Even the most prepared mamas recognize there are lots of unknowns in pregnancy and childbirth! From the moment you find out you’re pregnant, questions start popping up in your mind. 

Will I have a boy or a girl? Will morning sickness show up? How long will it last? Will I be able to work out during my whole pregnancy, and how can I do it safely? Will my delivery go according to my birth plan? 

I’m definitely speaking from experience here! No amount of knowledge surrounding pregnancy can clue you in to exactly what your personal experience will be like. Of course, I’m all about educating mamas and helping them make informed decisions! But there are some parts of pregnancy that we just have to accept as they come. One of those things? The position your baby wants to be in while they grow in utero. 

What is the optimal fetal position for vaginal birth?

Babies will twist, turn, and rotate plenty during pregnancy. If you’ve been pregnant before, you’ve felt the effects of all those moves and turns! But before you give birth, they usually settle into one position. 

Most commonly, they rest and wait for entry into the world in a “head down, face down” position. Officially, this is called occiput anterior (OA)  position, and it’s the most “optimal” position for you to give birth. Baby’s chin is tucked to his or her chest and facing your spine, which places the back of his or her head facing the front of your body. Most babies present left occiput anterior (LOA) at delivery time.

Don’t panic if you just read the word “optimal” and your baby is not in that position right now. This does not mean that all other presentations are inherently bad or unnatural! The OA position just allows the  easiest navigation through the pelvis for your baby. 

So, what are the other common presentations? 

Your baby could be occiput posterior (OP, often called sunny side up). In this position, your baby is head down, face up. You can deliver your baby this way! However, this presentation can cause a lot of back pain during labor due to the hard part of your baby’s skull pressing against your spine. 

Babies may also be sideways, which is also known as the transverse lie. Finally, babies may be in incomplete or complete breech presentation. 

What do we know about breech presentation?

Breech presentation simply means that a baby’s feet or buttocks are positioned to come out first during birth, rather than their head. Breech positioning occurs in 25% of babies prior to 28 weeks, but by 32 weeks, that number shrinks to 7%, and it’s even lower by the time delivery occurs. A breech baby is always a possibility for pregnant moms, so knowing your preferred plan well before delivery is helpful. 

The American College of Obstetricians and Gynecologists (ACOG) supports the option of vaginal breech delivery in women who meet specific criteria. However, skilled providers with the training to do so are not readily available in many hospital settings. Sadly, the number of providers who are trained in these techniques continues to decrease with every year. 

In the United States, breech babies are typically delivered via cesarean. Opting for a cesarean is a valid birth plan, but if you are someone who wishes to reduce your chances of a cesarean, then you may benefit from performing daily inversions in the weeks leading up to childbirth. Daily inversions can help to flip your baby into the optimal position for delivery. 

What are inversions and how do they help?

The forward-leaning inversion (FLI) is a common technique designed to help you shift your baby into an easier birthing position before childbirth begins. Its primary purpose is to reduce lower uterine ligament tension. In fact, no matter which position your baby is currently in, the FLI may help prepare you and your baby for delivery. 

Remember: your baby is not physically flipping as you do the FLI, so don’t worry! The FLI just creates more space to allow your baby to move and rotate into a more optimal position before delivery begins.

Before attempting an inversion, remember to get into position slowly. Your body is not used to being upside down in typical circumstances, much less with the added weight of a growing baby. Get into an inversion position using controlled, steady movements. It’s recommended to have a helper nearby should you need assistance!

To perform an inversion, you’ll need a surface for your knees and a lower surface for your forearms. Common places to get into the FLI are a set of stairs or the edge of a piece of furniture like a couch or low platform bed. 

First, kneel on the higher surface, keeping your head and shoulders high. Next, move your hands to the edge of that surface. Then, slowly lower one hand at a time to the lower surface (floor or lower stair). Once you feel steady in that position, lower further onto your forearms. After 30 seconds (or about three breaths), move back up to your hands, then to the edge of the higher surface, and finally, back to kneeling position.  

