Saturday, May 26, 2012

Helping the Baby Engage at The End of Pregnancy

...Solving the mystery of why I didn't go into labor on my own last time.

When I was at the end of my first pregnancy I had the general idea that when the baby engages, it's getting close to "go-time."  But I didn't have much more knowledge or insight into the whole ordeal.  

What is Engagement?

Your baby's  head is technically engaged when the widest diameter of the  head passes through the brim of your pelvis.  

How far the baby reaches down into the pelvis is measured in stations.  

Descent assessed by abdominal palpation:  Refers to the part of the head (divided into 5 parts) palpable above the symphysis pubis; recorded as a circle (O) at every vaginal examination.  At 0/5, the sinciput (S) is at the level of the symphysis pubis.  

What did that just say?  

How far the baby is down in the pelvis can be assessed by feeling the belly: You can feel how far the baby is engaged by feeling above the pelvic bone.  The head is divided into 5 parts.  At zero station (fully engaged) the front of the skull, from forehead to crown, is at the pubic bone level.  

Or...The extent of engagement is estimated by how many fingers you can grip the fetal head with. If all five fingers can grip the fetal head just above the mother’s pubic bone, the head is not yet engaged. When you can only grip it with the width of two fingers, the head is engaged.

When looking up these photos I found this general description of engagement on a doctor-y website:  

"Engagement is a common phenomenon at the end of the first pregnancy (36 weeks on) and is a positive sign that labor could start soon.  

Your baby's head does not need to be engaged for you to go into labor.  For the majority of women this is the case --- the baby's head is not engaged in the pelvis.  

If the fetal head remains very high at term then it is a concerning sign that the baby may not fit easily through the birth canal during labor, which could mean a more difficult and prolonged labor or else even an obstructed labor, resulting in a Cesarean section.  

Close application of the fetal head to the cervix will help the cervix to ripen for the onset of labor.  Alternatively if the fetal head is very high and not well applied to the cervix then it is more likely for a woman to go overdue and have an unfavorable cervix."  

So the first two statements of this description were basically all I was ever told during my first pregnancy.  And the tone of all of these statements kind of sounds like the treatment I was given during my first pregnancy.  A hands-off approach, just wait and see.  

The above statements make it sound like a baby's head may or may not engage, and there's not a lot anyone has to say about it.  And if it doesn't, well, the doctors are likely going to need to step in and take over.  

The funny thing is, I find this entire description to be contradictory to itself.  It says the baby's head does not need to be engaged to go into labor.  (Which IS true.)  BUT it goes on to say close application of the baby's head to the cervix will promote labor.  And if the baby's head stays high the mother is more likely to go overdue.  SO... it sounds like engagement is ideal for starting labor, perhaps necessary for some mothers to go into labor naturally.  And it also says labor will likely be more difficult if the baby stays up high.  

So it sounds like getting the baby to engage is pretty important.  

And this idea, is what I've been told in my second pregnancy.  As I've written before, my provider has told me she thinks I went overdue and was induced because my first baby was always in a awkward position and therefore never engaged.  So with her not pushing my cervix, there was nothing to promote my labor.  

My current care team's goal is actually to get this baby engaged (maybe not to zero station, but definitely down well into the pelvis) by 37 weeks!  Most literature that I've read says that after the first baby, subsequent babies usually don't engage until labor.  But yes, my care team is aware that it's my second pregnancy.  (And, even though I had a c-section, I fully dilated and pushed so I do count as a second time mom in terms of laboring.)  They just see engagement as a very good goal to achieve at the end of any pregnancy.  And I'd have to say I agree with them and am very excited about the prospect of the entire principle.  

For someone like me (who last time had an unengaged "floating" baby, causing me to go overdue to 42 weeks so that I was induced, which ended in a c-section), having the ability to help the baby do this, feels sooooo much better than just waiting around.  

So I've been given some very helpful tips that are very useful in encouraging the baby to engage.  

What can you do to help your baby engage? 

1: The first thing I was told was to see a Chiropractor.  

Here's why:
I was told there has been a lot of success for moms-to-be to help correct any pelvic and spinal alignment problems, allowing the baby to settle into the right position which will equate to engagement, which in turn will promote labor.  
(I was told the most likely reason I didn't go into labor last time was that my daughter was always malpositioned so that she couldn't press down on my cervix, and not having her press down was what held back the hormones which would be released to start labor.  And since she was malpositioned to start with, in our case, my baby wasn't able to correct it during our labor, which is what necessitated our c-section.)  

(For more Prenatal Chiropractic Benefits, see this entry.)

2: My prenatal chiropractor told me that putting on a maternity support belt after her adjustments will aid in getting the baby to engage.  And my caregiver agrees.  They both say wearing one is especially helpful in cases where a baby might otherwise engage and disengage during the end of pregnancy.  

