Optimal Positioning: Balancing the Pelvis for a Safer, Easier Birth (2022)

Author // Jeanne Ohm, D.C.

In preparing for a natural birth, we recognize two things: the mother’s autonomy in childbirth and the supremacy of normal physiology. A mother-tobe has many resources to draw from in preparation for birth, the greatest being her own innate capacities. Learning about how the body is designed to give birth can lend tremendous understanding and support for the whole birthing process. The words “optimal positioning” signify that the mother and baby have aligned in a way that is complementary for a natural, empowered birth.

The most desirable position for the baby in birth is when the baby’s head is down, with the back of the head (occiput) and spine facing the mother’s front left side. During birth, from the mother’s superior view, the baby’s body rotates clockwise, aligning the occiput with the mother’s symphysis pubis. Then the baby’s head emerges. Once the head is out, the shoulders continue to rotate in that same clockwise motion so they, too, can fit through the mother’s pelvis.

Appearing in Issue #53. Order A Copy Today

If the baby’s occiput is facing the mother’s right side, in order for the head to get into the most desirable position, the baby must do a “long turn” in the clockwise direction within the mother’s entire pelvis to arrive at her symphysis pubis. Frequently, the baby will stall with his occiput up against the mother’s sacrum. This is called an occiput posterior presentation. It may lead to a longer and more difficult labor and delivery, or even to interventions that prevent a natural birth from happening.

Babies move freely throughout pregnancy. Between 35–37 weeks, they settle into what usually becomes their position for birth. Obstetricians perform an ultrasound at 37 weeks, but how can a mother determine her baby’s position earlier? And what about mothers who choose not to have ultrasound? One way to learn your baby’s position is with belly mapping. You can read about belly mapping on page 56 in this issue of Pathways.

(Video) LABOR POSITIONS FOR EASIER BIRTH | Open Each Level Of The Pelvis

But the biggest question is, why do babies choose a less than optimal position to begin with? Many mothers are not aware that their pelvic balance throughout pregnancy affects their baby’s position in birth. Increasing your awareness of your posture and movement will support your baby’s ability to find his optimal position for a safe and natural birth.

Structure Determines Function

Malpositioning in labor may occur partly because of the modern, sedentary lifestyles that thwart optimal positioning during pregnancy. Especially while seated, we often compromise our spinal alignment and optimal positioning. Easy chairs, couches and car seats force us into a slouch position. Even when sitting in straight-backed chairs, we can find ourselves slouching, compromising our pelvic balance. Slouching misaligns the pelvis in such a way that it makes it more comfortable for the baby to turn posterior or breech.

If, instead, you sit with your pelvis tilted forward, your lower spine curves forward. Your pelvis will be open and the baby can choose the most ideal position for birth.

Be conscious of your posture as often as possible, especially when you are sitting. Sit with your hips rocked forward and your knees always lower than your hips. Cease slouching, leg-crossing, or sitting on your legs. Sitting toward the front edge of your chair will help overcome negative sitting habits. Wellinflated birth balls and the Swedish kneeling chairs make it easy to keep your knees lower than your pelvis.

When taking long car rides or when sitting at work, take breaks often and move your body. Spend time throughout the day moving your hips in a figure-eight-type motion. You can use the back of a chair to lean on to do this movement. This keeps the joints in your pelvis flexible and better able to maintain a balanced state. These positions also lean the uterus forward and encourage the baby to settle into the anterior position, an ideal position for birth.

Another beneficial movement is pelvic rocks. To start, get on all fours and arch your spine. This strengthens and tones your lower back muscles. Then allow your spine to arch forward. This motion opens up the pelvis, relaxes the uterus and gives ample room for the baby to move. Also, you can exercise by crawling on the floor to optimize positioning.

If you have an occupation that is restrictive to movement or has you maintaining a one-sided posture for long periods of time, it is important that you aim to change postures regularly so you can support pelvic balance. For example, chiropractors and massage therapists may spend their entire day on one side of their table. In this case, maintain pelvic balance by adopting alternate stances.

