Sunny side up sounds intensely cheerful, conjuring images of bright morning breakfasts and summer days. But hearing that the baby you are carrying is positioned for a sunny side up delivery is far less cheerful.
But not to fear, only 5 to 8 percent of all births are sunny side up. While your baby may not be ideally positioned for birth there is plenty you can do to prepare for — and possibly even avoid — any issues.
Also known as the occiput posterior position (OP), or posterior position, a sunny side up baby is a baby positioned head down but facing mom’s abdomen, so the baby’s occipital bone (the skull) is against the back of your pelvis.
Because a baby birthed vaginally in this position enters the world facing up, the term “sunny side up” is often applied to these deliveries.
After 34 weeks of pregnancy, your prenatal care will include your healthcare practitioner, doctor, or midwife checking the position of your baby. They’ll often estimate the position by simply feeling the outside of your belly, but the most accurate and reliable way to determine the baby’s position is with an ultrasound.
At some point, they may tell you that your baby is in this position.
What about this position makes it less desirable?
In the sunny side up position, the baby’s back is extended along mom’s spine and baby’s chin is lifted, making the head seem larger as it enters the pelvis versus if the baby is in the anterior position. (The head circumference measures larger from the back than it does from the front).
If you learn that your baby is in this position, take a deep breath. It will be okay! You can still have an entirely successful vaginal delivery, despite the additional strain a face-up position may bring.
Also, keep in mind, while many women are told their near-term babies are in this position, most babies naturally move into the preferred anterior position before delivery.
There are several positions that your baby may be in over the course of your pregnancy.
The best position for delivery is occiput anterior (OA), or “face-down.” This is also referred to as cephalic presentation. This is when baby is in a head-down position and the body is facing mom’s back. In this position, it is easier for the baby’s back to curl and chin to tuck as it travels through the pelvis.
If the baby is situated head-up in the mother’s uterus, feet aimed to enter the pelvis first, this is called the breech position. Most babies turn to head down naturally by 34 weeks.
But if the baby hasn’t turned by 36 weeks (when there is little to no room left to wiggle around), your healthcare provider will want to discuss the options for turning the baby and for delivery.
Extremely rare and also known as the sideways or shoulder position, when the baby is transverse lie, he or she is laying horizontally (crosswise) in the uterus.
This means the baby’s shoulder may enter the pelvis first, causing the baby to potentially sustain more birth trauma. If an examination finds that your baby is still in this position by 38 weeks, your doctor or midwife will discuss the delivery options available for you.
As with everything in life, labor comes with some risks. The sunny side up, or posterior position, puts baby’s head where it is more likely to get wedged against the pubic bone.
When this happens, pressure is placed on your spine and sacrum and can cause a longer and more painful delivery.
The potential complications of a sunny side up delivery include:
- back labor (more pain in the back than in the abdomen)
- prolonged labor and delivery
- severe perineal tearing
- increased risk for assisted vaginal delivery (forceps or vacuum)
- increased need for a cesarean delivery
- start and stop labor pattern
- less engagement from baby during pushing stage
- longer neonatal stay (admission to NICU) in the hospital
If too much strain is placed on you or your baby during labor, your healthcare practitioner, doctor, or midwife will decide if an assisted vaginal delivery or cesarean delivery is necessary.
If you’re nearing full term and your baby is in the occiput posterior position, try not to stress. The human body is capable of many things. Do spend some time discussing the potential risks for both you and your baby in detail with your healthcare provider before agreeing to any procedure.
Pay attention to your body. Your anatomical structure, your posture, and your level of activity all play an important role in how you progress through labor and delivery.
First-time mothers and women with an android pelvis (a narrow pelvic canal) are more likely to have a sunny side up baby. While you can’t change your pelvic shape, you can be aware of possible challenges and discuss options with your doctor.
Likely to be present in taller women, an android shaped pelvis has a heart-shaped or triangular inlet, which can make childbirth more difficult. Unlike women with a gynaecoid pelvis (optimal pelvic shape for having babies), women with an android pelvis typically have to push harder, move around more, and may encounter more labor and delivery difficulties.
Good posture also plays is a key role in how the baby’s position presents at the time of labor and delivery.
Staying in proper alignment while moving your hip and pelvic joints will help the baby move into a more optimal position. To help facilitate a natural rotation of position, stand up straight and keep active. Use an exercise ball instead of a chair (it forces proper alignment). Take a walk around the block.
If you sit for hours throughout the day, keep both feet firmly on the ground, lengthen your spine like a giraffe’s neck, and keep your shoulders back
Once active labor has begun, don’t feel like you have to stay in one laboring position. One
Women who favor other positions, such as on all fours, squatting, and sitting on a ball, may have a better chance of rotating the baby to an anterior position before delivery. As an added bonus, hands-and-knees positioning, where you’re relieving pressure of the baby pushing against your spine, can help provide pain relief, too.
It’s possible during labor that your doctor may suggest using forceps or a vacuum when a sunny side up baby gets stuck against the pelvic bone. Some doctors and midwives will even perform manual rotation from a posterior to an anterior position at full dilation.
Every woman, every baby, and every delivery is different.
Despite the difficulties, you can have a healthy vaginal delivery with a sunny side up baby. Working with your healthcare provider and discussing your options is key to your success.
If you have a sunny side up baby, it will be okay! Stay positive.
And don’t forget to stand up straight.