Anterior Placenta
What is the effect of an anterior placenta on fetal positioning?
An anterior placenta means that the placenta is located on the front of the uterus. Most of the baby will be hidden behind it. Palpation (a hands-on exam through the skin) can be more difficult, whereas, an ultrasound can determine the baby's position pretty well.
It is a common belief that the anterior placement of the placenta causes the baby to be posterior. The fact that this is sometimes true doesn't mean it is always true. Babies can be anterior with an anterior placenta. Abdominal tone, when loosened, can allow the baby to turn away from the placenta and face the mother's back.
In 1994, Gardberg studied the relationship between the placenta being located on the anterior wall of the uterus and the position of the baby near the due date.
Journal: Acta Obstetricia et Gynecologica Scandinavica 1994, Vol. 73, No. 2, Pages 151-152
Title: Anterior placental location predisposes for occiput posterior presentation near term
Authors: Mikael Gardberg
and Marketta Tuppurainen
Location: Department of Obstetrics and Gynecology, Vaasa Central Hospital, Vaasa, Finland
325
sonographies [Ultrasound] were performed in singleton pregnancies past 36 weeks with
the fetus in a vertex position [head down] in order to examine a possible
association between placental localization and occiput posterior
presentation (OP). OP was found in 11.6% of all cases. The distribution
of the placental locations in the OP group differed significantly from
the occiput anterior (OA) group. Also, an anterior placental location
was seen significantly more often in the OP group.
Gail's thoughts: Notice, however, that Occiput Posterior occurred a little more than one
in ten. This study was unlikely to have considered that babies in the
Right Occiput Transverse presentation are likely to rotate to the OP
position under usual labor "management."
An anterior placenta can contribute to a baby's
posterior position. However, babies can also be anterior with an
anterior placenta.
“Hi, Gail,
I was told at 18 weeks [gestation] that I had an anterior placenta.
The midwife I saw last week told me bub was probably posterior, and the heartbeat was low on my left hand side. The head was down which made me happy...I have been feeling most movements on the right hand side, just under my ribs, but also some lower on the left hand side (below my belly button, towards the left). This seemed to me to fit with your description of LOT, which I gather is much more favorable than a true posterior presentation. I wonder what your opinion is?
I have been spending time lying on my tummy supported by pillows, and kneeling with my tummy over the gym ball, since I saw the midwife last week, and I always sleep predominantly on my left side. Do you have any other suggestions for postures or exercises I should be adopting in order to achieve/maintain the best possible foetal position? Hope you can help with some suggestions for me, as I am feeling a little lost...
Thanks, Wendy
Dear Wendy,
Please don't feel lost.
It sounds more like you have an LOP baby from your description and the midwife's findings.
Follow the 3 Principles of Spinning Babies.
First Principle, Balance your uterus.
To do this, you may do 1-5 very short inversions a day and other techniques. See Techniques. Most first time mothers will find that the inversion helps to relax the uterine tone. By releasing the chronic tension caused by sitting in chairs in school and at the computer, we can relax the broad and round ligaments to let the baby rotate past them into the left occiput anterior (or left occiput transverse/lateral) position to begin labor in.
You may be able to reach a balance to allow improved fetal position by doing activities in your home. But a number of women may need a professional body worker, someone who knows myofascial release.
Being sifted with a rebozo and/or having myofascial release of your abdomen (diaphragmatic release) and sacrum (standing sacral release) are usually necessary to reposition the head of an OP baby which is behind an anterior placenta.
However, labor contractions might also help reposition your baby by softening the lower uterine segment over time.
See the list of Professionals in the Pregnancy section to see what other help is available. If doing one or two things doesn’t work within days, than add techniques or seek professional assistance.
Second Principle, apply gravity using Maternal Positioning.
When your uterine tone is made flexible the maternal positioning techniques you are using will be much more effective.
In labor, kneeling and leaning over a ball is a good choice. Let your knees remain further from your belly rather than folded up near the ball and your belly, if you can follow that description. Don't worry about lying mostly on your left side, the right side is good, too, unless your midwife tells you to lay mostly on your left for your blood pressure. Changing your position every 30 minutes to 2 hours is best. (Let a sleeping woman snore. Don’t wake a woman to have her change position unless it is medically necessary.)
You can try the inversion as shown in the Techniques section. Have a helper to help you maneuver on the stairs safely.
Drink a gallon of fluid (not counting milk consumption since that turns to cheese during digestion) every day. This will increase your amniotic fluid and support movement of the baby.
Third, Movement (of the Mother).
When the baby is active it is a good time to get down on your hands and knees and do 40 pelvic rocks. It may even be a good time to do the inversion (though not shortly after eating a meal!)
Swimming in deep warm water is helpful, too, since a submerged belly is easier for baby to adjust position in. It would be hard to time this to baby’s active time unless you noticed a daily pattern with a reliable active time. Driving to the pool may put baby back to sleep, however!
The baby can use the pelvic mobility to rotate to LOT and then LOA as descent occurs. This is what I see work.
If the baby doesn't change position in pregnancy, doing these things will help the pelvis be more mobile in labor.
Have a great birth!
Gail