If you are frequently holding an older child during pregnancy, and you elevate your hip for added support, know that this repetitive torque to your pelvis can cause structural imbalances that may adversely affect your baby’s positioning in utero. This was the case for me when I was pregnant with my sixth baby. Having held my fifth child on my left side consistently, my baby was led into a posterior occipital presentation for labor.

(Video) Pelvic Side Lying Release - safe technique for women during pregnancy labor and birth

It might seem inconvenient to balance out your daily positions, but your awareness and effort to do so throughout pregnancy can make a significant difference in your birth experience.

Longstanding Imbalances

Previous physical trauma may cause issues in optimal positioning as well. Can you recall falling, tripping, or being in a car accident? Maybe a sport you played, such as hockey or lacrosse, had you repeat a one-sided, twisting motion? These traumas, regardless of how long ago they happened, may have affected your spinal alignment, and therefore your pelvic balance may be compromised for birth.

When the pelvis is out of alignment there is often tension in the attached ligaments. Because these ligaments also attach to the uterus, an uneven pulling can cause the uterus to rotate, making it difficult for the baby to assume his ideal position.

Chiropractic care throughout pregnancy is a safe and effective way to balance pelvic misalignments. Doctors who are certified in the Webster technique use gentle and specific adjustments to realign the pelvis and restore function to the nerves, muscles, and ligaments associated with pregnancy and birth.


Restrictive and repetitive movements and postures, along with old injuries in our spine and pelvis, create further restrictions in our joints. These restrictions affect muscle, ligament, and nerve function. In pregnancy and birth, we want the joints in the pelvis to open and move. We want the muscles, ligaments and nerves to be working for maximum strength and optimal function. Movement throughout pregnancy is essential. Certain movements during pregnancy support joint mobility and at the same time help establish optimal positioning.

Pelvic rocking. Get on all fours, arch the back up and down. If the baby has settled into a less than ideal position, pelvic rocking can provide the motion and space for a baby to move.

Figure eight. Lean against the back of a chair, and while you are leaning forward, gently and evenly move your pelvis in a figure-eight-type rotation to keep your pelvic joints uniformly balanced.

Hip shimmy. As you lean forward (over a birth ball or a chair, or on all fours), your birth assistant holds each side of your hips and rocks them back and forth. In this way, the baby responds to the movement as your hip joints mobilize. The combined support and motion to the hips feels great!

(Video) A balanced pelvis for optimal labor - Exercises and Stretches for Pregnancy - Minot Chiropractor

Belly sifting. Get on all fours. Have a partner wrap a scarf or shawl under your belly, then pull up and gently jiggle right and left.

Pelvic sifting. Lie on your back. Have a partner put the scarf under your pelvis and, while lifting, jiggle your hips. Depending on the baby’s position this ancient technique helps encourage baby movement.


There are three causes of dystocia in birth, per the Williams Obstetrics textbook. The first relates to the power of the uterus and its ability to function as designed. The uterine muscle needs proper nerve supply in order to function correctly. Pelvic imbalance puts undue stress on uterine nerves and ligaments, affecting their optimal function.

The second cause of dystocia relates to the passageway, or the alignment of the mother’s pelvis. If the pelvic bones are not balanced correctly, it will be more diffic ult for the baby to move through the pelvis.

The third cause of dystocia relates to the passenger, or the baby’s movement through the mother’s pelvis and birth canal. Again, pelvic misalignments put undue tension on
uterine muscles and ligaments, which in turn pull on the uterus and impair the baby’s ability to optimize its position and movement.

Preliminary clinical studies indicate that regular chiropractic care throughout pregnancy may, in fact, address these three causes of dystocia.

Movement During Labor

Even if the baby is in an optimal position at the onset of labor, new positions may arise. If these new fetal positions slow labor down or even stall labor (a condition called dystocia), unnecessary interventions may ensue.

Movement is key in all labors, and all mothers should be encouraged to get into any positions that they feel are necessary. During my sixth labor, it became apparent that my baby was in the occiput posterior position.

