Hearing that your baby is in a posterior position can feel discouraging, especially if you’re hoping for a smoother labor and delivery experience. While many babies naturally rotate before or during labor, some remain in a posterior position, which can sometimes contribute to longer or more difficult labors.

A posterior baby, often called “sunny-side up,” is positioned with the back of the head toward the mother’s back instead of facing her spine. Although many women still have successful vaginal births with posterior babies, healthcare providers generally consider an anterior position more favorable for birth.

Several natural techniques may encourage your baby to rotate before or during labor. Understanding what a posterior position means and what options may help can give you more confidence as you prepare for birth.

What Is a Posterior Baby?

The full medical term for a posterior baby is “fetal occiput posterior.” This means the back of the baby’s head (occiput) is toward the mother’s back (posterior). In other words, the baby’s spine is to the mother’s spine.¹ You may also hear a posterior baby referred to as a “sunny side up baby.” This is because if a mother gives birth on her back, the baby will be face-up when they come out of the birth canal. Baby’s face (its “sunny side”) is facing up.¹¹

How Common Is the Posterior Position for a Baby?

Posterior positioning is relatively common during late pregnancy and early labor, though many babies rotate on their own before delivery.

Between 15% and 32% of babies are posterior when labor begins. When your cervix fully dilates, and it’s time for delivery, the likelihood that your baby is still posterior is between 1.8% and 12.9%. Since many babies rotate independently during labor, posterior babies are more common in the earlier stages.^2,3

Related: Signs of Labor: How To Know When Baby Is Coming

Why Does a Posterior Baby Position Matter?

The best fetal position for birth is called occiput anterior, meaning the baby is facing the mother’s back. It’s when the crown of baby’s head emerges first through the dilated cervix, and the chin is likely flexing toward the chest. This position minimizes the baby’s head diameter, allowing it to fit optimally through the mother’s pelvis and birth canal.³

When a baby is posterior or faces forward, the presenting part of the head is larger. This can make labor and delivery longer and more complex.⁹

Related: Guide to Breech Baby Delivery Options

Risks of Having a Posterior Baby

Although many posterior babies are born safely, this position can sometimes increase the likelihood of certain labor and delivery complications for both mom and baby.³

Risks to the mother giving birth include the following:^13,14,15

• Longer labor
• Increased likelihood of labor augmentation
• Operative vaginal deliveries
• C-section
• Worsened tearing (third- or fourth-degree perineal lacerations)¹⁰
• Hemorrhage

Risks to baby include:^10,13,14,15

• Lower APGAR scores
• Increased rates of NICU admissions
• Longer hospitalization

Many of the risks to a posterior baby are related to the fact that their positioning often causes more prolonged labor.⁴

Related: Perineal Tearing: How To Reduce Your Chance of Tearing and Heal After Baby

Who Is Likely To Have a Posterior Baby?

Certain maternal and pregnancy factors are associated with a higher likelihood of a baby remaining in the posterior position through labor and birth.³

• First-time mothers
• Black mothers
• Moms older than 35
• Moms of shorter height
• Moms whose labor was induced or augmented with Pitocin
• Moms with an anterior placenta
• Babies past their due date
• Large babies

How Do I Know if My Baby Is Posterior?

Many women wonder whether they can tell if their baby is posterior before labor begins. Some of these signs may suggest your baby is posterior, but confirming fetal position often requires an exam or ultrasound.

Back Labor

Back labor refers to pain in your lower back during labor contractions. It may persist between contractions, whereas uterine pain is relieved between contractions. Back labor is worse when baby is posterior because the back of their head pushes on your spine and tailbone. If you experience back labor, you can be suspicious that your baby is in the posterior position.^2,5

Related: The Best Comfort Techniques for Back Labor

Leopold’s Maneuvers

Your provider may perform hand movements on your abdomen to identify which part of baby’s body is presenting at each part of your uterus. Your provider’s experience, your baby’s gestational age, and body mass can all affect the accuracy of these maneuvers for identifying fetal position and orientation.⁶

Digital Vaginal Examination

During a vaginal exam, your provider may be able to feel the soft spots (or fontanelles) on your baby’s head. This can help them identify the baby’s head orientation and determine whether your baby is posterior. This method of determining the baby’s position is often inaccurate, but more likely accurate with more experienced providers, if the cervix is more dilated, and if the baby is more descended.^3,5

Ultrasound

Ultrasound is the superior method of confirming a baby’s position during labor. (Depending on your baby’s height, a doctor can perform an ultrasound on your abdomen, through your vagina, or on your perineum.) If you’re giving birth in a hospital, most labor and delivery units have a portable ultrasound machine to observe a baby’s position quickly.^3,5

Related: How to Flip a Breech Baby and What You Need to Know

How To Naturally Turn Your Posterior Baby

While no technique can guarantee that a baby will rotate, several positions, movements, and comfort measures may encourage a posterior baby to turn before or during labor. Many of these positions and movements are commonly referred to as posterior baby exercises and are designed to encourage optimal fetal positioning.

Gravity

A baby’s head and back are the densest parts of their bodies. Any maternal position that allows her belly to act as a hammock lets the baby’s heavy back rotate toward the mother’s front. Forward-leaning positions also make the uterus larger and rounder, leaving more room for baby to rotate.⁴

Examples of forward-leaning labor positions that work with gravity to rotate your baby include:^2,4

• All fours or hands and knees
• Standing while leaning forward and resting hands on a bed, wall, or ball
• Straddling an armless chair backward and resting arms and head on the back of the chair

Pelvic Rocking

Pelvic rocking, or pelvic tilts, also uses gravity and can effectively encourage your baby to rotate its back toward your front.⁴ For pelvic tilts, get on the floor or bed on all fours and alternate arching your back to the sky and the ground. Crawling on your hands and knees across the floor can mimic this pelvic movement and allow baby to move into a better position.²

Rebozo

While there are no formal studies on its efficacy, a rebozo, or a Mexican woven shawl, has a rich history and tradition of repositioning a fetus.

It can also provide physical relief and comfort during labor. There have been anecdotal reports and case studies of rebozo work helping to get a baby into the best position for delivery.⁷

A large scarf or a folded bedsheet will also work in place of a rebozo. To use the rebozo technique, a laboring mom can be on her hands and knees, in a child’s pose position, or lie on her back. Depending on which position is most comfortable and practical, the rebozo can serve as a hammock or a grip for the mom’s buttocks, hips, or belly to aid in rocking, sifting, or shimmying the baby to encourage them to reposition.⁷

Related: Rebozo: What Is It and How To Use It in Labor

Relaxation

Relaxing the uterus and pelvic floor may create more space for your baby to move into a better position for birth. Some of these relaxation and repositioning methods include Webster chiropractic care and acupuncture. Both can be effective when performed by a qualified professional.⁸

If these natural methods of rotating your posterior baby fail, rest assured that baby may turn spontaneously at delivery. Contrary to traditional beliefs, evidence suggests that such interventions may not always be warranted, particularly when diagnosing an occiput posterior position antepartum or during the early stages of labor. Studies indicate spontaneous rotation to the occiput anterior typically occurs without additional measures, rendering interventions unnecessary.¹² If not, your provider may also attempt manual rotation of your baby’s head to help your vaginal delivery go more smoothly.^3,5

Posterior positioning is common, and many babies continue to turn before or during labor. In fact, many posterior babies turn during labor without any intervention at all.

While no method can guarantee a baby will turn, these techniques may encourage better positioning and help you feel more proactive as you prepare for birth. If you have concerns about your baby’s position, talk with your healthcare provider about the options that may be appropriate for your situation.