Here's why:
Lifting the lower abdomen with a pregnancy belt can support the slope of the uterus and help the baby get into a better position and slip behind the pubic bone, instead of on top of it.  
     Loose ligaments are supported by wearing a pregnancy belt.  The baby can get angled in a way that gives them an advantage to improve fetal positioning.  A pregnancy belt may help the looseness that makes it hard for the baby to have a toned slope to settle head down on.  

3: The last thing I was told by both sources was to spend time on your hands and knees. (Don't wear your maternity support belt during this time. Let your belly hang freely.)  During this time do pelvic tilts, as well as any butt wiggling in general --- hip circles, figure eight movements --- anything that swings your hips.  My chiropractor says at least 20 minutes a day.  My caregiver says as much as possible.  (So I'm assuming she'd love even longer than 20 minutes a day.)  

Here's why:
Being on hands-and-knees opens the pelvis by 2 cm.  That, mixed with gravity pulling on the baby's heaviest parts, allows the baby the more space and opportunity to scoot down in the the pelvis.  The longer you are on your hands and knees, the more time you are giving the baby to do its job.  

4: It's also a good idea to stay very hydrated.  My chiropractor suggests drinking a gallon of water per day!  
Here's why:
Staying hydrated ensures your baby the best chance at having a good amount of amniotic fluid, which will allow he or she the freedom to move around in your womb with the most ease.  

Happy Engagement!

*Click here for more of my healthy pregnancy tips!

(Update 7/18/12: It took me a while (nearly 42 weeks), but I finally did go into labor on my own and had a successful VBAC.  You can read my birth story here.)


  1. Could you tell me what kind of belt you used? Thanks! This post is SO helpful!
    Alexis, CT

    1. Sure...I was told it didn't matter much what kind, so I just went to Motherhood Maternity and tried on all theirs to see what I liked. (Of course turned out to be the most expensive option.) It was very comfortable. It looks huge, so I thought it would be really visible under my clothes -- but it was actually much less visible than the small belts (because it doesn't make muffin top issues.

    2. And I did find their size recommendations to be accurate (order size small if your pre-pregnancy size was 3-6, size medium if your size was 7-16, size large if your size was 17-20).

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  2. Hi Lydia,

    I am currently 25 weeks. When should I begin the hands and knees exercise and begin wearing the maternity belt?



    1. Hi Kasey!
      The belt is something you can save for a little later. My chiropractor mentioned the idea to me at 34 weeks and I went ahead and started wearing one at 35 weeks. (My back felt so great from seeing the chiropractor I didn't need it for comfort, but I put it on as much as possible after that just for the baby positioning aspect.) But really, you can start wearing one as early as you like.
      And the hands and knees every day is good to do as soon as possible. Your baby's position isn't a big deal yet, but doing hands and knees and pelvic tilts are so good for you. (They are even good for your lower back when you aren't pregnant.) Plus getting used to it now will help your arms get stronger, for holding your belly up as it grows. The further along you are, the more time you will want to spend doing hands and knees time. I got bored and my arms got tired doing it, so after I did it as long as I could stand it, I would prop a bunch of pillows up under my chest to hold me up and then I would read or watch a movie as long as I could stand that.
      Here is a link to how to do pelvic tilts and why they are so great. (This website is really helpful)

  3. Very informative post. Thank you.

  4. thanks this was very useful!

  5. The most informative post I've read thus far. I am 38 weeks 2day and at my last apt 37w+3d I was told that the baby has not yet engaged and my MW wants to schedule a c-section for this weekend. This is my 1st pregnancy and I'm considering against the c-section because I think I still have time for the baby to be engaged when labour kicks in.

    1. As someone who (is not a trained professional, but) had a c-section with my first, and has learned a lot in between my first and second baby, if there is no actual health reason which a c-section is needed present, I would definitely give it time and not schedule the c-section. You should be allowed to go to 42 weeks, or at least 41+6 without needing to schedule a c-section or a induction, as long as the baby seems healthy and you have enough amniotic fluids (keep drinking your water!) you should be allowed to go full term (you aren't post term until you actually hit 42 weeks). And my choice in the matter (if you make it that far without going into labor) would be schedule an induction before I signed up for a c-section. Vaginal birth has a general overall lower risk for everyone involved. Good luck to you. I hope you seek out as many answers as you can as you go into this process, it is your right to know, always ask yourself & your provider BRAN :
      Benefits What are the Benefits of this intervention?
      Risks What are the Risks of this intervention?
      Alternatives Are there any Alternatives to this procedure?
      Nothing What would happen if we did nothing? (or do we have to act Now?)

  6. Did you see your chiropractor throughout all three trimesters or just later into the pregnancy? How frequently did you get adjusted?

    1. While it is a good idea to go throughout your pregnancy (or even beforehand) I didn’t learn about seeing a Chiropractor until I was half way through my second pregnancy. That’s when I started going. How often is going to depend on your circumstances (your chiropractor can work with you in determining that -- it depends on your body and what’s going on --- and generally speaking they can also try and work with your budget to make everything come together.) Essentially I went once a week. (I went slightly more often initially to get my body used to the adjustments. And I went slightly more at the end because I tend to stay pregnant really long and I wanted to avoid going to 42 weeks this time.) I have another post about Chiropractors and pregnancy if you are interested here:

  7. That’s very informative, Lydia! It’s true that this treatment would help correct the pelvic and spinal alignment for an easier delivery. I hope this enlightens those who doubts the safeness and effectiveness of chiropractic treatment. Thanks for sharing!

