Is LOA, or baby towards the front and left, the best position for your baby for birth? The answer is: it depends!
You may be bombarded with the pressure to get your baby in the “perfect position” for birth, without realizing that there are multiple positions that your baby needs to rotate through as they make their way through the pelvis for birth!
Let’s break down the positions that baby needs to find during labor to fit through the pelvis!
The 3 Positions Your Baby Needs to Find During Labor!
The three pelvic levels each have a different shape:
- The inlet (top of the pelvis) is wider from side to side, but narrower from front to back.
- The midpelvis (middle of the pelvis) is wider diagonally, but this space is similar to a corkscrew!
- The outlet (bottom of the pelvis) is wider front to back, but narrower from side to side.
Understanding that each pelvic level has a different shape hopefully helps you understand that this means your baby needs to align to each pelvic level in a different way.
AKA your baby needs to rotate to face different directions to best fit through each pelvic level!
We break down how the pelvic opens and moves in combination with your baby’s position + movements to do to prepare for birth in our labor biomechanics course!
This course includes our 90-minute labor biomechanics webinar recording plus our 24-page labor biomechanics quick reference guide.
- 90-min webinar
- 24-Page E-Book
- Upcoming Live Webinar & Q&A
- Watch on Mobile Device
How does your baby rotate through the pelvis?
How your baby rotates through the pelvis correlates to how well your baby’s head aligns with each pelvic level.
- Top of the pelvis: wider from side to side, so your baby wants to align with the back of their head towards one hip (usually the left).
- Middle of the pelvis: wider diagonally, so your baby wants to rotate through this space from that LOT to LOA to OA. (see below for fetal positions).
- Bottom of the pelvis: wider front to back, so your baby wants to align with the back of their head to the front so that they align to the space and can extend their head under the pubic bone.
Watch this video for a demonstration of how your baby is going to rotate through your pelvis!
What position means what?
Understanding fetal positions!
Your baby’s position is determined by where the back of their head is to your pelvis.
If the back of their head (the occiput aka O) is towards the front of the pelvis, they are occiput anterior, or more commonly referred to as OA.
If the back of their head is towards the back of the pelvis, they are occiput posterior, or OP.
If their head is towards either hip, it is occiput transverse. And then it depends on which hip: left hip = LOT; right hip = ROT.
Then we have our diagonal positions!
If the baby is more towards the left = LO + either A or P if they are to the front of the back. If the baby is more toward the right = RO + A or P.
In total, there are 8 positions your baby can be in for a head down position! See the graphic for a visual of this!
1) LOA to LOT: Engaging into the pelvis
The first position your baby will start their descent into the pelvis may be an LOA. Why the left side? It is due to the uterine shape prompting a better head position on the left side. Want to learn more about this? Check out our childbirth education courses!
The first position is usually an LOA as baby angles their head into the pelvis, but then they will rotate to LOT to actually enter or engage into the pelvis.
Engagement could occur during pregnancy, but some babies don’t engage until labor.
Early engagement is not a predictor of labor onset nor how labor will go, so an overemphasis on forcing baby to engage during pregnancy is not necessary. Rather, we can focus on ensuring that baby has the space and ability to rotate once labor begins by releasing the tension in their path.
See the video below for an example of a uterine ligament and posterior pelvic floor release circuit we incorporate into our prenatal fitness programming.
2) Rotation from LOT to OA in the Midpelvis
After baby has engaged into the pelvis, they will eventually find that “perfect” LOA that everyone raves about being the best position. But, as you should hopefully notice by now, LOA is just ONE position that your baby needs to find!
Baby internally rotates from LOT through LOA to OA as they rotate through the midpelvis. You may find that you are favoring a lot of side to side or one-sided focused movements at this point during labor!
The midpelvis requires a lot of different movement patterns, particularly the lower midpelvis.
We need to be able to find:
- Unilateral movement (movement only with one leg that is different than the other)
- External rotation of the femur or a open hip position of one leg + an anterior pelvic tilt
- Internal rotation of the femur or a closed hip position of one leg + posterior pelvic tilt
The internal rotation aspect tends to be more challenging for most since it is commonly neglected in fitness programming and daily life. And there tends to be an overemphasis on deep, wide squats in many prenatal fitness programs.
Luckily, we incorporate internal rotation work into our prenatal fitness programs. Internal rotation work is commonly neglected with birth preparation!
Starting in the third trimester, we incorporate pelvic opening-focused workouts designed to help you find the movements required to open the pelvis for birth!
3) OA to Extend Under the Pubic Bone
After baby has finished their rotation through the midpelvis, they are ready to extend under the pubic bone into the outlet!
Baby tends to align in an OA, with the back of their head towards the front, so they can better extend under the pubic bone for birth!
And then, it’s time to meet your baby, finally!!
LOA is NOT the perfect position for your baby: they need to rotate through several positions for birth!
LOA is not the perfect position for your baby, so you can let go of the pressure to force them into this perfect position to finally go into labor or to have a “good” birth.
Your baby needs to rotate through several positions depending on which pelvic level they are at!
Your baby cannot physically stay ONLY in an LOA as they move through the pelvis! They would simply not fit without rotation.
Baby may start in LOA to angle to the pelvic inlet, but then they enter in a LOT. From there they rotate from LOT to LOA to OA, and then finish by extending under the pubic bone for birth!
Want to learn more about the science of birth?? Check out our childbirth education courses!