

A breech delivery can result in the baby’s head or shoulders becoming stuck because opening to the uterus (cervix) may not be stretched enough by the baby’s body to allow the head and shoulders to pass through. Umbilical cord prolapse can also occur. This is when the cord slips into the vagina before the baby is delivered. If the cord is pinched then the flow of blood and oxygen to the baby can be reduced.

If an exam reveals your baby is sitting in a breech position and you’re past 36 weeks of pregnancy then external cephalic version (ECV) might be attempted to improve your chances of having a vaginal birth. ECV is performed by a qualified healthcare professional and it involves them pressing their hands on the outside of your belly to try and turn the baby.

Most babies found to be in a breech position are delivered by c-section because studies indicate that a vaginal delivery is about three times more likely to cause serious harm to the baby.

Brow and face presentations

Babies can also arrive brow- or face-first. A brow presentation results in the widest part of your baby’s head trying to fit through your pelvis first. This is a rare presentation, affecting about 1 in every 500 to 1400 births.

Instead of flexing and tucking their chin, babies presenting brow-first slightly extend their head and neck in the same way they would if they were looking up.

If your baby stays in a brow presentation it’s highly unlikely that they will be able to make their way through your pelvis. If your cervix is fully dilated then your doctor may be able to use their hand or ventouse - a vacuum cup - to move your baby’s head into a flexed position. If there are signs that your baby is becoming distressed or labor isn’t progressing then a c-section may be recommended.

More than half of the babies presenting brow-first, however, flex their head during early labor and move into a better position that allows labor to progress. Although, some babies tip their head back further and present face-first.

A face presentation is another rare position for a baby to be born in, occurring in only 1 in every 600 to 800 births.

Almost three quarters of babies presenting face-first can be delivered vaginally, especially if the baby’s chin is near your pubic bone, although labor may be prolonged.

Some baby’s presenting face-first may need to be delivered by c-section, particularly if their chin is near your tailbone, your labor is not progressing or your baby’s heart rate is causing concern.

Shoulder presentation

If your baby is lying sideways across your uterus - in a transverse lie - their shoulder can present first. Shoulder presentation occurs in less than 1 percent of deliveries. Virtually all babies in a shoulder presentation will need to be delivered by c-section. If labor begins while the baby is in this position then the shoulder will become stuck in the pelvis and the labor will not progress.

What factors can influence the position of my baby?

A number of factors can influence the position of your baby during labor and delivery, including:

If you have been pregnant before
The size and shape of your pelvis
Having an abnormally shaped uterus
Having growths in your uterus, such as fibroids
Having placenta previa - the placenta covers some or all of the cervix
A premature birth
Having twins or multiple babies
Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid
Abnormalities that prevent the baby tucking their chin to their chest

How do I tell what position my baby is in?

Your midwife or your obstetrician-gynecologist (OB-GYN) should be able to tell you the position of your baby by feeling your belly, using an ultrasound scan or conducting a pelvic exam.

You might also be able to tell the position of the baby from their movements.

If your baby is in a back-to-back position your belly may feel more squishy and their kicks are likely to be felt or seen around the middle of your belly. You may also notice that instead of your belly poking out there is a dip around your belly button.

If your baby is in the ideal occiput anterior presentation you’re likely to feel the firm, rounded surface of your baby’s back on one side of your belly and feel kicks up under your ribs.

How do I get my baby into the best position for birth?

Here are some tips to try to encourage your baby to engage in the ideal position for birth:

Remain upright, but lean forward to create more space in your pelvis for your baby to turn.
Sit with your back as straight as possible and your knees lower than your hips. Placing a cushion under your bottom and one behind your back may make this position more comfortable. Avoid sitting with your knees higher than your pelvis.
When you read a book, sit on a dining room chair and rest your elbows on the table. Lean forward slightly with your knees apart. Avoid crossing your knees.
If pelvic girdle pain is not an issue, try sitting facing backwards with your arms resting on the back of a chair.
Watch TV kneeling on the floor leaning over a big bean bag.
Go for a swim.
Sit on a birth ball or swiss ball - they can be used both before and during labor.
Lie down on your side rather than your back. Place a pillow between your knees for comfort.
Try moving about on all fours. Try wiggling your hips or arching your back before straightening your spine again.
During Braxton Hicks (practice contractions), use a forward leaning posture
During contractions, stay on your feet, lean forwards and rock your hips from side to side and up and down to get your bottom wiggling as you walk

Remember to attend your antenatal appointments and contact your midwife or OB-GYN if you have any questions or concerns about the position of your baby.

Article references

MedlinePlus . Your baby in the birth canal. Available at: https://medlineplus.gov/ency/article/002060.htm . [Accessed May 19, 2022].
NHS Inform. How your baby lies in the womb. August 17, 2021. Available at: https://www.nhsinform.scot/ready-steady-baby/labour-and-birth/getting-ready-for-the-birth/how-your-baby-lies-in-the-womb . [Accessed May 19, 2022].
The American College of Obstetricians and Gynecologists (ACOG). If Your Baby is Breech. November 2020. Available at: https://www.acog.org/womens-health/faqs/if-your-baby-is-breech . [Accessed May 19, 2022].
MedlinePlus. Breech - series - Types of breech presentation. March 12, 2020. Available at: https://medlineplus.gov/ency/presentations/100193_3.htm . [Accessed May 19, 2022].
Medscape . Breech Presentation. January 20, 2022. Available at: https://emedicine.medscape.com/article/262159-overview . [Accessed May 19, 2022].
Physicians & Midwives. Which Way is Up? What Your Baby’s Position Means for Your Delivery. November 15, 2012. Available at: https://physiciansandmidwives.com/what-your-babys-position-means-for-delivery/ . [Accessed May 19, 2022].
BabyCentre. What is brow presentation? Available at: https://www.babycentre.co.uk/x564026/what-is-brow-presentation . [Accessed May 19, 2022].
NCT. Bay position in the womb before birth. Available at: https://www.nct.org.uk/labour-birth/getting-ready-for-birth/baby-positions-womb-birth . [Accessed May 19, 2022].
NHS Forth Valley. Ante Natal Advice for Optimal Fetal Positioning. 2020. Available at: https://nhsforthvalley.com/wp-content/uploads/2014/01/Ante-Natal-Advice-for-Optimal-Fetal-Positioning.pdf . [Accessed May 19, 2022].

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Image of a woman and her baby at 32 weeks of pregnancy

Parenting , Pregnancy

The truth about ‘back to back’ birth

*This article was originally published in April 2015. It is my most read article to date, frequently appearing at the top of my analytics. I’m re-sharing this on that basis*.

