Head Down Baby — Optimal Fetal Positioning

Thank you 😉 Had a scan at OB appt today and saw that little head was down!!! Yesssss..! You can stick your fingers up my butt anytime :)) ~ Client, 36 weeks pregnant

Let me clarify, I was releasing her pelvic floor muscles (externally), but we did work on her piriformis and hip rotator muscles, deep to her glutes too, so close. One of the primary concerns of this client was the position of her baby – a transverse lie, uncomfortable for her and not exactly conducive to an easy delivery.

One of my goals when working with pregnant women is to facilitate optimal fetal position. Biomechanically correct alignment and full mobility of the pelvic bones (sacrum, ilia, and coccyx) is essential. The sacrum needs to counter-nutate (the top portion moves backward while the lower (tailbone) part moves forward to increase the diameter of the pelvic inlet. Movement allows the baby’s head to enter into the pelvis. Later the sacrum needs to nutate (the tailbone moves backward) to increase the diameter of the pelvic outlet for delivery.

I often find restricted mobility in one sacroiliac (SI) joint (typically the left) with compensatory instability and irritation in the other SI joint. The pubic symphysis may also react, leading to a constellation of symptoms and dysfunction commonly labeled pelvic girdle pain. The restricted movement may prevent the baby from assuming a head-down position as space is limited. The alignment and mobility of the entire spinal column are also important as imbalances above can create abnormal stresses on the pelvis. Similarly, altered foot and leg mechanics can affect the pelvis from below.

The psoas muscle is a frequent contributor to altered alignment. Excessive tension can affect organ function, restrict blood flow and alter neurological input. Intimately connected to the diaphragm, the psoai (plural of psoas) can inhibit active breathing, increase internal pressures and reduces interior space, pushing the uterus and baby forward and out in front of the body. Imbalances between the left and right can cause the uterus to deviate slightly to one side affecting the fetal position. (If you look at the illustration below you can see how the psoas muscles, attaching to the lumbar vertebrae, can cause the spine and pelvis to bend or twist slightly.) The psoai also help guide the spiral descent of the baby’s head through the pelvis.

The pelvic floor muscles play a crucial role too. Hypertonic pelvic floor muscles pull the lower part of the sacrum and coccyx forward and restrict sacral nutation and counter-nutation. They also limit the mobility of the ilia that form the remainder of the pelvic bowl. Osteopathically we consider the pelvic floor muscles to be a diaphragm, moving in sync with the thoracic diaphragm to balance pressures. Hence, the tension here also reduces space for an optimal fetal position.

So by releasing tension in my clients pelvic floor and “butt” muscles I was helping mobilize her bony pelvis to create space. In turn, this helps release the internal ligaments attaching to the uterus and cervix to correct their position and ultimately that of the baby. We also worked on her psoas and adductor/hamstring group (in direct relation to the pelvic floor muscles), necessary for achieving healthy pelvic alignment.

I recommended she practice actively breathing into her lower ribcage regularly, in addition to psoas release. And walk, of course! I also reminded her of correct sitting posture with a neutral pelvis and ribcage – on her sit bones (ischial tuberosities) with ribs relaxed down as much as possible.

After our first session working on fetal positioning, she was much more comfortable and felt the baby had more room to move. At our follow-up appointment three weeks later she described her morning routine of sitting cross-legged on a bolster, actively breathing, as so relaxing that she could fall back asleep after five minutes or so. We both felt the baby was now in an optimal position, head down facing her sacrum. The following day I received an excited email confirming the good news.

How you move plays a tremendous role in how your body functions. Sometimes a few changes can make a big difference. Here’s a quick how-to on active breathing:

Active Breathing

• Wrap a yoga strap around your ribcage at bra strap level; hold it at your sides palms up or Tie a pair of stretchy nylons or exercise tubing around your ribcage so your hands can relax.
• Stand in alignment (feet pelvis width, outside edges parallel, hips over heels with butt untucked and ribs relaxed down) or Sit comfortably with weight on sit bones. Allow the front of your ribcage to relax down.
• Breathe deeply, feeling your ribcage expand into the resistance. You should feel the strap move.
• Take 10-15 breaths (1 set).
• Start with one set; build up to 3 or 4 sets as you get more comfortable.

Caution: You might feel a little dizzy if you overdo it as you will be taking in more oxygen than normal – all good!
Reminder: Please consult with your obstetrics provider if you have any health concerns before changing your exercise/movement routine.