Let’s talk about the biggest childbirth lie ever sold. Prenatal optimal fetal positioning.
This prevailing notion that maternal positioning in pregnancy can prevent a posterior baby in labor and improve outcomes. This is one of the most persistent lies sold in the childbirth profession.
I accept right up front that there are many people who will not like this post. Many will become defensive and angry. There is nothing more humbling than finding out you were wrong.
It sucks. It wounds your pride a little, sometimes a lot. I get it. I’ve been there.
This notion persists in spite of countless studies spanning from the 1800s to present that find that there is no difference in outcomes. So why do birth professionals continue to believe and teach that if we just have mothers assume certain positions to “correct a malpositioned baby during pregnancy” we can prevent a posterior baby in labor?
This practice is outdated and unfounded, devoid of any supporting research, and persists and is profited from daily.
If you’re a birth professional reading this, do you subscribe to this disproven theory and if so are you passing it on to your clients? If so, why?
I used to be that person who was 100% committed to prenatal optimal fetal positioning. I taught it to clients, it was like a religion. For so long I bought into that lie. I sold that lie. Believing all the while that I was helping my clients.
My first was born direct occiput posterior. I was 15 years old, and yes, he was born vaginally.
I spent years after I became a doula believing that it was my positioning during pregnancy that caused it. Then I was forced to confront my assumptions. I’m not gonna lie, It was a painful process. But pain is often a necessary part of growth.
You know what happened to my outcomes when I stopped buying into the prenatal optimal fetal positioning lie?
THEY STAYED THE SAME! There was no increase in cesarean births, my client’s labors didn’t become longer, nothing changed. Let me repeat that, nothing changed. And yes, for the majority of my career I tracked outcomes.
I cringe when I remember telling clients to balance their driving time with hands and knees time because our modern bucket seats keep our knees higher than our pelvis and contribute to a posterior baby in labor. I cringe when I think of telling my clients to avoid recliners and reclining positions or they’d influence their baby to turn posterior. I’d elaborate on how that would make labor longer, more painful and increased their odds of having a cesarean birth.
But there’s nothing more upsetting than imposing beliefs on another even with the best of intentions and having them feel like a failure for not “doing it right,” because their baby was posterior in labor at some point.
When something “seems to work” we need to be willing to look deeper and be critical and look for confirmation bias.
Confirmation bias is a phenomenon wherein decision makers have been shown to actively seek out and assign more weight to evidence that confirms their hypothesis, and ignore or underweigh evidence that could disconfirm their hypothesis.
I think a lot of birth professionals actively work against the body and the baby when they try to “fix” something that they assume is broken. Somewhere along the way, we seem to have lost our faith. Faith in the body and the baby to navigate this thing called labor and birth together. As they have for thousands of years.
Some doulas curse the medical system for not leaving birthing individuals and babies alone. Yet at the same time fail to see that what they are doing is just as distrustful and potentially damaging.
I’ve been confronted by birth professionals who have all but demanded that I sit down and shut up when it comes to this topic.
I will not be silent. There is no science to support that maternal posture in pregnancy has any impact on fetal position in labor. Stop the madness.