Before having children I had only ever heard a couple of references to ‘ back to back birth ‘. These were vague and pretty much just about where contractions are felt during a labour, where the baby is lying on the mother’s spine. Phrases like ‘back contractions’ and the description of the location of the pain being ‘all in the back’ were used.

I never gave it much thought.

I filed it away safely at the back of my mind along with the description of newborn poo and the fact that the car park machine at the hospital required several £1 coins.

I knew that in order to prevent a back to back delivery, I needed to get my baby into the ‘optimal’ birth position and well, I had been swimming; in the gym; taking aqua natal sessions and pregnancy yoga so I had this optimal birth position thing nailed right anyway?

Baby number 1

My first baby was two weeks late and following multiple sweeps and several goes at induction , labour spanned the best part of four days and resulted in a very tightly wedged back to back baby that had to be dragged out with forceps.

Baby number 2

A breeze in comparison to the first – not easy, as I would never describe giving birth as being easy, 9 days late and a sweep later he finally got moving and was born in water .

Baby number 3

Now, clearly I was hoping things would be getting easier, or at least that this would resemble baby 2’s arrival, more than baby 1’s. 12 days late and three sweeps later, nothing. Received a date for induction which seemed to frighten me into action. One very long, drawn out labour later, another tightly wedged back to back baby arrived, narrowly avoiding the need for forceps.

Baby number 4

I knew this would be the last baby, so was clearly once again hoping for the relaxed, hypnobirth in water . Baby had other ideas and decided to be 12 days late just like his brother. This time five sweeps and lots of trampolining didn’t move anything and I ended up being induced again. Another back to back baby started coming quickly and then got stuck and delayed things somewhat in the latter stages of labour, causing some concern, before eventually making an appearance, thankfully without the forceps.

I lost count of the number of people who told me after my first baby that they would all “fly out” or that I would only be in labour for 30 minutes. That’s just not how I have my babies clearly, they like to make me work hard for them.

I can tell you that a back to back labour is hard work. It can last a very long time and you can feel you make very little progress for all your hard work. A baby is in the ‘back to back’ or ‘occipito-posterior’ (OP) position when he/she is lying head down but instead of the back facing frontwards it faces the mother’s back. About 10% of labours involve babies in the ‘back to back’ position and in over half of these cases the baby will turn around naturally. None of mine did.

If you have a back to back baby you might be asked if you lounged on the sofa a lot, as this can cause the baby to go into that position. That couldn’t have been further from the truth with me, I’m not exactly a lounging on the sofa kind of person, quite the opposite. So not only will you be tackling a back to back birth, but you might also be fighting off disapproving and unwarranted comments.

A back to back baby might mean that the head does not engage fully; it might mean you have a longer early labour phase ; you might have a longer pushing stage; you might feel the bulk of your pain in your back – for me it was in my back and the tops of my legs. Leaning forward helped hugely, as did having the TENS machine on my back, and firm pressure being applied to the base of my spine gave some relief as well.

With this type of birth you are more likely to tear, more likely to need an assisted delivery and more likely to have a birth that ends in in a c-section, BUT this is not always the case. I had an episiotomy with my first baby, only 5 stitches with my water birth, and then quite a substantial tear with both the following back to back births, but nothing that didn’t mend pretty quickly. Out of three back to back births, only one of them was assisted and I managed with Gas and Air with all of them.

It can be done, it doesn’t feel like it at the time, but it can be. It was without a doubt the most pain I have every experienced, and each time I said “never again”.

If you’ve been told your baby is back to back don’t panic. There is lots of time for the baby to turn before labour and if they don’t you can still do it. There were a few concerned looking faces during my last two births but I was so determined to get my babies out without forceps that I eventually started to shift them in the right direction.

Good luck and trust your body! It will all be worth it.

This article contains affiliate links.

Charlotte Camplejohn

Mum of four active children. Lover of skiing, marathons, kettle bells, family walks, random acts of kindness, movie nights, green tea and dark chocolate.

18 comments

Two out of my five were back to back and I had natural deliveries with just gas and air and no stitches either. The pain was very different to my other three labours, it was all in my back and bum but still no more painful than the others really? I think that there is such a fear of back to back babies when actually, your body just does what it is supposed to!! Thanks for sharing! #sharewithme

Yes exactly – it’s manageable isn’t it but very different. Thanks for sharing your experience !

Oh just reading this makes me hold my breathe. I won’t say I can relate I have heard so much about back to back labor being the hardest and toughest labors. You are so strong and brave to go through it four times. Mother of steel I call you. While I think I am a big wimp and couldn’t handle that I had my babies both very quickly so I think the big man upstairs knew I was a wimp and helped. You really did work hard for your babies darling. 🙂 Impressive. Thank you so much for linking up to Share With Me blog hop. I hope to see you again this week for another great round. #sharewithme

Ah thanks Jenny – they certainly made me work for them. I guess everyone gets a unique experience and mine were just never going to come easily x

My daughter was born back to back it was a hard dilivery and I pained for my wife, my little girl was finally born after a hard labour but had a lot of bruising and 2 black eyes we also had to go back a few days later as she was jaundace I would never wish this on any other expectant mother child birth is hard enough without all the extra problems I tilt my hat to you after having 4 x

Sounds very similar to my first. Not straight forward is it. So traumatic for everyone.

Both my girls were back to back, with my first I had very poor midwife care and was kept on my back with feet up in stirrups!!! Pushing for over an hour before forceps delivery in theatre 🙁 but with second I was determined to have minimal intervention and got to hospital only an hour before delivery! 🙂 which was waterbirth with only small tear. It can be done without intervention but good midwifery care plays big part. Midwives at hospital I had my second were amazing! They also explained to me that some ladies just have pelvises that have back to back babies and also having a toned tummy can also encourage back to back baby! Far from lounging on sofa!! 😉

Thanks for sharing your experience Anna – the stirrups are familiar as that happened with my first and third. You are right about the pelvis too I’m sure, I think mine were always going to be that way by preference lol. Sounds as if you had a much better experience second time around which is so great to hear 🙂

My last baby was back to back with his hand and shoulder presenting first. I hadn’t even heard of it before till I was in labour and was getting contractions in my back. Let’s just say it was an interesting experience. I managed it naturally with gas and hair but after that experience said never again. Fair play to anyone that goes back for more. Interestingly though tearing I had the best post birth experience with him and feel I recovered quite quickly. It can be done with the right midwife helping you out.

I had a back to back labour with my first and that’s why 5 yrs later she’s still my only child haha. http://www.earningbythesea.co.uk

My last delivery was back to back and it was the worst. I thought something was wrong because there was no break in pain, just waves of even worse pain and it was all in a different place. I really want another baby but I’m too scared since the last delivery and it’s been 2 years!

