Engagement, Rotation and Chin Tucking

This page contains a number of movements, postures, tips and tricks to help a baby to move into a favourable position, tuck their chin and engage in the pelvis before labour begins. They can also help the baby to move down through the mid pelvis during labour. These videos with the eggcup demonstrate why this order of helping is most effective. Prevention is better than cure, so if you ensure that you have made space and balance for the baby BEFORE the journey even begins, it will be more likely to go more smoothly.

Begin with Balance:

Find balance within your body. Address any areas of tightness or discomfort. If you are feeling a pain one side and not the other, in the front of your body or the back, seek some help to relieve this discomfort, it is most likely your body telling you something needs help there. Perhaps there is a tight muscle, a baby pressing backwards or to one side, tension in the fascia or a ligament.

We need to balance the tissues, to make the possibility of space for the baby to move. Before putting a key in a lock, we must first clear the cobwebs. Use massage, stretches, harmonics to balance and relax the body, boost that oxytocin and make space for the key to slot easily in. Click here to download a yoga flow for birth preparation. If your own exercise and stretches at home do not feel like enough or is not resolving discomfort, please seek help from a body worker such as an Osteopath or Physio who specialises in pregnancy or pelvic health and a pregnancy massage or reflexology treatment is always wonderful.

Harmonics to the left, Hamstring stretch above and seated Glute stretch to the right

Then Use Gravity:

Keeping upright helps the baby to come down into the pelvis in a good position, especially if you have made the space with balance and resting wisely in the lead up to your birth journey. Using gravity does not mean you have to be standing, dancing all of the time, though slow dancing with someone you like or love can feel wonderful in labour. Sitting on a birth ball is great throughout pregnancy, labour and beyond as well as walking, using stairs, lunging and squatting (don't worry you don't have to be a super athlete as there are tricks to make all of these easier).

Birth Balls:

Birth Balls are amazing (peanut balls are great too). To learn more about which size would be right for you and lots of different positions and things to do with them, click here.

Birth balls effectively put you into a squatting position with your knees lower than your hips which helps the baby to nestle forward into the hammock of your abdomen, rather than be pressed back to back against your spine. If you can, sit on a birth ball rather than an office chair when working at the computer, sit on one or drape yourself over one whilst relaxing at home as well. This way you will get birth fit without really realising it, as always you are moving slightly on the ball and engaging your muscles to keep you stable. This builds up strength subtly over time that can really make all the difference when you have your baby (and after in carrying them around as they just keep getting heavier and heavier).

Birth balls are great in pregnancy, during labour and after birth too. They are fantastic for rocking or bouncing a baby and are a soft comfortable place to sit after birth. When they are born, babies seem to know when you sit down and often they don't like it. The birth ball however seems to have magical powers, so you can sit and rock and roll and bounce. The baby is happy and you can be comfortable and exercising gently. You can usually pick them up for around £15-20 and they will sell easily again when you have finished with them. What's not to love?!

Helpful Positions with a Birth Ball:

Sitting on it:

The ball is soft so is much nicer for your pelvis and pelvic floor than a hard chair, it encourages you to have a forward tilt in your pelvis, helping your baby to move into a more favourable position. You can plant your feet wide and do giant circles to help your baby find a space to rotate and settle down into your pelvis. You can rock or sway gently with the rhythm of your surges and you can also bounce if this feels nice for you. Remember you can sit on your ball and lean on a companion or a bed or other surface, you do not have to be bolt upright. Find your comfort.

Leaning on it:

The birth ball is a great leaning surface. You can use it naked or cover it with a scarf or add pillows on top if you would like, to lean and rest your upper body. The positions and uses are pretty much only ending with the limit of your imagination but here are a few ideas that you could find useful:

Leaning over on all fours to rock back and forth or perhaps have some harmonic techniques
Leaning as you do kneeling side lunges
Having the birth ball on the bed so you can stand and lean over it (you can also use a birth companion for this and they can hug back if that would feel nice for you)

Help with Specific things:

If you have tried other things like circles on the ball, side lunges, side stair walking, etc and they are not working, you could try the following if they feel right for you:

An asynclytic or back to back baby - You can use the ball sat on a bed with your hips open and relaxed as wide as is comfortable and feet with the soles together, cradling the ball between your legs for you to lean on. You can rock forward and back here or side to side. If your baby is asynclytic and struggling to engage or enter the pelvis or press down on the cervix, you can do the pendulum technique where you have a birth companion either side of you and you swing vigorously between them catching you each side, swinging back and forth can help the baby to wiggle into the space