    Erick Barnes @ Back 2 Life Health

  8. Thanks a lot, it's been helpful and calming am 37w + 2days, with my first pregnancy and my baby is not engaged yet. Was so worried until I read this. Feels there is still time for the engagement.

    1. Yep you are doing great. You have time. Give your body and your baby grace to work in their own time. All the best to you!!

  9. Im 39w + 5d. Im dilated 2-3 cm and effaced 60-70% and my baby is not yet engaged??? Is this bad and how can i get things moving fast?

    1. That’s not bad at all! Dilated and effaced that much is great.Just try spending tons of time on your hands and knees to give baby space to get down in there. (I would prop up pillows under my chest to help support me and read or watch tv/movies in that position for as long as I could stand it.) As well as the other suggestions listed. You can’t always get baby to hurry. I did all that stuff religiously and my baby waited till 42 weeks on the nose. Sometimes babies just hang out for a while. You could try acupuncture -- I have no experience with it, but my midwife had recommended it to try and get things going. Other than that, I’d say just try and let your emotions relax -- stressing over not being in labor doesn’t help things stay loose. Good luck momma!! All the best to you.

  10. I am 38 wks 4cm dilated 70% effaced. I went into false labor two days ago. They said everytime they checked me that my sons head would just float back up. I am worried he's not engaged.

    1. I wouldn’t worry if you are already 4cm dilated at 38 weeks. That’s great progress!! (I mean they call it active labor once you hit for 4cm -- so you are basically right there.) And you have another month before most providers push induction -- it doesn’t sound that you will have any worries. You can definitely still go into labor without your baby being engaged, it just helps things along. Just try spending lots of time on your hands and knees, to give your baby room to make it down and get into a good position, along with these other tips. And then it’s all just a waiting game.
      (I’m 38 weeks right now with my third -- so believe me, I get the mental space of that waiting game -- never fun.)

  11. I have been going to a chiropractor for ages, but during this second pregnancy I made a point of going regularly. I didn't go during my last pregnancy and I believe I could have avoided many hip/back and neck troubles post pregnancy. Since entering my third trimester I have been going once a week and it has been a tremendous help with the symphysis pubis disorder I have this time around. It definitely took care of the tailbone pain I was having around 30 weeks. Thanks for the tip about going on the hands and knees for at least 20 minutes a day. I've been doing a couple of minutes here and there but will amp it up. It definitely feels good to take the weight off the hips. Nice to know there's added bonuses to it!

  12. Im 38 weeks tomorrow and i have alot of fluid im getting hurting twinges down below can anyone tell me whats happening ?

  13. Im 38 weeks tomorrow and i have alot of fluid im getting hurting twinges down below can anyone tell me whats happening ?

  14. Thank you so much for this! My first son (born March 2014) was similar to yours - I had to be induced, fully dilated, pushed for 2 hours but his head never ever engaged and it resulted in a csection.

    I currently 36 weeks pregnant with boy #2 and he still hasn't engaged and I'm starting to do my research to figure out how to get him down there! I've been seeing a chiropractor my whole pregnancy, I'll be ordering a belt and spending as much time on my hands and knees as possible!

    Thank you again, it's so nice to see other moms in similar situations.

    Linda :)

  15. Thank you so much for this! My first son (born March 2014) was similar to yours - I had to be induced, fully dilated, pushed for 2 hours but his head never ever engaged and it resulted in a csection.

    I currently 36 weeks pregnant with boy #2 and he still hasn't engaged and I'm starting to do my research to figure out how to get him down there! I've been seeing a chiropractor my whole pregnancy, I'll be ordering a belt and spending as much time on my hands and knees as possible!

    Thank you again, it's so nice to see other moms in similar situations.

    Linda :)

    1. Thank you for sharing that with me, Linda. It sounds like you doing a great job. I'll be thinking of you and hoping for the best!
      There is also a website called spinning babies that is very insightful on the topic of fetal positioning.
      Also, I thought I'd share that at this point I've had a third baby. During that pregnancy I was too sick to see a chiro but I did spend a ton of time on my hands and knees. My baby never engaged prior to labor, but he was positioned well and I had a great labor. I had him naturally the day I turned 42 weeks. I personally have gone that long with every pregnancy, so for me I am very picky to find a provider who is willing to let me go that long without interventions. (For me that's ment homebirths.)

  16. As someone who is currently 40w3d with #2....trying for a VBAC...and a failed induction 12-days late with my first this is all very helpful. I'd be lying is I said I wasn't already feeling discourage, but I appreciate you thoughts, insight and advice...I'll give it a shot!!

    1. You have my heart, thoughts and prayers.

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