(Video) How to Engage Baby’s Head in the Pelvis | Positions to Help with Labor and Birth | LABOR POSITIONS

This was likely due to carrying my fifth son exclusively on my left hip during pregnancy. By the end of labor I experienced very intense back pain and became exhausted. Although I do not usually choose to lay down for birth, that little voice inside of me prompted me to go to my bed. Giving in, I laid down on my left side and drew my right knee upwards. No sooner than I had done this my baby did a 180 degree rotation, moving from occiput-posterior to occiput-anterior. As soon as the rotation was complete, she came sliding right out!

Labor is a dance between the mother and baby. Together they find the ideal movements and positions that allow for a safe and easier birth experience. Listening to our inner voice and literally moving with it is the essence of this dance. It can make the difference between a safer, easier birth and one filled with intervention.

Simple things, such as standing upright if you have been lying down, walking if you have been stationary, rotating the hips, and other movements in labor, can help this dance unfold. All of the techniques shown above for pregnancy can be used in labor as well. Some are more suited to certain cases, and all have the possibility of balancing the pelvis and helping the baby descend into the birth canal for a safer, easier birth.

It’s important for moms to realize how to support their own physiology and trust that their body and baby knows what is best for their birth.

Thank you to midwife Amy Hoyt for the inspiration to write this article.

Optimal Positioning: Balancing the Pelvis for a Safer, Easier Birth (2)This article appeared in Pathways to Family Wellness magazine, Issue #53.

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(Video) Module 3: Aligning Your Pelvis for an Easier, Quicker Birth

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What is the optimal position for birth? ›

Ideally for labor, the baby is positioned head-down, facing your back, with the chin tucked to its chest and the back of the head ready to enter the pelvis. This is called cephalic presentation. Most babies settle into this position with the 32nd and 36th week of pregnancy.

How do you keep your pelvis aligned when pregnant? ›

To start, get on all fours and arch your spine. This strengthens and tones your lower back muscles. Then allow your spine to arch forward. This motion opens up the pelvis, relaxes the uterus and gives ample room for the baby to move.

What is the importance of positioning the baby with head lower than the feet after birth? ›

This is called cephalic presentation. This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.

What does it mean to be 4 5 engaged? ›

4/5 = sitting on the pelvic brim. 3/5 = lower but most still above the brim. 2/5 = engaged, as most is below the brim. 1/5 or 0/5 = deeply engaged. If it's your first baby, engagement tends to happen in the last weeks.

Why do we lay down to give birth? ›

"The main reason people give birth in that position is because it's comfortable, and they can get their legs in a good position to help open their pelvis to give the baby lots of space," says Dr Elder.

How do you align your pelvis? ›

3 steps to realign your pelvis - YouTube

Can you give birth with a tilted pelvis? ›

Having a cervix or uterus that tilts back toward your spine is a normal variation of the uterine position in the pelvis. Most of the time, women with a tipped uterus don't have any symptoms at all. A tilted uterus shouldn't have any impact on your ability to get pregnant or deliver a baby.

How does pelvic tilt induce labor? ›

Keep the joints loose by completing pelvic tilt exercises. Here's one way to do them: Lying on your back, place your feet flat against the floor and bend your knees. Slowly lift the pelvis until it becomes parallel with your torso. Hold for 10 seconds, return to your starting position, and repeat several times.

What happens if your pelvis is too small to give birth? ›

A pelvis too small for baby is actually incredibly rare and very hard to diagnose. It is very discouraging for women and more often than not, leads to a woman having repeat c-sections for the rest of her babies without even being given a chance at a vaginal birth.

What is the best fetal position for birth quizlet? ›

What is the best fetal position for vaginal delivery? -vertex position (head down) with the back of the head furthest down= best position to deliver a baby.

Is my pelvis big enough for birth? ›

The gynecoid pelvis is thought to be the most favorable pelvis type for a vaginal birth. This is because the wide, open shape give the baby plenty of room during delivery. Android. The narrower shape of the android pelvis can make labor difficult because the baby might move more slowly through the birth canal.