Opening the brim if you are a flexible yogi - If you are used to doing back bends in yoga, are flexible and strong, you can use the birth ball to lean back over in an adaptation of Walchers technique in order to open the brim of the pelvis. Make sure you have support each side to help guide you out of the position, as it is not likely to be comfortable. If you can hold for three surges, it could well be just the trick to help a baby into the pelvic inlet who has been struggling to do so

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Lunges:

Don't run away! You are not lunging for strength particularly in pregnancy (though if you love to strength train, and if feels right for you, crack on Amazon). Lunges can be hugely helpful to find balance in the pelvis and surrounding tissues as well as strength and flexibility in the legs, back, buttocks, abdomen and pelvic floor. Lunges are good because you do them on each side individually, which helps to bring balance to the body. There are lots of different ways to do lunges and lots of different types. General guidelines for lunges:

Do not let your knees overshoot your toes when lunging as this puts too much pressure on the knees
Try to keep the knees in line with the toes so you are not introducing a twist through the knee, hip or ankle
If lunging alone feels too challenging, do it with a companion or use a surface, scarf or birth ball to support you
Begin with a little and increase your depth, don't dive in too deep and put yourself off. Little and often, consistency is key

When using a scarf, tie a knot and close it the other side of the door to make sure it is secure

Make sure the knee does not go beyond the toes, whatever kind of lunge you are doing

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Types of lunges and how to do them:

Forward, back and side lunges are the types most useful in pregnancy and labour. Forward and back lunges are great for strength and balance of the muscles and pelvis, 5-10 each day, each side will really help and if you enjoy them, you can do more.

Forward lunges:

Have a partner, surface or scarf suspended from a doorway to hold on to if this feels right for you
Step one foot forward at about hip distance apart
The back leg is almost straight but knees are soft, do not lock them
With your front foot planted, all four corners of your foot anchored in the ground, sink your weight down as if you were a horse on a carousel. Keep your upperbody upright as if lifted from a piece of string above but angled slightly forward.
As you sink down, make sure your front knee does not go beyond your toes. Take at least one deep breath at the bottom, breathing all the way down to your baby and then rise back up.
You can repeat 5-10 times on this side and then switch to the other side. Notice if one side feels easier than the other, here we are creating balance

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Backward lunges:

Have a partner, surface or scarf suspended from a doorway to hold on to if this feels right for you
Step one foot backward at about hip distance apart
The back leg is almost straight but knees are soft, do not lock them
With your front foot planted, all four corners of your foot anchored in the ground, sink your weight down as if you were a horse on a carousel. Keep your upperbody upright as if lifted from a piece of string above but angled slightly forward.
As you sink down, make sure your front knee does not go beyond your toes and allow your back leg to bend, the knee going down towards the ground as far as is comfortable. Take at least one deep breath at the bottom, breathing all the way down to your baby and then rise back up stepping your back leg back in line with your front leg.
You can repeat 5-10 times on this side and then switch to the other side. Notice if one side feels easier than the other, here we are creating balance

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Side Lunges:

Side lunges are great for making space in the middle of the pelvis, so can be really useful in active labour
Have a partner, surface, birth ball or scarf suspended from a doorway to hold on to if this feels right for you, you can even use a higher surface like a step or chair to add a bit of a tilt to the pelvis if this feels right
Side lunges can be done on your feet or on your knees
Step one foot out at a diagonal angle to the front and side of your body
Keep your body upright as if suspended from above (or lean comfortably over a birth ball or companion) Move diagonally so your knee bends in line over your feet but does not extend over your toes. Rock back and forth 10 times or if in labour for 3-6 surges and then change sides

Squatting

Squatting is fantastic for building strength and for making space in the pelvis, aiding the descent of the baby through the pelvic bowl and eathside into your arms. You made it through lunges, so stick with me for squats and you might be pleasantly surprised.

Again, squats don't have to be scary. Sitting on a birth ball is a great way to build your strength and flexibillity, you are in a squat but you are supported and we LOVE supported squats. Use your birth ball, your scarf or your partner for the wonderful dangle. Your things don't need to burn for you to be in a squat.

Not all squats are equal, so read below:

The deep or malasana squat:

These can help to align your pelvis and provide a good balance of strengthening and stretch to the muscles of your pelvic floor and around your pelvis and abdomen. They can relieve low back pain and provide a good stretch for the calves, as well as being a great full range strength movement when you are coming in and out of the squat. As always you can use a scarf, surface or companion to help you to balance and move into and out of the squat, as well as something to support you in the squat if needed such as a yoga block or cushions. Remember your centre of gravity changes as your baby gets closer to coming to meet you, so always be mindful of your connection to the earth and your balance and choose the support that is right for you. Sitting in a deep squat for a few breaths a few times a day can be wonderfully soothing.

*Be cautious of using deep squats in late pregnancy if your baby is not in an optimal position.