Easy labour ! No such thing – never knew if you ” lounged” you are more likely to have a back to back Great read

I know – apparently that’s a ‘thing’

My first baby was back to back. I was told I was fully dilated but baby was very high up and they were worried about a cord prolapse if my waters burst. After being put on a drip to speed things up she was born 6 hours after being told I was fully dilated weighing 9lb. I had gas and air and pethidine. Sadly I was rushed straight off to theatre after she was born. I had torn very badly. I even needed more surgery when she was a year old because of the scar tissue. I did ‘lounge’ a lot in late pregnancy as my back was in bits and I was signed off work weeks early. I was a lot bigger with my son but he was not back to back and I didn’t have the excruiating back pain in late pregnancy.

Oh gosh sounds traumatic! They certainly make us work for them these babies!

I can concur back birthing is painful and needs good or experienced midwives. Mine was with my first and it’s a relentless pain, I opted for epidural but it slowed everything down and in the end gave birth with gas and air, that was the most pain free part!! Hoping it will be a normal delivery this time….!!

All 3 of my babies were back to back (or face to pubes as one no nonsense midwife put it). Long hard labours definitely. No forceps or vacuum but a lovely episiotomy and plenty of stitches. Getting cut had been my worst fear but after 24 hours it was that or emergency c section. Quick snip and 3 minutes later my beautiful bruised 7lb 11 son shot out. Years later when I was getting coil fitted my GP remarked that I have a tilted womb which probably explained the back to back births. Only advice…poo before you push! Oh and the other 2 were 8lb 12 and 9lb 4 (the babies, not the poos)! ?

Very interesting reading this as I had a back to back birth with my first but it wasn’t until she came out face up that the midwives realised. She was a bit bashed and I tore a bit. It was a long painful birth I think it helped that she was only small 5 1bs. I still had no idea exactly what had happened, so fortunately I had no worries about my next 2 pregnancies as no one discussed it with me at all. my second was quicker but a bit traumatic as his shoulders got stuck (he is 30 now but still struggles to get non stretchy tops over his head and fasten shirts at the neck). The third was in a hurry so only 2 hours from waking up to giving birth but cord around his neck and I went into shock ( that was the only time in his life that he has ever been in a hurry to do anything). Even though it was 32 years ago that I gave birth to my daughter it helps knowing a bit more about it. So thanks to everyone for their experiences.

MYTH: It is important to know the fetal position.

Penny Simkin lists this myth in her talk about What We Don’t Know About the OP Baby. Midwives have been debating the importance of fetal position — gently — for years. And I agree this is a myth.

Gail’s thought: Finding a solution for a non-progressing labor can occur without knowing the fetal position.

The muscles, ligaments and pelvic diameters may need accommodation in a slow, or a painful, labor regardless of fetal position. In other words, tension in the psoas pair of muscles or pelvic floor can delay an anterior baby and a posterior baby. Extension of the anterior baby’s head can prevent engagement in some pelvises. The main point is that we can, when needed, promote progress regardless of fetal position.

MYTH: If we prevent OP before labor than we can prevent OP in labor

To answer this question correctly we would have to study 2nd trimester prevention exercises among one group of women with no prevention methods in another group. Why? Because while most babies that start labor in an OP position will rotate to OA before the end of labor, there is a consistent small group of babies who are OP throughout labor.

These need Spinning Babies ® . But how do we identify this group? Why not help the other mothers, too?

The point I’m making is, that just because most OP babies rotate to OA (about 87%, according to Gardberg), we shouldn’t ignore the 15% (Lieberman) who are OP when they are born, either vaginally or via cesarean .

MYTH: If the baby is Occiput Anterior (OA, the “best” starting position) in early labor the baby will stay in a good position throughout labor.

The recent Lieberman study confirmed statistical trends of earlier studies. 83% of the OA babies who were OA in early labor were OA when they came out. But a small 5.4% rotated to a direct Occiput Posterior position for birth.

MYTH: Midwives and Doctors can tell the baby’s position.

While this is sometimes truth, in reality sometimes we can and sometimes we can’t. There are three common ways a baby’s position is sought:

By hands-on palpation, or feeling the abdomen. The bumps in the belly mean something to a practiced hand. The problem is in the variation of bellies and bumps. Sometimes they don’t make a picture that the person feeling can make out. Bellies come in different thicknesses. Babies sometimes are curled up in interesting ways. Lots of amniotic fluid or muscle strength can hide details that might be needed to “see” the position.
Feeling inside, through the open cervix, sometimes gives clues. But the little sutures (not stitches, but lines showing where the skull bones meet) can be just out of reach or the edge of the soft spot (fontanel) can feel like a suture, oddly enough. Feeling babies position is not as simple as it looks in the books or on the plastic chart some hospital labor and delivery units have.
Ultrasound can tell the baby’s position. Funny we rely so wholeheartedly on technology. We are looking through dark water to see a 3-D person displayed on a 2-D computer screen. There can be blurred pictures of the crucial landmarks of the baby’s head or the viewer can make a mistake.

Dr. Karen Davidson, the ultrasound sonologist for the Lieberman group studying 1,766 women in labor (see a discussion on this interesting study by clicking on a link below), found she had to exclude 162 women because their ultrasound pictures were uninterpretable. In the first six-months of the study she found 13% of early labor ultrasounds were uninterpretable. She got really good at it as the study went on, but she was their expert to begin with, so I would think her early rates must be at least on par with the nation’s ultrasound interpreters.

Of the 1,562 births remaining in the Lieberman study, 51% had an interpretable ultrasound picture in late labor. That means 49% didn’t. I don’t think we can hang our hats on ultrasound. And furthermore, how the baby’s back is situated doesn’t always tell us how the head is facing.

MYTH: Back pain is a sign of an Occiput Posterior (OP) baby.

Some women in each of these categories are likely to get some back pain in labor:

Short women
Women who aren’t flexible
Women who’ve had accidents
Women who have weak back muscles
Some of the women with posterior babies or babies who have one of their arms up in late labor

The women with OP babies in early labor (3 to 4 cm mostly) enrolling in the Lieberman study did not report more back pain at 3-4 cm dilation. As a doula of women with and without epidural pain relief, many without, I have noted that OP back pain, when it does come, often comes between 4 and 6 cm.

Some women have relatively straightforward OP labors if we are still permitted to call laborers by the fetal position name. These women often do not report back pain at an intensity to get attention. Some have no more labor pain in their backs than they do in the front. A few women have severe back pain early in labor, at 2 cm. These women are candidates for inversion as soon as possible if they are up for it. Back pain is more about the fit of the baby than the position. Some posterior babies fit their mother’s pelvises better than others.

MYTH: When a woman is having prolonged labor without back pain, it is from a reason other than a posterior position.

Oh, thank you, Penny, for bringing this myth to our attention. I can’t list the times a midwife, doula or nurse has told me their frustration at not being able to think of a labor progress trick to help a woman in a long labor. They often say something quite close to this, “I thought of the Open-Knee Chest position (or another technique) but didn’t try it because she didn’t have back pain. While the cesarean was being done, the doctor said the baby was posterior and that’s why the baby wasn’t coming through the pelvis.”

A delay or a stall in labor, with or without back pain can often be corrected by one form of inversion or another. Check out Labor Progress and more technical information here .

Back pain, with or without a stall in labor, may also be soothed by inversion.

Sometimes back pain is from a spasm in a ligament low in the back of the uterus, such as the ligament holding the cervix to the sacrum. Inversion gives that ligament a gentle stretch and then when the mom gets up the ligament can relax. Ahhh.

There are some protective guidelines about inversion. See the article and ask your care provider: “Is there a medical reason not to do it?” This great little question also comes to us via Penny Simkin.

There is new research on a stall in the progress of dilation during the active phase of labor . In his study, California researcher Aaron Caughey found patience reduces cesareans by 1/3 (400,000 a year).

MYTH: Position changes can change the OP position in the labor

This hasn’t been studied like I’d like to it to be studied. The studies aren’t designed in a way that will answer anything, but regardless, 30 minutes of position changes are not enough to overcome the tension in the womb holding the baby in an unfavorable position.

These studies are why I developed the The Three Principles of Spinning Babies ® .

First, you have to relax the involuntary muscles, and release tension or torsion in the muscle fibers and fascia making up the uterine ligaments. Second, you get gravity helping and third, move the pelvis in ways that open the level of the pelvis that the baby’s head is resting at.

If the head is stuck at the brim, you don’t open the bottom of the pelvis, for instance, and wonder why squatting works for some women and not for others. If your front doorbell rings, do you open the back door and wonder where your company is at?

Pelvic shape and size do have an effect on the course of posterior labor in a small percentage of women. A pelvic shape which is longer front to back allows a few women to have a posterior baby without back labor, as long as there isn’t another reason for backache, like a muscle spasm.

A pelvic shape which is triangularly (once called an android pelvis) can make it hard for a larger, posterior baby to fit through. A woman with a smaller than average android pelvis will need to, in my observations, eat carefully to get good protein and vegetables without a lot of sweets and white bread. Baby’s position is considered more important in the 2nd Trimester so baby can come into the brim months later from the left side, especially if in a first-birth or first vaginal birth. This may help avoid the scenario I have often seen of trying to help a large OP baby to turn around at 8 months to get settled into position for birth.

The baby’s back shifts right and left and right again, trying to turn his little forehead out of the narrow pointy space at the mother’s pubic bone. But the pelvis isn’t round so he can’t. He’ll have to come up and out, away from the brim to turn. He can only do that if the mom relaxes her ligaments, and gets upside down a bit each day.

It isn’t always comfortable, of course, to be 8 months pregnant and hang upside down for a minute. And even then, some of these moms need bodywork to overcome the muscle spasms in their round or broad ligaments. It’s much easier to do at 4 and 5 months pregnant. Even 6 months. If these few OP babies aren’t able to navigate their mother’s pelvic brim, they will have to be born by cesarean. The problem is that few people, and I mean providers, can tell who will be the one that gets stuck and who will be the one to get through.

Someone with a round pelvic brim has a much better chance of experiencing their posterior baby rotate in labor. Depending on various factors, like eating in labor, keeping hydrated, leaning forward, being patient, resting belly down (somewhat), avoiding positions on her back, having her water broke or an epidural that increases the likelihood of a challenge with the labor (length, vacuum or surgery), baby may come around readily or only eventually. A long labor can soften up tight spots on the route out.

The pelvic shape isn’t the only consideration, of course. The soft tissues are more often the case, especially when they aren’t soft at all! Remember, a pelvis shape isn’t a pelvic type . Learn more about the racist roots of name calling the pelvis by typing the pelvic according to racial heritage. And at the same time, consider the personal environment of the baby you are caring for (as provider or parent) and their needs for engagement, rotation, and descent through the pelvis they get to be born through!

The OP fetus: How little we know , Penny Simkin
Changes in Fetal Position During Labor and their Association with Epidural Analgesia , Ellice Lieberman et al.
Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries, M Gardberg et al.
Human Labor and Birth , Oxorn and Foote
Holistic Midwifery, Vol II , Anne Frye
Labor Progress Handbook , Penny Simkin and Ruth Ancheta

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What Is Back Labor and How Do You Deal With It?

Medical review policy, latest update:, what is back labor, what causes back labor pains, read this next, what does back labor feel like, signs of back labor, when to go to the hospital with back labor, back labor vs. back pain: how can you tell the difference, back labor vs. regular labor, are there risk factors for back labor, is back labor more harmful than regular labor, how can i prevent back labor pain, what can i do to relieve back labor pain.

Though back labor can be quite painful, the good news is it will be over as soon as you've given birth. And once you see your beautiful new baby, the pain will seem well worth it.

What to Expect When You're Expecting , 5th edition, Heidi Murkoff. WhatToExpect.com, Breech Position: What It Means if Your Baby Is Breech , February 2021. WhatToExpect.com, When to Go to the Hospital if You Think You’re in Labor , March 2022. WhatToExpect.com, What Are the Stages of Labor and How Long Does Labor Last? , September 2021. WhatToExpect.com, Labor Contractions , December 2020. WhatToExpect.com, Signs of Labor , August 2021. WhatToExpect.com, Forceps Delivery , April 2022. American College of Obstetricians and Gynecologists, How to Tell When Labor Begins , November 2021. American College of Obstetricians and Gynecologists, If Your Baby Is Breech , November 2020. American College of Obstetricians and Gynecologists, Medications for Pain Relief During Labor and Delivery , January 2021. American College of Obstetricians and Gynecologists, Safe Prevention of the Primary Cesarean Delivery , 2019. American College of Obstetricians and Gynecologists, Back Pain During Pregnancy , December 2021. BMC Pregnancy and Childbirth , Maternal Positioning to Correct Occipito-Posterior Fetal Position in Labour: A Randomised Controlled Trial , February 2014. Cochrane, Sterile Water Injections for the Relief of Pain in Labour , January 2012. Cleveland Clinic, Fetal Positions for Birth , March 2020. Mayo Clinic, Labor Induction , May 2022. Mayo Clinic, Vacuum Extraction , August 2020. Mayo Clinic, Fetal Presentation Before Birth , August 2020. Merck Manual, Abnormal Position and Presentation of the Fetus , July 2021. National Institutes of Health, National Library of Medicine, Persistent Occiput Posterior Position - OUTcomes Following Manual Rotation (POP-Out): Study Protocol for a Randomised Controlled Trial , March 2015. National Institutes of Health, National Library of Medicine, Your Baby in the Birth Canal , December 2020. National Institutes of Health, National Library of Medicine, Low Back Pain During Labor and Related Factors , September 2008. National Institutes of Health, National Library of Medicine, Delivery Presentations , October 2020. National Institutes of Health, Office of Research on Women’s Health, Labor and Birth , June 2018. University of Rochester Medical Center, Postpartum Hemorrhage . UpToDate, Occiput Posterior Position , May 2022.

