What Should I Do to Prepare for Vaginal Delivery?

I am nearing the finish line of my pregnancy and am looking for ways to prepare for a vaginal delivery. I’ve heard that the best fetal position for birth is when the baby’s head is down, facing your back. Is there anything I can do to help get him into that position? Everything I read is about flipping a breech baby, but I’m just looking for ways to prepare my body.

––Jamie

When we talk about fetal positioning, you’re right that the main focus is on whether the baby is breech or not. Some breech positions can be delivered vaginally, although this is less common than it once was. If your baby is breech, it is likely you’ll be offered a scheduled C-section, or a procedure called an ECV in which doctors try to turn the baby from the outside.

But you are right that the way the baby is facing also matters. A baby facing your back is easier to deliver vaginally than one facing up. The technical term for this is “occiput posterior,” or OP, position.

This position can make it more difficult for the head to progress through the birth canal. It is absolutely possible to deliver a baby face-up vaginally; it just may be more difficult or take longer. The pushing phase of labor has been estimated to be 45 minutes longer with this position.

During early labor, an estimated 15% to 50% of babies are in this position (yes, I know that’s a big range; it seems to vary with who is assessing the position). However, a very large share of babies turn during labor — only an estimated 5% of babies are actually face-up during delivery. Most of this turning is right at the point of full cervical dilation.

There are some risk factors for having a baby face-up during delivery (your first child, a large baby, a small pelvis), but virtually none are modifiable. And since the vast majority of babies who are face-up at the start of labor will turn, there isn’t much reason to worry about it before you go into labor. If you do end up with a baby facing the wrong way at the time of pushing, your doctor may try to turn the baby manually (if you’ve had an epidural).

Bottom line: There are plenty of things you can do to prepare for labor (pack a bag, perineum stretching, breathing techniques, etc.). The face position of the baby will likely take care of itself.