This may sound complicated, but it’s very intuitive once you try it! Remember that this is meant to be a quick exercise: daily for 3 breaths, which is about 30 seconds. If your baby has not flipped by week 30-32, consider performing the FLI 7 times in a 24 hour period along with a breech tilt, which is another helpful non-invasive measure to help flip your baby.

These tips from Spinning Babies are incredibly helpful as you get started: 

• “Before you start, do some shoulder and neck circles to warm up.”
• “While inverted, let your head hang freely, but keep your chin tucked. Don’t rest your head on the floor. You can move your head if you like.”
• “Straighten your shoulders to make room for your head to hang. Do not use a pillow for your head. Do not rest on your head.”
• “Your knees should be close to the edge, and your bottom up high. You can tilt or sway your hips if you’d like, or gently, slowly undulate your spine.”
• “You can flatten your lower back (posterior pelvic tilt) to make more room for the top of your pelvis. You can make slow movements in your spine and neck or not.”
• “When we first get upside-down, our body warns us with a throbbing head. After 3-6 times your body will realize you intend to be upside-down and your head will stop pounding. Just get up early if this happens and try again, one time each day. The feeling will go away soon enough.”

Do inversions have other benefits aside from potentially allowing a baby to flip?

It’s a great question – and yes! The FLI position essentially allows the uterus to hang from its own ligaments. This helps it to lengthen, stretch, and even untwist ligaments that have gotten out of position. This stretching can reduce low back pain, hip pain, round ligament pain as your  lower uterine ligaments release. And of course, being upside down also relieves pressure on your uterus and pelvis! It may even help to position your cervix well for labor.  

The FLI can actually be performed during labor, too! Consider adding it to your childbirth positions if: 

• You want to ease cervical dilation in early labor (if your cervix is dilating quickly, it can cause pain and swelling. Getting into a FLI can reduce pressure on your cervix and allow it to catch up!)
• You’re experiencing strong contractions without cervical dilation
• Baby is behind your pelvic bone
• Baby is not in optimal position for delivery yet
• You can hold the inversion through one contraction to help move baby

Contraindications or medical considerations to performing inversions

While the FLI is a helpful tool, it is not beneficial for everyone! You should NOT perform this inversion if: 

• You have high blood pressure (HBP) during pregnancy or are at risk for stroke
• You have heartburn (avoid performing right after eating to reduce heartburn) 
• You have high amniotic fluid levels
• Your baby is not growing at the expected rate (IUGR/FGR)
• Your baby moves frantically (consult your provider if this is the case)
• Your placenta is anterior or bleeding
• You’re experiencing uterine pain (consult your provider if you are!)
• You have a respiratory or sinus infection and the pressure is uncomfortable
• You’ve been diagnosed with glaucoma
• You try it and experience pain
• You just don’t want to!

The FLI is just one of many tools at your disposal. It is completely up to you whether you decide to use it! 

Preparing Well for Labor

Along with inversions, there are a number of other daily movements to prepare your body and your baby for childbirth. My Movement Through Pregnancy workouts begin or end with an inversion in the 3rd trimester, but you’ll also find lots of  other hip and trunk opening movements to prepare you for delivery!  

If you’re nearing your delivery date and are looking for labor prep and childbirth education you can trust, try the Movement Through Labor and Delivery program. This course was created by me (a pelvic floor physical therapist) and Skyler (a certified nurse midwife) to help you prepare your mind, your pelvic floor, and even your birth partner for delivery.

Inside, you’ll find 6 weeks of labor prep flows, as well as other movement flows to help flip your baby from a breech or OP position. You’ll also learn from 12 educational modules about inductions, pain management, breathing, positions, and more! Regardless of your desired birth setting, you’ll be empowered to make informed choices and be prepared for your baby’s birth.

We designed this program to cover childbirth education and practical prep all in one — because those two things go hand in hand. And with three options — the full course, the mini course, and the pushing guide — you’ll be able to grab the resource that makes the most sense for YOU. Join the Movement Through Labor and Delivery crew today!