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What Experts Want You To Know About Back-To-Back Pregnancies

Sometimes it's planned, other times it's a surprise, but there's nothing unusual about having "Irish twins" — a pair of siblings who are only about a year apart. Many people who are the product of closely spaced pregnancies have positive memories of the special bond forged with a sibling of similar age. From parents' perspective, it may be difficult initially, but ultimately it can be a relief to get your whole family here as quickly as possible and move on from the pregnancy and diapers stage of life. But what are the risks of back-to-back pregnancies ? If you only think about the big picture, you may not have considered how back-to-back pregnancies affect your body and your emotional wellbeing.

Whether you're already pregnant or still figuring out how you want to space your children, it's time to learn the physical effects and risks of back-to-back pregnancies on you and your unborn baby, along with some tips for coping. Romper spoke with two OB-GYNs over email, Dr. Amy Peters of Saddleback Memorial Medical Center in Laguna Hills, California, and Dr. Yen Tran of Orange Coast Memorial Medical Center in Fountain Valley, California. Together, these two doctors provide differing perspectives on the risks and physical effects of closely spaced pregnancies, breastfeeding while pregnant, and what you can do to maximize your wellbeing and make life easier during a challenging time.

For starters, the physical shape you're in at the beginning of your second pregnancy contributes to the effects on your body. According to Peters, "a nine-month interpregnancy interval could make it difficult for the mother to be her healthiest for the second pregnancy." In particular, "she may not have lost all of the weight gained, and she could be increasing her risk for gestational diabetes in the second pregnancy."

If the pregnant mother is still breastfeeding her previous baby, Peters observes that "weaning naturally occurs fairly quickly, although I have had a couple of patients who continued to nurse their first [child] during the entire second pregnancy." But Peters points out that weaning may occur whether or not you're trying to because "milk supply frequently declines during the second pregnancy." As for why this is, she explains that "pregnancy requires about 300 calories extra per day and a lactating woman may require 500 calories extra, so combining those together may make it challenging for some women to have adequate nutrition and hydration."

A 2003 article, "Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies," published in The Journal of Nutrition, supports Peters' point with the finding that "women with early or closely spaced pregnancies are at increased risk of entering a reproductive cycle with reduced reserves [of nutrients]." In other words, every pregnancy makes extra demands on your body and nutrient supply, but if you begin a pregnancy with depleted stores of nutrients, it will be harder to catch up and get the amount of nutrients and calories you need, especially while simultaneously breastfeeding.

Another point about breastfeeding while pregnant, made by Tran, is that breastfeeding increases your body's production of oxytocin, which could potentially cause uterine contractions and result in premature delivery.

C-section history is another important factor in how back-to-back pregnancies physically affect your body. According to Tran, "it's highly recommended for patients with histories of C-sections to wait 18 months before their next pregnancy to allow the scars enough time to heal to prevent uterine abruption."

She also mentions the common physical effects of pregnancy, like fatigue and morning sickness that every mom is familiar with. However, Tran points out that these symptoms can be harder to deal with in a second pregnancy, especially one that follows closely after the first one. For example, "having another baby immediately could be exhausting to moms because of a lack of sleep from caring for her infant."

The more responsibilities you have, including work outside of the home and one or more children, the harder it will be to rest and care for yourself during a second or subsequent pregnancy. I can attest to this even though my first child was nearly 2 when I became pregnant for the second time. I found my second pregnancy to be much more physically demanding and exhausting than the first one, mainly because I couldn't just flop on the couch whenever I wasn't at work.

Besides the potential adverse effects on your body, closely spaced pregnancies can also put your unborn child at risk. According to Mayo Clinic, a subsequent pregnancy within six months of a live birth can increase your chances of "premature birth, placental abruption, low birth weight, congenital disorders, and schizophrenia." The website also noted recent studies that link closely spaced pregnancies to an increased risk of autism. However, Peters clarifies that "the risk for preterm birth tends to be more so for women whose first baby was born prematurely."

So how can you take care of yourself during a closely spaced second pregnancy? Both Peters and Tran recommend taking a prenatal vitamin and accepting help from others, whether that's a babysitter, relatives, or friends. Peters adds that pregnant women should try to maintain a healthy weight. (This is different for everyone, so talk to your doctor.) Tran also recommends calcium and Vitamin D supplements, and reminds pregnant women to get enough sleep and hydration.

If you're not yet pregnant again and trying to figure out how best to space your children, Tran recommends waiting at least two years after your first child is born. Peters adds that older women may not be able to wait that long, and "the small potential for complications arising from a short interpregnancy interval does not compare to the exponential increase in risks associated with advancing age." She also suggests planning for postpartum contraception and pregnancy spacing while still pregnant with your first child.

If you are already pregnant with a second or subsequent child less than a year after giving birth, talk to your doctor about how the risks and effects apply to your particular situation. Focus on caring for yourself and your children, and ask for/hire as much help as you need to make this happen.

Supreme Court considers Starbucks’ challenge to labor board’s authority

A Starbucks challenge to the National Labor Relations Board’s reinstatement of fired baristas will go before the Supreme Court on Tuesday.

In 2022, Starbucks fired seven baristas , who were organizing a union at their Memphis coffeehouse. The Seattle-based coffee giant says their move was within their rights under the law, because the workers violated company policy by inviting a TV news crew into the store after hours.

But the National Labor Relations Board agreed with the workers’ claim that Starbucks had fired them for their union activity. A federal judge then approved the agency’s request for an order that Starbucks reinstate the workers. An appeals court upheld that decision.

The case arrives before the Supreme Court as Starbucks appears to have taken a new, more cordial tone, agreeing to talks with the local union that could pave the way to the first labor contracts for stores that have already unionized. The company and the union resume bargaining this week, following a breakdown in talks months ago, with a goal of withdrawing ongoing litigation.

However, the case continues before the Supreme Court because Starbucks is disputing the standard that federal judges use to determine whether workers should get their job back, when requested by the National Labor Relations Board.

