My daughter recently delivered a lovely baby girl, but she had lots of back pain late in her pregnancy. She had to have a caesarian section (c-section), partly because the baby was in the “sunny side up” position. Most women have heard about breech birth, but the sunny side up position is actually the most common abnormal position for a baby. [1,2]
The medical term for the sunny side up position is occiput posterior or OP position. The baby is head down but turned the wrong way. The occiput – the back part of the head – is posterior, so the baby’s face is pressed up against the pubic bone. In this position, it can be hard for the baby to extend the head out from under the pubic bone. Your labor can be longer and more difficult. 
What Do We Know About the OP Position?
There have been quite a lot of studies on the OP position, what it means for delivery, and how it might be prevented. Here is what the studies show: [1,2,4]
- OP position is common in the first stage of labor, occurring in up to 30 percent of pregnancies.
- Most babies will rotate to a normal position by the time of delivery. Only about five percent of babies have persistent OP.
- Persistent OP may result in longer labor, assisted vaginal delivery, or emergency caesarian section. Studies show that about 20 to 30 percent of babies with persistent OP are delivered by c-section.
- You are more likely to have a persistent OP positioned baby during your first pregnancy. The risk is about seven percent.
What Can Be Done if Your Baby Is OP?
Options for managing an OP baby other than c-section include an operative delivery (using forceps or a vacuum device), attempting manual rotation of the baby (via the birth canal during labor), and maternal posturing. [1,2]
Maternal posturing is assuming a position on your hands and knees with your chest leaning forward and your back stretched out. In a review of previous studies, maternal posturing had been reported to reduce back pain but there has not been enough evidence to say that posturing affects OP position. 
Maternal posturing has been recently compared to watchful waiting for mothers with babies in OP position in early labor. The study was published in the American Journal of Obstetrics & Gynecology. OP position at the start of labor was confirmed by ultrasound in 220 women. Half of the women tried maternal posturing and were asked to assume this position as long as they could during labor, and the other half were allowed to go through the stages of labor without posturing. 
This study found that 78 percent of the posturing women and 76 percent of the non-posturing women converted to a normal anterior position before delivery. Rates of c-section or operative delivery ranged between 18 and 19 percent for both groups. The researchers concluded that maternal posturing did not have a significant impact on persistent OP. 
So the good news is that even if you start labor with your baby sunny side up, your baby will probably get into the right position before you deliver. It would be nice if posturing could improve the odds, but so far, it does not seem to help. [1,2]
Ask your healthcare provider about his or her experience with OP positioned babies. Talk about the options for delivery if your baby is sunny side up. The more you know about what can happen, the better you will be prepared for what does happen.
Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial, American Journal of Obstetrics & Gynecology, http://www.ajog.org/article/S0002-9378(12)02029-7/pdfSummary
Maternal positioning to correct occipito-posterior fetal position in labour: a randomized controlled trial, BMC Pregnancy & Childbirth, http://www.biomedcentral.com/1471-2393/14/83
Slideshow: Fetal positions before birth, Mayo Clinic, http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/multimedia/fetal-positions/sls-20076615?s=3
Persistent Fetal Occiput Posterior Position, American Family Physician, http://www.aafp.org/afp/2004/0101/p191.html