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Parallel Squat:

These are great for building strength and pelvic flexibility and balance. When doing a squat use the support you need. As with lunges, keep your knees in line and level with your toes, do not overshoot your toes when squatting. The movement is best achieved by imagining you are sitting back into a chair. This means your hamstrings are greatly helping the movement and it takes strain off your knees.

This can feel wonderful in labour when holding onto a companion or door handles or scarf. You can come up between surges and rest on your companion or on the door and when you feel the urge, you can lean back into a squat. Rock or sway there if that feels nice for you.

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Outlet Opening Squat:

A lovely doula once said to me that she describes this squat as the nasty festival toilet squat.. You know, the one where you really don't want to have any contact with that toilet whatsoever! It is a great opener for the outlet of the pelvis. The arching of the back like this really opens the outlet, so if you are in the late stages of labour and this position feels right for you, make sure someone is ready to catch! This same arching can be achieved on hands and knees or leaning over a birthball or surface or edge of a pool.

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The Dangle:

This is a form of supported squat that can be held during surges with the support of a partner or scarf or birth sling/apparatus. The birthing person can stand up between surges and move around. There are different variations, this is hard work on a companion and the following may be useful to ease strain on the back and other muscles:

Supported squat - The companion stands behind the birthing person with their arms under the birthing persons shoulders, one leg is stepped back so they can support the weight of the birthing person leaning into them and hanging during a surge. This is heavy going and can be eased by using a wall behind the support person.

The birthing person can use a sling or scarf to support in a squat or lean as shown here. It is better if the sling can be supported from the ceiling as the birthing person can really lean back and relax into the support of the hammock.

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The companion can sit on a raised bed with chairs either side where their feet are planted directly under their knees (if the feet are closer or further away it will require muscular strength to support). The birthing person can then stand between the companion's legs, facing away from them and rest their bent arms over the thighs of the companion and gently lower and dangle so the weight is take off their legs and pelvis and they can hang during surges. The companion can press into the sides of the birthing person's chest gently during surges, hugging and supporting them.

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Resting Wisely:

Congratulations you made it through all the hard work! Now lets learn about resting wisely. Rest is very important in pregnancy, during birth and beyond and resting so that you and your baby benefit even more from that rest means you are killing it even when you are snoring! Awesome.

The best side to lie on when you are pregnant is your left. This allows for the baby to drop into the gentle hammock of your abdomen, away from your spine and major blood vessels so both your uterus and baby are comfortable and with a good blood supply and your baby is being encouraged to settle into the best position for birth which is generally Left Occiput Anterior (where the back left of their head is settled to the front left of your body). But why is this the best I hear you ask? Well if you would like to know in more detail, do consider joining one of my courses but suffice to say the left side of the uterus is more curved and so your baby is likely to settle into a chin tucked position ready to slot into your pelvis more easily so your labour is likely to be shorter and more comfortable for you both.

Why shouldn't you lie on your back or front?

If you wake up on your back or front when you are pregnant, please don't panic. It is normal to move about when you are asleep. You can readjust and get yourself comfortable, ready to go back to sleep again.

Lying on your back isn't great for a few reasons:

It encourages the baby to be back to back which potentially can lead to a longer and more difficult and uncomfortable labour
The baby, uterus and other abdominal organs fall backwards onto your vena cava and it can become a bit squashed and make you feel unwell, sick or dizzy

If you feel you might explode if you can't sleep on your stomach for 9 months, there are things you can do.. There are special pillows you can purchase to support around your bump, though they tend to be expensive or you can get a pool ring, semi inflate it and create your own nest with pillows and duvets to make your front sleeping dream a reality, with your baby bump suspended through the hole in the ring.

If lying on your side sounds good for you, remember you can lie on your left or right and change between the two.

It is best whatever position that you are in when sleeping that your spine is aligned and supported. Make sure your pillows aren't too high or low causing your neck to be bent.
Make sure your bump is supported when it gets larger, with a pillow to avoid strain.
Make sure your legs are supported from knee to ankle with a pillow in between if they are both straight or the one in front is supported so that your spine is not rotated. This helps to keep balance in the pelvis and prevent strain in the knees, hips and ankles as your joints become more lax through your pregnancy.

Take pillows in the car to the hospital. You don't have to carry them in all at once but have them nearby in case you need them, if you can, as they are often lacking in birth centres and on labour wards. You can NEVER have too many pillows. Ones from home also smells like home, so they can be really comforting and help to build oxytocin.

The roll over technique is described in the Labour Progress Handbook and is a useful way to rest in different positions to help of a labour has stalled. It uses gracity in different positions to help the baby find their way. You can see it described and illustrated here.

Shellie Poulter

Doula and Educator

Engagement, Rotation and Chin Tucking