While the Supreme Court will examine the power of the NLRB around the workers’ reinstatement, experts fear a ruling against the NLRB could weaken labor organizing in other scenarios. For example, the labor board can also request that a federal judge require that a company bargain with unionized workers, reopen closed stores or provide other remedies to rectify unfair labor practice charges.

“This could have a substantial impact,” said James Cooney, a labor studies professor at Rutgers University. “If a stricter standard is adopted by the Supreme Court, it’ll be more difficult for the labor board to maintain the status quo for workers during an organizing drive. If there have been terminations of pro-union workers, those people are going to be out of work for years.”

Starbucks is arguing that the federal courts should use a stricter standard when it comes to going over the company’s head to reinstate fired workers. The company said that the federal district court wrongly relied on “a minimal standard” for approving the request to reinstate the Memphis workers rather than what it says is a tougher “four-factor” test used by courts in other regions of the country.

Kathleen McKinney, a regional director for the National Labor Relations Board, Starbucks’s opponent in the case, has argued that the courts already apply a consistent formula for granting relief that has been adapted to labor law and considers the same factors across circuits.

A decision in the Starbucks case could make it tougher for the NLRB to obtain relief for labor activists ― which could have a chilling effect on union drives during a period of heightened union activism in the United States. The Supreme Court has consistently ruled in favor of employers and corporate interests, including in a 2023 decision to make unions more liable for financial losses attributable to work stoppages.

President Biden’s appointed leader of the labor board, Jennifer Abruzzo, has earned a reputation for taking an aggressive approach to defending workers’ organizing rights. In 2022, she urged the agency’s staff to request relief from courts in “earliest phases of unlawful employer anti-union actions.”

Meanwhile, pro-business groups, including the HR Policy Association and the U.S. Chamber of Commerce, have rallied in support of Starbucks’s argument that the current process for granting relief is too lenient and stacked against employers.

The “watered-down approach” for obtaining relief has become “a cudgel that the Board has wielded against American businesses with increasing frequency in recent years,” the Chamber wrote in a brief filed with the Supreme Court in support of Starbucks.

Twelve current and former Starbucks baristas from around the country wrote to the Supreme Court that they had all either been fired or retaliated against for supporting union drives — losing their health insurance and having their electricity turned off because they couldn’t pay bills.

The baristas are “united in their conviction” that relief from the courts “is critical to preventing employers from illegally suppressing attempts to improve working conditions,” they wrote.

More than 400 of the company’s 9,600 company-operated U.S. stores have voted to unionize with Starbucks Workers United since the campaign went public in 2021.

Union officials expressed disappointment that Starbucks has forged ahead with its Supreme Court case.

Lynne Fox, president of Workers United, Starbucks’s workers parent union, told The Washington Post that “the day [Starbucks] committed to a new path should’ve been the day that they pulled back the case before SCOTUS.”

And the National Labor Relations Board is facing other, more drastic legal challenges to its authority. SpaceX filed a lawsuit in a federal court in Texas earlier this year claiming that the agency’s structure is “unconstitutional” after the Labor Board issued a complaint against the space rocket company alleging it illegally fired eight employees for criticizing the company’s leader Elon Musk.

Starbucks, Amazon and Trader Joe’s have since echoed SpaceX’s argument in legal proceedings at the Labor Board.

Abruzzo, the labor board’s chief,, has slammed these corporate challenges. At a panel earlier this month, she called the companies “deep-pocket, low-road employers” who are trying to divert the agency from its mission to defend workers’ rights “because they have the money to do so.”

'We're taking our power back in our workplace': Nurses, Amazon workers pushing back on labor issues

CINCINNATI — A federal hearing later this week will look into allegations that Amazon's management violated the rights of workers trying to form a union. Just miles away, union nurses at the Cincinnati VA are accusing their employer of violating their contract.

Some Amazon workers told WCPO they believe the hearing provides an opportunity for the National Labor Relations Board to hold Amazon accountable for allegedly mistreating workers who are trying to join a union.

It comes days after the United Auto Workers added thousands of new workers to their bargaining unit from the Volkswagen plant in Chattanooga, Tennessee.

"Amazon stripped my position as a learning ambassador due to my union activity, they continue to retaliate against pro-union workers," said Braeden Pierce, a ramp agent for Amazon at CVG Airport.

Pierce is one of the Amazon workers at CVG who will testify this week in front of the NLRB about how the company allegedly discouraged and tried to intimidate workers from organizing.

"Personally, I've been written up on a final written notice for insubordination off the clock i was standing outside doing my union tables like we usually do," said Marcio Rodriguez, a ramp worker for Amazon at CVG Airport.

Rodriguez also said he plans on giving similar testimony at future NLRB hearings.

"All of the veterans deserve safe care," said Shana Rivera, a medical ICU nurse at the Cincinnati VA.

Miles away from the Peck Federal Building in downtown Cincinnati, there's another organized labor fight happening at the Cincinnati VA.

"We want the administration to take us seriously and come to the table and work with the union where they're supposed to," said Rivera, who is also the director of the nurses union at the Cincinnati VA.

Some nurses are pushing back against management after the VA reassigned 27 float pool nurses to other units. Their union said they're not trained to handle those different units.

"At the end of the day, we don't want plumbers doing your electricity," said Rivera.

Despite some organized labor unions feeling like they have momentum after some recent victories, a Gallup Poll found union worker membership reached an all-time low in 2022, at 10%. Back in 1983, the union membership rate was 20%. A recent Pew Research Poll found with that drop, 54% of adults in the U.S. feel it's been for the country, with 59% saying it's bad for working people.

"I think that theme is the people have had enough, that we're taking our power back in our workplace," said Pierce.

WCPO 9 News reached out to Amazon for comment and a spokesperson provided this statement:

In response to the KCVG ULP hearing: "Our employees have the choice of whether or not to join a union. They always have. No one at our site has been disciplined for exercising their rights. These allegations are without merit and we look forward to showing that as the legal process continues." In response to our position on unions: "We favor opportunities for each person to be respected and valued as an individual, and to have their unique voice heard by working directly with our team. The fact is, Amazon already offers what many unions are requesting: safe and inclusive workplaces, competitive pay, benefits on day one, and opportunities for career growth. We look forward to working directly with our team to continue making Amazon a great place to work." In response to our solicitation policy: "Our employees have the right to distribute materials to their co-workers as long as it's not during working time or in working areas." In response to small group meetings: "These meetings have been legal for over 70 years. Like many other companies, we hold these meetings with our employees because it's important that everyone understands the facts about joining a union and the election process itself." In response to surveillance claims: "Our focus is on supporting our teams and delivering for our customers, not monitoring employees. Like most companies, we maintain a level of security within our operations to help keep our employees, buildings, and inventory safe - it would be irresponsible if we didn't do this. We use technology to help keep our employees safe and to allow them to be more efficient in their jobs."

