To help baby engage in the brim

Sometimes labor seems late to start because the baby isn't able to enter the pelvis. Usually the first baby will engage about two weeks before the due date. Many of the occiput posterior babies don't engage before labor starts. Some do, of course. When the baby hasn't engaged and the due date has come and gone, I've almost always found the baby to be in the posterior position. When labor does start, contractions can be strong without much dilation and the baby remains high in the pelvis. Before the cervix opens well, we need to help baby come down into the pelvis well.

Mothers and midwives alike can feel frustration when the baby is still high at the end of pregnancy or as labor begins. Studies report that a first time mother has a high chance of cesarean section if the baby hasn't dropped by the time labor begins. After all, the baby has to get into the pelvis in order to go through the pelvis.

The techniques to help a baby drop, or engage, center around making space at the top of the pelvis to let baby in.

 

  • Align the pelvic brim
  • Align the sacrum which may be rotated on a vertical axis and distorting the lower uterine segment
  • Relax the spasm out of the cervical ligaments (history of retroverted cervix)

  • Relax the psoas muscle pair (the illiopsoas)

  • These and other ways to help baby tuck the chin (flex the head)
  • Helping a baby rotate to left occiput transverse (lateral), left occiput anterior or occiput anterior

These can be done before labor or during labor with body work.

It would be quite rare to have a placenta blocking baby's way and preventing engagement.  The soft tissue issues of a twist in the lower uterine segment from the above list is more common. A tight psoas can be another cause.



 

In Labor, techniques to help the baby engage



 

  • Ten contractions in a row doing the abdominal lift
  • Sitting on a firm birthing ball and doing rather rapid hip circles (hoola hoops) or figure "8s"
  • Open the pelvic brim with Walcher's trochanter roll
  • Open-knee stretch in the pool (Walcher's in the pool)
  • Again, helping baby rotate to the LOT, LOA, or OA fetal positions so the head fits more readily
  • Helping the baby tuck his chin with the abdominal lift and with circles on a birthing ball

 

Contractions can be quite strong, long, close together and painful until the baby engages for some labors. The early labor can go on for a day or two or three. Women in this situation often don't dilate beyond 3 cm when the baby is so high. Once the baby engages and comes down closer to the cervix, perhaps the baby rotated and dropped into the pelvis, then the labor often seems to stall. Its just the uterus resting. The mother can rest too, as long as her and baby's vital signs are good. 

Once the uterus is rested and the mother fed and slept, the labor will pick up. It won't seem as painful as it starts up again and the contractions will be more manageable. Then they will get closer and longer lasting and the cervix will open in response this time. Things will be more predictable and as expected when the baby's chin is tucked and the head fits the pelvis better.

If the baby drops but the chin remains up, though the baby is coming down, the labor can still take a long time.

If the baby drops but the head is tipped, as if the baby is listening to the outside world, in an asynclitic position, then the labor will remain long. Opening the pelvis at each level for the head to pass through helps. See the article on asynclitism in Baby Positions.

Generally, the Walcher's position does amazing work in just three contractions to help the baby engage.

Generally, we hope for rotation before engagement when baby starts posterior. Don't go for descent before rotation unless you know the mother has a very roomy pelvis.

I hope you give these techniques a try if you need them after 38 weeks of pregnancy or once labor begins. Write and let me know. We'd like to hear more stories.