How do you know if baby is engaged in pelvis? ›

In the physical exam, doctors check your stomach, pelvis, and abdomen to feel for your baby's head compared to your pelvic bone. In general, if they feel the curve of your baby's head above your pelvis, then your baby hasn't finished dropping yet. If they don't feel the curve, then your baby is likely engaged.

What does it mean if baby is 2/5 engaged? ›

Your midwife will note how many fifths of your baby's head they can feel above the edge of your pelvis. So 5/5 or 4/5 in your notes means that your baby hasn't dropped all the way down yet, while 3/5, 2/5, or less means that your baby is engaged.

How long can a baby stay engaged for? ›

In first pregnancies, however, it usually happens several weeks before birth — anywhere between 34 weeks and 38 weeks gestation. In subsequent pregnancies, your baby's head may not engage until your labor starts.

Can you give birth without pushing? ›

Laboring down is the process of not actively pushing once the second stage of labor and intense contractions begin. Some people wait one to two hours before pushing, which allows the baby to naturally move down the birth canal. Laboring down has risks and benefits.

Why do we not give birth standing up? ›

In the absence of anesthesia, it would be too uncomfortable. Movement is an instinctive way of coping with the discomfort of labor. Remaining upright also appears to facilitate labor progress and, aided by gravity, descent of the baby in the birth canal.

How many times a woman can give birth? ›

The mother's body after childbirth

Girls generally start menstruating at the age of 13 and this continues till she becomes 51, which gives her 38 possible years of reproductive action. However, counting that every delivery requires 9 months, a limit of about 40 pregnancies actually seems probable.

How do you know if your pelvis is aligned? ›

Steps to check alignment:

Straighten your legs slowly until you are flat on the table. Take your hands and find the front of your hip bones on both sides(the pointy part of your pelvis) Feel to see if one side is higher towards your chest than the other (if needed have someone else help you with this part)

What happens when your pelvis is out of alignment? ›

When symptoms occur, they commonly include lower back pain, hip pain, leg pain, and gait problems. A tilted pelvis can also irritate the SI joint, causing inflammation. This may cause additional symptoms, including pain radiating to the buttocks, leg weakness, and numbness or tingling.

How do you align your hips and pelvis? ›

How to Self Correct a High Hip in 30 SECONDS - YouTube

How can I keep my baby low in my pelvis? ›

Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way around. We recommend squatting on a low stool instead, and keeping your spine upright, and not leaning forwards.

How do you do a pelvic tilt postpartum? ›

Postpartum exercise: Pelvic tilt with bridge - YouTube

Can you give birth naturally if you have a tilted uterus? ›

A retroverted uterus has no effect on your ability to get pregnant. And it very rarely has any effect on pregnancy, labor, or birth. Most often an inverted uterus will correct itself by the second trimester, as it grows. After delivery, it may or may not return to its retroverted position.

Does walking help cervix dilate? ›

Getting up and moving around may help speed dilation by increasing blood flow. Walking around the room, doing simple movements in bed or chair, or even changing positions may encourage dilation. This is because the weight of the baby applies pressure to the cervix.

Does squatting help dilate cervix? ›

*Squatting can help open the pelvis and signal to the body that it's time to prepare for birth. Sitting in a supported deep squat and tapping into your core and pelvic floor connection can be extremely helpful during labor as well.

What should be the pelvic size for normal delivery? ›

Pelvic inlet: The obstetrical conjugate is the distance between the sacral promontory and the inner pubic arch; it should measure 11.5 cm or more.

How do you know the size of your pelvis? ›

Measure the circumference of your waist with the measuring tape parallel to the floor passing over your belly button. 9) Pelvis: measure the circumference of your pelvis at its widest point keeping the measuring tape parallel to the floor.

What happens if I don't push my baby out? ›

The truth is that giving birth is a physiological act and it's going to happen as long as the woman feels safe. Even if she's very tired, her body will go through the whole process of birth perfectly, with or without her active cooperation.