In the past, the company has denied that its workers would be fired for attending union rallies or trying to form a union.

The Cincinnati VA didn't address the allegations from their nurses but said they're collaborating with the union and they value their input. However, the nurses told us if they do not find a resolution with management, they plan on filing a formal complaint with the NLRB.

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Hecs help is on the way – but is it too little, too late to help struggling students?

Labor’s solution to spiralling debts would’ve worked a treat if it had been in place for the past two years. Now it may make no difference

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Last week there was good news for struggling students and recent graduates saddled with sizeable student debts.

The prime minister, Anthony Albanese, in an outing on FM Radio , acknowledged there was “a range of areas where we need to do much better with the younger generation … and Hecs [the Higher Education Contribution Scheme] is one of them”.

After a horror year of 7.1% indexation of student debts and with the parliamentary library estimating that this year will see another 4.2% – 4.8% growth in the amount outstanding, help is on its way.

The Universities Accord final report, released in February, recommended the commonwealth ensure that loans didn’t outpace wage growth by setting the indexation rate to whatever was lower out of the consumer price index (CPI) and the wage price index (WPI).

The tertiary education sector considers this a lock, and Guardian Australia understands this is the government’s preferred solution, likely to be announced ahead of the budget.

The only problem is it may not actually restrain the growth of student debts.

As Andrew Norton, professor in higher education policy at the Australian National University, has noted : “In the last 25 years the WPI has been lower than CPI indexation only four times, including 2022 and 2023.”

So the solution put forward by the accord and the government and supported by much of the crossbench, including independent MP Monique Ryan, would’ve worked a treat if it had been in place for the last two years but otherwise very rarely would’ve made any difference.

Norton says that indexation is calculated using a composite of two years of CPI, “the practical effect of which is to dilute recent changes [in inflation]”.

“At the start of the inflationary cycle, indexation was below what it should have been, but on the downside [as inflation decreases] indexation is above inflation,” he tells Guardian Australia.

One tune-up could be to ditch the two-year calculation method. Using a one-year method, WPI has been lower than CPI seven times in the last 25 years, Norton calculates.

Let’s turn from the past to the future. The mid-year economic update projected WPI to be higher than CPI this year (by a whisker, 0.25%) and every year, growing to a 1% gap in the third and fourth year.

This is explicit government policy. Listen to the treasurer, Jim Chalmers, or workplace relations minister, Tony Burke, and they will boast that Labor has got wages moving again, as they are growing faster than inflation.

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While good for workers the upshot for students is this: even if the Myefo inflation estimates are a bit optimistic, the WPI will probably not be lower than CPI and the accord model will not be a handbrake on the growth of student debts.

The year it would have been is the horror year that’s already in the rear-view mirror.

Norton argues that unless the government is planning to make the changes retrospective, it’s “too late” for changes to take effect on the next round of indexation on 1 June 2024. If that’s correct, it would be another increase of more than 4% already baked in.

Legislating the accord model to apply from June 2025 would be the very definition of shutting the stable door after the horse has bolted.

Norton prefers a simpler cap, a maximum indexation rate that would provide students certainty with “no worrying about outlier years in the CPI or any of the other possible indicators”.

A cap of 4% would “cost the commonwealth next to nothing”, Norton says, but could knock the hard edges off tough years like the runaway 7.1% last year. If you wanted to be more generous to students, it could be set lower, at 3%.

As Labor dawdled, the Greens have been attempting to capitalise, campaigning to abolish indexation of Help debts altogether, including with a private senator’s bill introduced in November 2022.

Perhaps that is an ambit claim and they could meet halfway: a cap that limits indexation more than once in a blue moon, but not set so low that it ruins the budget.

Norton predicts that when the opposition, the Greens and teals see that the wage price index has so often outpaced CPI “that will change the politics of this”.

The accord changes are broader than Hecs indexation. We expect the government will also move to direct banks to treat Hecs differently for assessing mortgages and other loans.

In line with the accord, repayments should be treated like taxation, something that cribs your ability to repay, rather than another debt – something which is now a big roadblock to borrowing enough to get in the housing market.

Changes to the income threshold and the rate of repayment would make a huge difference to easing cost-of-living pressures on recent graduates.

Given Albanese flagged “a range of areas” where young people could be helped, we’ll wait until we see the whole package.

But when it comes to the growth of debts it seems the Albanese government, so determined to govern from the so-called “sensible centre”, may have passed up the opportunity to help when it was most needed.

Australian politics
Australian education
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Optimizing Baby Position in Preparation for Birth
Birth Positions In Labour
Everything You Need to Know About Posterior Baby Position
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COMMENTS

