First, why does it matter how your baby is positioned during labor? A baby with a flexed head, or tucking their chin towards their chest, presents a smaller diameter of their head to the cervix and pelvic openings. The head seems to mold better. And there is less resistance with a flexed head during the descent through the pelvis (Parente et al, 2010). When a baby’s head is deflexed or extended, they present a larger diameter of their head to the cervix and pelvic openings, and seem to find stalls in later stations (Parente et al, 2010).
Even when it comes to posterior (OP) positioning (back of baby’s head is towards mom’s spine), if baby’s head is flexed there is a greater chance of vaginal delivery when compared to deflexed or extended head positions (Bellussi et al, 2017). Babies that were both OP and deflexed were born via cesarean in their study.
It is really important that your baby’s head is flexed during labor, regardless of what position they may be in!
How can you help your baby tuck their chin during labor to facilitate descent through the pelvis? Movement seems to be the key.
Labor tends to be a normal physiological process when left alone; your baby is smart and knows what it needs to do to be born, and you are connected with your baby during pregnancy and during your labor process. In my experience, mothers tend to move intuitively to help their baby descend throughout labor by creating space where they need it the most. This intuitive connection does tend to go away once she receives an epidural, but not always.
There are several levels of the pelvis: inlet, midpelvis, and outlet, which all open with various biomechanical movements. Inlet opens with wide knees and tucking the butt under for a posterior pelvic tilt. Midpelvis opens more with diagonal, sideways, and/or uneven hip movements. Outlet opens with knees in and ankles out, and allowing for space for the sacrum to move.
When mothers move intuitively, they are creating space at the level of their pelvis that the baby is currently trying to navigate. It has been incredibly powerful to witness, and then to find my observations were accurate when a mother receives a cervical check. She is very much an intelligent and active participant in her own birth experience with her baby.
How can we emphasis head flexion? We create space at the level of the pelvis baby is at: inlet, midpelvis, and outlet. If baby has engaged and the head is tilted or deflexed (usually accompanied with stalled labor or an abnormal labor pattern), then we can do inversions to back baby out of it and hopefully reposition itself.
The forward leaning inversion by Spinning Babies is a great movement to use to help baby reposition, accompanied with Shaking the Apple Tree. Spinning Babies has a great quickbook that provides some helpful suggestions at each level of the pelvis to create space and possible solutions if issues arise. I carry this booklet in my doula bag for all my births!
The other component is balance: baby will fit where there is space.
If there is tension in the muscles/tissues that support the pelvis or uterus, it may force baby into a less optimal position. This is particularly true of the pelvic floor. If the pelvic floor is tight and cannot release, baby will find themselves tilted or forced into less optimal positions. Think of it like this, your pelvic floor could be tighter on one side than the other for whatever reason, when baby hits your pelvic floor, the side that is tight prevents descent while the side that is at ease allows baby’s head to move down, but only on that side. Enter: head tilt, deflexion, or even extension.
How can we release tension in the pelvic floor?
Helping your baby descend through your pelvis during labor is much easier if their head is flexed! We can achieve this through creating space at each level of the pelvis, following mother’s lead and intuition, and finding balance in the pelvis during pregnancy and labor. Use the Spinning Babies Quick Book as an easy guide or check out our Childbirth Education Courses that we regularly update with new information and easy to reference sections on labor and pregnancy!
We need to work on it during pregnancy! Diaphragmatic breathing is a great way to introduce release into the pelvic floor. When you inhale, focus on expanding and lengthening in the pelvic floor. When you exhale, focus on either completely relaxing and allowing the pelvic floor to “spring” back up to its original location or you could add a Kegel/pelvic floor activation. If you are trying to focus on releasing tension, focusing on complete relaxation would be more ideal.
You could also look to do pelvic floor internal massage (**I am not a medical provider, this is you exploring your own body), where you insert your own fingers to feel for any banding in your pelvic floor muscles. Similar to if you had a tense spot in your shoulders or back, we would knead out the tension to help the muscle release. Except now it’s your pelvic floor. Avoid any massage towards the top of the vaginal opening or where the urethra is, as it may cause damage or discomfort.
childbirth education courses
References:
Bellussi, F., Ghi, T., Youssef, A., Cataneo, I., Salsi, G., Simonazzi, G., & Pilu, G. (2017). Intrapartum Ultrasound to Differentiate Flexion and Deflexion in Occipitoposterior Rotation. Fetal Diagnosis and Therapy, 42(4), 249–256. doi: 10.1159/000457124
Parente, M. P., Jorge, R. M. N., Mascarenhas, T., Fernandes, A. A., & Silva-Filho, A. L. (2010). Computational modeling approach to study the effects of fetal head flexion during vaginal delivery. American Journal of Obstetrics and Gynecology, 203(3). doi: 10.1016/j.ajog.2010.03.038