What is the most common fetal presentation quizlet? ›

LOA is the most common (and most favorable) fetal position for birthing today, followed by right occiput anterior (ROA). refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines.

How is a fetus positioned if it is in a frank breech position quizlet? ›

What is frank breech? In the frank breech position, both hips are flexed and both knees are extended so that the feet are adjacent to the fetal head.

Which of the following positions allows a fetus face or chin to present first in the pelvis? ›

In reference to the cephalic position, the fetus head is extended all the way back. This allows a face or chin to present first in the pelvis.

Which type of delivery is best? ›

Vaginal delivery is the most common and safest type of childbirth. You'll probably hear the term “natural childbirth” used to describe a vaginal delivery without medication for pain or to start or speed up labor. Some mothers will still choose to have other medical help during labor like a monitor for the baby's heart.

What are the 4 types of pelvis? ›

Although pelvises can be classified according to diameter, in obstetric practice they are often divided into 4 main types: gynecoid, android, anthropoid, and platypelloid, based mainly on the shape of the pelvic inlet [5].

Which type of pelvis is common and ideal for childbearing? ›

The Anthropoid pelvis

It has an oval brim and a slightly narrow pelvic cavity. The outlet is large, although some of the other diameters may be reduced. If the baby engages in the pelvis in an anterior position, labour would be expected to be straightforward in most cases.

Is Roa a good position for birth? ›

The ROA baby is not on the Spinning Babies® list of clearly ideal or optimal fetal positions. The ROA position is not clearly associated with a resulting labor pattern. The baby may rotate to the posterior and, if so, labor may have a posterior pattern of cluster contractions with slow downs or stalls.

Should baby be on left or right side? ›

Left is best. When baby is LOA, you'll feel the firmness of baby's back on the left side of your belly, the bulge of their butt up by your left ribs, kicks under the right side of your ribs or over by your right hip bone, and baby's heart beat will be strongest on the lower left side of your pelvis.

What is Roa mean in pregnancy? ›

Conversely, right occiput anterior (ROA) means the back of your baby's head is toward your front and slightly rotated to your right.

What is the best fetal position for birth quizlet? ›

What is the best fetal position for vaginal delivery? -vertex position (head down) with the back of the head furthest down= best position to deliver a baby.

How do you know if baby has engaged in pelvis? ›

In the last weeks, some time before birth, the baby's head should move down into your pelvis. When your baby's head moves down like this, it's said to be "engaged". When this happens, you may notice your bump seems to move down a little. Sometimes the head does not engage until labour starts.

Who kicks more boy or girl? ›

One study, published in 2001 in the journal Human Fetal and Neonatal Movement Patterns, found that boys may move around more in the womb than girls. The average number of leg movements was much higher in the boys compared to the girls at 20, 34 and 37 weeks, that study found.

What is the last organ to develop in a fetus? ›

Most babies move to a head-down position in the uterus toward the end, with the head on the mother's pubic bone. The lungs are the last major organ to finish developing.

Is it painful when the baby is turning head down? ›

External cephalic version (ECV)

ECV means gently massaging your tummy to encourage your baby to turn by doing either a forward or backward flip in the womb. It can be uncomfortable, but it shouldn't be painful. You may be given some medication to relax the muscles in your womb before you have this.


1. How to help baby's head engage in the pelvis "The right way" - Forward Leaning Inversion
(Optimal Maternal Positioning)
2. Birth Positions For Easier Labor | Optimal Maternal Positioning
3. Exercises to INDUCE LABOR at HOME fast | Get baby in position & engaged!
(Fearless Momma Birth)
4. Tips To Help Keep Your Baby In Optimal Position For Birth
(Fit Mums Channel)
5. How to use a Peanut Ball during labor and birth to enable labor to progress the correct way
(Optimal Maternal Positioning)
6. Optimal Fetal Positioning Tips & Tricks
(Antenatal Ireland)

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