Optimal Foetal Position

I imagine my baby in their ideal position...

What is OFP?

"Optimal Foetal Positioning" was developed by midwives Jean Sutton and Pauline Scott. They found that women could influence the position of their babies through activities in the later weeks of pregnancy, and this could impact how their labours unfolded.

What is the "best position"?

For most (not all) babies, their best position is LOA (left occiput anterior) and flexed (chin tucked to chest).

In simple terms, "occiput anterior" means head down, and facing your back. In LOA, their head is rotated slightly to the left.

Why is position important?

Have you ever heard the phrase, size isn't everything? It's never truer than when it comes to birth! Positioning is a much more important factor than baby's size, and one which you have more influence over. (Not total influence - just some.)

A big baby in a good position can slide out like a squidgy bar of soap, and a small baby in a poor position can struggle to be born.

So, to give you and your baby the best chance of a smooth birth, positioning is key - theirs and yours!

The Limits of OFP

Baby's position is something you only have some influence over. There are many factors which affect the position of your baby, and not all of them are under your control.

It's thought certain positions and movements can encourage your baby to adopt a good position. These are certainly benign and have other benefits as well, so they are worthwhile.

But it is important to keep in mind that some babies will remain in a "poor" position no matter what you do. Some will appear to be well positioned during pregnancy, and then move into a less favourable position just before or during birth.

It is wonderful to have a feeling of control, in a situation where it's common to feel you don't have any. To be able to do something to positively influence how the birth unfolds, for both you and your baby.

However, on the flip side of this, mothers can end up blaming themselves when it doesn't go well. They might think things like, "If I had done that exercise more," or "If I hadn't done such and such, then maybe..."

Absolutely do things which help prepare your body, mind and baby for the epic task of birth! But this must be balanced against the awareness that there is an element of luck involved. Just as with stretchmarks - have you noticed that some women do nothing to care for their skin and get none, and others are careful to stay hydrated and slather on plenty of cocoa butter, and they get lots! It doesn't seem fair, does it? We want to be able to control. We say, "If I just do this and that, then [the bad thing - be it stretchmarks, or a tricky labour, or or or] won't happen to me.

The best you can do is stack the odds in your favour. Get your ducks in a row. I am here to help you do that.

Why is LOA the best position?

Your baby must enter your pelvis, rotate, and then exit your pelvis. This position (LOA) usually gives them the shortest route to do that. It also means the "right bit" of baby's head is pressing on the cervix, achieving a good amount of pressure and a strong contraction pattern.

Note that the chin tuck is also important, whether baby is LOA or not! This makes the baby a nice convenient tube shape, which is the easiest shape to be born. This is because it presents the narrowest part of the baby's head first. It maximises the pressure on the cervix, helping it to open and encouraging more and stronger contractions. This is what we want!

What influences my baby's position?

Earlier, I mentioned that there are many factors which influence your baby's position. I'm just going to touch on a few here:

The dimensions of your pelvis

All women are different. Our pelvises are also different! It follows, then, that LOA is not going to be the ideal position for every baby.

Imbalances in the body

Modern life can lead to key muscles being shortened and contracted, and usually more on one side than the other. This makes it more tricky for your womb to settle into a good balanced position, which, in turn, makes it more difficult for your baby to find a good position and navigate their way through your pelvis. There are things you can do about this (see below).

Activity

It's possible that certain positions can encourage your baby to adopt a less-than-ideal position, although this seems to be largely anecdotal. For example, it's thought that lots of "sofa sitting" (with your pelvis rolled forward) does not give your baby the best chance to move into LOA. We tend to adopt the same sort of sitting position when driving, and many of us have long commutes for work. Unavoidable for the many who need to keep working as long as they can during their pregnancy. Being aware of it means we can counter it.

Differences in the womb

For example:

• fibroids
• bicornate uterus (womb has a deep indent at the top, like an M shape)
• septate uterus (womb has a wall of muscle dividing it).

All these impact your baby's ability to get into their best position.

What other positions might my baby adopt?