My baby is back to back
Other tips from NCT include: • Sit on a wedge cushion in the car, so your pelvis is tilted forwards. • Use yoga positions, like sitting with your back upright and the soles of the feet together, knees out to the sides. • Sleep on your side, not on your back. • Use yoga positions, like sitting with your back upright and the soles of the ...
A Guide to Posterior Fetal Presentation
There are four posterior positions. The direct OP is the classic posterior position with the baby facing straight forward. Right Occiput Transverse (ROT) is a common starting position in which the baby has a bit more likelihood of rotating to the posterior during labor than to the anterior. Right Occiput Posterior usually involves a straight back with a lifted chin (in the first-time mother).
Fetal Presentation, Position, and Lie (Including Breech Presentation
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.. In brow presentation, the neck is moderately arched so that the brow presents first.. Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor.
Baby positions in the womb before birth
Here are the stats: Between 15% to 32% of women have a baby in an OP (back-to-back) or occipito-lateral position when they go into labour. This happens more often among women who haven't given birth before. (Simkin, 2010) . Only five to eight babies out of every 100 will stay in the OP position. (Tommy's, 2016)
Fetal Positions for Labor and Birth
This presentation can lead to more back pain (sometimes referred to as "back labor") and slow progression of labor. 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. Tips to Reduce Discomfort
Mothers' positions in labour when baby is lying 'back-to-back'
The way a pregnant woman is positioned during labour may help rotate a baby so that the back of the baby's head lies towards the front of the mother's abdomen. This improved position may help the mother and baby have a more normal labour and birth. However, it is not yet known which posture, if any, is effective and when is the best time to use it.
Tips: how to get your back-to-back baby into position for birth
It can also be helpful in the first stages of labour to ease backache (Guittier et al, 2016). 2. Don't panic. In the end, your baby is very likely to end up in the occiput anterior position - one of the best positions. Only five to eight of every 100 babies end up back-to-back with you anyway (Tommy's, 2016). So try not to worry too much. 3.
Fetal position during labor
Sitting with hips higher than knees on chairs or exercise balls. Cat-cow yoga sequences. Forward-leaning stretches. Squatting. Sitting upright on sitz bones. The fetal position dictates how the baby is going to rotate to come through the pelvis. A "textbook birth" has the baby essentially corkscrew as they are born.
What to know about baby's position at birth
Occiput posterior position or back-to-back presentation occurs when the occiput - back of a baby's head - is positioned towards your tailbone or back during delivery. ... which can lead to a longer labor. This presentation is three times more likely to end in a cesarean section (c-section) compared with babies presenting in the ideal, occiput ...
Fetal Positions For Birth: Presentation, Types & Function
Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth parent's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left. This is called left occiput anterior or right ...
Face and brow presentations in labor
The vast majority of fetuses at term are in cephalic presentation. Approximately 5 percent of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face ( figure 1A-B ), or brow ( figure 2) [ 1 ]. Diagnosis and management of face and brow presentations will be reviewed here.
Management of malposition and malpresentation in labour
Diagnosing a face presentation can occur pre-labour by ultrasound or be suspected by abdominal examination detecting a marked depression between the fetal head and back. In labour, vaginal examination will palpate the eyes, nose, mouth and chin, although as labour progresses and oedema develops, detection of these landmarks can be more ...
Back to Back Babies
Sometimes a baby in a back to back position takes longer to navigate the pelvis, meaning the 'pushing' or second stage of labour can also be extended. It can also mean that you feel a lot of the sensation in your back itself rather than your bump, and is sometimes why it's referred to as a 'back labour'. Occasionally you may be ...
Getting your baby into position for birth
Most back-to-back babies are born vaginally. But this position can make labour more difficult for you, particularly if your baby's chin is pushed up, rather than tucked in. If your baby is occipito-posterior when your labour starts: You may have backache, as your baby's skull is pushing against your spine. Your labour may be longer.
3 positions to ease back pain in labour
One out of four pregnant women experience back pain in labour, which can happen when your baby is "back-to-back". Here are three positions to help relieve pressure on your spine during childbirth. Show transcript. Advertisement | page continues below. Track your pregnancy on our free #1 pregnancy & baby app
Labor with Abnormal Presentation and Position
Abnormal presentation and position are encountered infrequently during labor. Breech and transverse presentations should be converted to cephalic presentations by external cephalic version or delivered by cesarean section. Face, brow, and compound presentations are usually managed expectantly. Persistent occiput transverse positions are managed by rotation to anterior positions and delivered ...
Positioning During the Second Stage of Labor: Moving Back to Basics
The advantages of an upright position during labor are presented, with historic, physiologic, and psychosocial aspects discussed. The influences of modern obstetric practices such as electronic fetal monitoring and anesthesia practices are discussed with findings related to the use of upright positions from the Association of Women's Health, Obstetric, and Neonatal Nursing National Research ...
16 birthing positions for labour: images
16 birthing positions for labour: images. Written by Chess Thomas. Using different positions to stay mobile and upright during labour can help it to progress more quickly. They can also relieve back pain, encourage your pelvis to open, and help you to cope with the pain of contractions. Many of the following positions are designed to let you ...
Anterior Placenta: Is it a Cause for Concern?
If your baby is in a back-to-back position when you go into labour, they will probably turn and get into the best position for a vaginal birth, and you will have a normal vaginal delivery. But if your baby stays in a back-to-back position during labour, it is more likely you will have: a longer labour a more painful labour
The truth about 'back to back' birth
A baby is in the 'back to back' or 'occipito-posterior' (OP) position when he/she is lying head down but instead of the back facing frontwards it faces the mother's back. About 10% of labours involve babies in the 'back to back' position and in over half of these cases the baby will turn around naturally. None of mine did.
OP Truths & Myths
These women often do not report back pain at an intensity to get attention. Some have no more labor pain in their backs than they do in the front. A few women have severe back pain early in labor, at 2 cm. These women are candidates for inversion as soon as possible if they are up for it. Back pain is more about the fit of the baby than the ...
Back Labor Pain, Signs, Symptoms
Labor contractions can cause pain in just the lower abdomen or the lower abdomen and the back. Normal labor contractions feel like intense menstrual cramps that come and go with increasing intensity. Regular contractions are only slightly felt in the back. Back labor is much more intense pain in your lower back.
What Are The Risks Of Back-To-Back Pregnancies? Experts Weigh In
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My baby is back to back – what do I do?

What is a "occipito-posterior" or "back-to-back" position?

Back-to-back baby symptoms

What happens when you're in labour with a back-to-back baby?

Why are some babies back-to-back?

How do you help your baby get into the anterior position?

How can I improve the chances of anterior position during labour?

My baby's not back to back, but I've got an anterior placenta, should I be worried?

Fetal Presentation, Position, and Lie (Including Breech Presentation)

Position and Presentation of the Fetus

Occiput posterior position

Breech presentation

Other presentations

Fetal Positions for Labor and Birth

Right or Left Occiput Anterior

Right or Left Occiput Transverse

Tips to Reduce Discomfort

Right or Left Occiput Posterior

How a Doctor Determines Baby's Position

How You Can Determine Baby's Position

Mothers' positions in labour when baby is lying 'back-to-back'

Tips: how to get your back-to-back baby into position for birth

1. Lean forward

2. Don’t panic

3. Get into positions where your pelvis and belly tilt forwards

4. Avoid certain positions:

This page was last reviewed in August 2018.

Information you can trust from NCT

Related articles

Courses & workshops

NCT New Baby course

NCT Introducing Solid Foods workshop

Baby & Child First Aid

What to know about baby’s position at birth

Position of the baby before birth

What’s the ideal position of a baby for birth?

What other positions are babies born in?

Occiput posterior or back-to-back presentation

Breech presentation

Brow and face presentations

Shoulder presentation

What factors can influence the position of my baby?

How do I tell what position my baby is in?

How do I get my baby into the best position for birth?

Article references

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Where to go next

The truth about ‘back to back’ birth

Baby number 1

Baby number 2

Baby number 3

Baby number 4

Charlotte Camplejohn

18 comments

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MYTH: It is important to know the fetal position.

MYTH: If we prevent OP before labor than we can prevent OP in labor

MYTH: If the baby is Occiput Anterior (OA, the “best” starting position) in early labor the baby will stay in a good position throughout labor.

MYTH: Midwives and Doctors can tell the baby’s position.

MYTH: Back pain is a sign of an Occiput Posterior (OP) baby.

MYTH: When a woman is having prolonged labor without back pain, it is from a reason other than a posterior position.

MYTH: Position changes can change the OP position in the labor

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