Optimal Fetal Positioning – Helping Your Baby Find A Good Position For Birth

Optimal Fetal Positioning (OFP) is a theory developed by midwives, Jean Sutton and Pauline Scott. They found that the mother’s position and movement could influence the way her baby positioned itself in the final weeks of pregnancy. This is believed to be a lifestyle issue as a result of society becoming more sedentary than we once were, with less physical labour on a day-to-day basis.

Sometimes longer, more painful labours and even caesareans result from, ‘mal-position’, where the baby’s position makes it more difficult for it’s head to move through the pelvis.

Some women have even been wheeled off for emergency caesareans with a diagnosis of CPD (cephalo-pelvic dispropotion) which you may hear as baby being to big or pelvis being too small, only to find baby was posterior or malpositioned. The actual incidence of true CPD is quite low – you can read more about CPD in our article HERE.

Why Is It Relevant?

Influencing the way the baby lies and promoting optimal positioning of the baby could help to make the birth easier for mother and child.

Ideally, baby will lined up as to fit through your pelvis as easily as possible. To be in this position, baby needs to be head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby’s head is easily ‘flexed’, i.e. his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. This position is called ‘occiput anterior’ or in shorthand (OA).

The ‘occiput posterior’ (OP) position is not as ideal. In a posterior position, the baby is still head down, but facing your tummy instead of your back. Mothers of babies in the ‘posterior’ position are more likely to have longer and more painful labours (backache labour) as the baby usually has to turn all the way around to face your back in order to be born. He cannot fully flex his head in this position, and diameter of his head, which has to enter the pelvis, is greater. This means that often posterior babies do not engage (descend into the pelvis) before labour starts. The fact that they don’t engage means that it’s harder for labour to start naturally, so they are more likely to be born post-dates. Braxton Hicks contractions before labour starts may be especially painful, with lots of pressure on the bladder, as the baby tries to rotate while it’s entering the pelvis. Sometimes a low anterior placenta can be the reason why baby is posterior.

How Do I Know What Position My Baby Is In?

When the baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, and you will normally feel kicks under your ribs. When the baby is posterior, your tummy may look flatter and feel more squashy, and you may feel arms and legs towards the front, and kicks on the front towards the middle of your tummy. The area around your belly button may dip in to a concave, saucer-like shape.

How Do I Avoid A Posterior Presentation?

The baby’s back is the heaviest side of its body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower than your back, e.g. if you are sitting on a chair leaning forward, then the baby’s back will tend to swing towards your tummy. If your back is lower than your tummy, e.g. if you are lying on your back or slouching on a sofa, then the baby’s back may swing towards your back.

Avoid positions which encourage your baby to face your tummy. The main culprits are said to be lolling back in armchairs, sitting in car seats where you are leaning back or anything where your knees are higher than your pelvis. The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.

BellyBelly highly recommends purchasing the Pink Kit which contains a video / dvd and booklets which you can watch in the privacy of your own home. It helps you map the pelvis, understand what you are working with in terms of the shape of your pelvis and what it is capable of. It also helps by giving you suggestions on how you can make the most of your pelvis in labour and much more.

Here are some suggestions:

• If you are watching television, do this while kneeling on the floor, over a beanbag, fitball or cushions, or sit on a dining chair. Try sitting on a dining chair backwards and if you need, prop some cushions under your bottom to ensure your pelvis is higher than your knees.
• Use yoga positions while resting, reading or watching television – for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides). While we are on the topic of Yoga, taking classes in general are wonderful for the pregnant woman!
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright
• Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front
• Don’t put your feet up unless your doctor has advised you to or you need a quick rest! Lying back with your feet up encourages posterior presentation.
• Sleep on your side, not on your back.
• Avoid deep squatting in late pregnancy, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way round. It is useful later in labour though!
• Swimming with your belly downwards is said to be very good for positioning babies – not backstroke, but lots of breaststroke. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
• A fitball can encourage good positioning, both before and during labour. Opt to sit on a fitball over a chair.
• Various exercises done on all fours can help, eg wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.

Remember above all that you are able to labour well even if your baby is in posterior position. Reasearch ahead of time what positions are helpful to posterior babies and what relief is available for backache labour – pressure, massage etc. If you hire a Birth Attendant or Doula, they can be a fantastic resource and the extra pair of hands you may need.

—Author unknown, with editing by Kelly Zantey, Birth Attendant and BellyBelly’s Creator. A useful website for more information on Optimal Fetal Positioning and Baby Mapping is Spinning Babies