There are several, but I'm just going to touch on two:

Back to back

Rather than being occiput anterior, your baby might be occiput posterior (often abbreviated to "OP"). This is commonly referred to as "back to back". If your baby adopts this position, your labour may unfold differently. As well as working to open your cervix, your contractions may also try to shift baby round. You might experience:

• intense sensations early on
• a very early urge to push (say, around 3 or 4 cm, rather than towards the end)
• an irregular contraction pattern
• contraction pain in your back

Breech

Roughly 4% of babies are "head up" rather than "head down" when labour begins. Some of those babies present bottom-first; this is known as "frank breech". Some are "footling breech" (feet first). Some of that 4% will roly-poly into a head down position during labour (NB. It is a myth that babies move less near the end of pregnancy! If you notice a marked change in their movements, please contact your midwife!) If your baby is breech, your doctor might recommend a caesarean birth. This is entirely your choice. Many breech babies can be born safely without surgery. I recommend the works of the late and wonderful Mary Cronk if you would like to learn more about breech birth.

How can antenatal classes help?

You might already know that I teach antenatal classes in Shrewsbury. These involve lots of movement to encourage and facilitate optimal foetal position (whatever that might mean for you and your baby). There is little emphasis on encouraging LOA specifically, as that is only "best" for "most" babies - not all! Instead, we focus on:

• making space for your baby to move
• bringing balance to your body
• building confidence in your body and baby

These movements also help to prepare your birthing muscles and ease pregnancy symptoms. They are helpful for you during labour, to maximise the efficiency of each contraction and help your baby rotate and descend.

The importance of muscle memory

It is important to be aware that you are extremely unlikely to draw on any of these techniques if you have not practised them antenatally. This is why classes are recommended in blocks of six, to allow time for muscle memory to build.

Building muscle memory is the goal! It's important so that the techniques are helpful to you even in advanced labour, or if there is a lot going on and you have moments of overwhelm or panic - both very common during such an intense experience. We want the techniques to come naturally to you. To become second nature, like riding a bike or driving a car. You can probably drive home from work "on autopilot" now - but you couldn't do that the first day you sat behind the wheel, could you?

Note: Not all antenatal classes will offer this approach. There are many elements to effective birth preparation, and different classes will focus on different things.

What if my baby is not in a good position? Is there anything I can do?

There are several exercises and position I can show you which are worth trying if you find yourself in this situation.

The most important thing is to give them the best chance to move through your pelvis. What they need most is space and time so that is what's I'm going to focus on here.

Space

This is most easily achieved by retaining freedom of movement, and choosing dynamic positions. In more simple terms: STAY OFF YOUR BACK. Supine is not a dynamic position. It is relatively difficult to move out of. Contrast this with kneeling and leaning forward on a bed or a birth ball. In this position, you can respond to each sensation with movement, which helps enormously. You can bring one knee up to create more space in the pelvis. You can bring yourself more upright to utilise gravity, or shift and bring your head and upper body right down to ease the pressure on your cervix. See? Dynamic.

Remember the mobile part of your pelvis is the back. You need to stay off it to allow it to flare back and give your baby all the space they need to move down.

Time

If your contraction pattern is irregular and/or your labour is slow, your midwife or doctor might suggest speeding things up artificially. If your baby is coping well, consider doing other things to facilitate a good labour pattern first. I will go into this in more detail another day! Hurrying your baby through the pelvis when they have not made the adjustments they need to can be problematic. This is discussed in Mary Cronk's piece I linked to earlier. She was speaking specifically about breech babies, but it is relevant to head down babies as well.

Important notes:

• A positive birth is possible, no matter what position your baby is in.
• Some mums have a hard time giving birth even with their baby head down, LOA, and flexed.
• Your position is also very important. This is something you can have almost total control over, unlike your baby's position which you only have some influence over. I'm working on another piece about positions for birthing women.

A glossary

Here is a summary of some of the terms and abbreviations that you might come across in the course of your maternity care which are handy to know:

• Optimal position - the best position for baby to be born in
• Malposition - when baby is in a poor position
• LOA - left occiput anterior. Considered "optimal" for most babies.
• Cephalic - Head down
• Breech - Head up
• Flexed - chin tucked to chest

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Please note - I am not a midwife, and articles on the internet cannot replace good midwifery care. This is not intended to replace the advice given by your health care professionals. If you or your baby are unwell, please seek help in the proper places.

Best wishes, and happy birthing!

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For antenatal classes in Shrewsbury: