Introduction

This month’s Brilliant Activities for Birth Educators idea suggests an effective and fun way to help pregnant families learn about the baby’s position in utero, and consider ways that their actions and movements can influence those positions.  It incorporates an ingenious tool created by Andrea Lythgoe, longtime Lamaze Certified Childbirth Educator and easily can be applied to both virtual and in-person classes.  For free access to all the Brilliant Activities for Birth educator posts, please follow this link.

The laboring person’s pelvis and the baby’s head fit together like a lock and key.  But getting that key correctly placed in the lock can at times be challenging. Depending on how the baby’s head is lined up and moves as it descends and rotates through the parent’s pelvis during labor can make the difference between an efficient and effective labor and birth or a long, difficult labor, potentially painful back labor and an extended pushing period.

Helping families to understand exactly what their health care provider means when they are sharing their assessment of the baby’s position can be useful.  Families may be unfamiliar or confused by the information or the terminology used, or often both.  Once pregnant people have a clearer idea of what the baby is doing when the provider provides the baby’s position, they can start to consider movements and positions that will promote the baby rotating into a position that supports further progress. Andrea’s tool makes this concept easy to understand and helps the childbirth educator communicate the impact of movement, position changes and upright pushing positions during the labor and birth.

Material

• Exploring Head Down Positions Interactive Tool (shared with permission of Andrea Lythgoe)
• Fetus
• Pelvis
• Device connected to the internet for families to access the tool link

When to conduct this activity

There are many points during a childbirth class where this activity might be appropriate.  When talking about the six ways to progress in labor, when practicing positions and movements that are helpful for promoting labor progress, and when talking about labor variations such as a malpositioned baby that can create difficulties and may require interventions in first or second stage.

How long to allow for this activity

Allowing about 10-15 minutes from start to finish would be enough time to explain the concept, introduce the tool and allow families to try it along with some practice positions.

How to conduct this activity

Introduce the pelvis and take a moment to show how it is wider from side to side at the inlet and front to back at the outlet.  Demonstrate how the sacrum has the ability to move and increase the space available for the baby as it descends and rotates.  Show families how the fetal head is also widest from front to back and how the baby tucks its chin to its chest to help decrease the head diameter.  Let families know that the baby’s head is made of five bony plates, with suture lines and fontanels where the plates come together.  This allows the head to mold during labor and birth.

Demonstrate how the baby enters the pelvis and needs to rotate in order to be born.  Let families know that each position the baby might assume as it rotates has a name, based on the position of the baby’s Occiput bone compared to the front, back and left and right sides of the birthing person.  Health care providers often assess this position during a cervical exam, but this assessment can be inaccurate.

At this point, you can bring up the Exploring Head Down Positions Interactive Tool on a large screen in an in-person class, or share the link with families to access on their device.  In a virtual classroom, you can share your screen or invite families to go to the shared link on their device.

You and/or the families can click through the various positions on the interactive tool to understand how the baby is orientated in each position.  As the instructor, challenge the families to consider how they might change the shape of their pelvis to encourage the baby to continue its rotation into a more suitable position.  What positions might be helpful?  Encourage them to practice them, through demo and return activities.

Use the interactive tool to show how the baby’s position might create a painful back labor situation.  Encourage families to watch how the baby has to rotate to fit through both the inlet and the outlet.

What families say about this activity

For people first learning about labor and birth, the concept of the baby’s position in relation to their own body can be confusing and difficult to visualize.  Families really appreciate the opportunity to virtually manipulate the baby to fully understand all the possibilities.  It makes the concepts you are explaining as an educator easier to understand and brings home how effective moving and changing position can be during labor.  They have a clear understanding of what their health care provider is saying when they share their assessment of the baby’s position.

Conclusion

Lamaze International’s Healthy Birth Practice 2: Walk, move around and change positions throughout labor and Healthy Birth Practice 5: Avoid giving birth on your back and follow your body's urges to push, take on more significance when families understand how a baby may be oriented in their pelvis and what changes the baby makes to its position as the labor and birth progress.  Andrea Lythgoe’s clever creation; Exploring Head Down Positions Interactive Tool makes explaining this concept easy, fun and interactive.  Why not consider how you might incorporate it into your in-person or virtual childbirth classes.

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