Optimal Foetal Positioning

Rocking Your Way to
a Straightforward Birth By Shel Franco

Modern society would have you believe that childbirth is something that simply happens to you. That besides eating right and taking your prenatal vitamins, you have little importance to the whole shebang once conception has taken place. But what if someone told you that the activities in your daily life could actually sway the course of your labor?

Jean Sutton, a midwife, and Pauline Scott, a childbirth educator, coined the phrase Optimal Foetal Positioning (OFP) to describe their idea that a pregnant woman could help her unborn child settle into a position in the uterus that would lend itself to a normal, straightforward labor and birth.

During your prenatal check-ups, especially in the last trimester, the doctor or midwife will palpate your abdomen to detect the baby's position. While most moms-to-be know that head down is good, few understand the significance of a baby facing the mother's naval or the mother's spine.

Occipito-anterior (OA) and occipito-posterior (OP) – often called "anterior" and "posterior" for short – are the technical terms to describe the way your baby is positioned in the uterus. Both of these terms apply to a baby who is head down. "The optimal position is occipito-anterior and is the most effective way technically for a baby to journey through the maternal pelvis," says Pauline Scott, co-author of Understanding & Teaching Optimal Foetal Positioning. In the OA position, your baby is head down with his or her face looking at your spine. In the OP position, your baby is head down, facing your naval.

Anterior presentation

An OP baby and mother must do more work in order to have a vaginal birth. Labor is often longer and more painful, while the baby attempts to rotate to the anterior position. A common occurrence in OP labors is excruciating back pain, caused by the hard surface of the baby's skull pressing on the mother's lower back.

How Can Optimal Foetal Positioning Help?
"The concept of OFP helps the pregnant woman to be aware of her baby's position towards the end of her pregnancy," Scott says. "If she discovers that her baby is not in the most effective position for labor, she can encourage her baby to move by adopting simple postures to assist alignment, thereby increasing the chances of a normal and straightforward delivery."

The meat of OFP lies in its instruction for simple posture and lifestyle changes. Many of today's inventions of comfort, such as soft sofas, and trials of modern society, such as long car rides, compromise the posture that a normal delivery may be dependent on.

In order to counteract the daily assault of good posture-robbing activities, Optimal Foetal Positioning outlines simple steps for encouraging an occipito-anterior presentation.

Angela Horn, childbirth veteran and OFP advocate in London, England, sums it up like this:

• 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.
• Watch television while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing the back as well.
• 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. Lying back with your feet up encourages posterior presentation.
• Sleep on your side, not on your back.
• Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he or she is facing the right way.

Various exercises done on all fours can help. For example, try wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down (pelvic rocks). Check with your health care provider before attempting these excercises.

Does It Work?
Horn's experience with Optimal Foetal Positioning has made her a true believer. "I would feel Lee turning towards my front as he got larger, and every time I would go down on all fours, rock my hips and wiggle around until I felt his back towards my belly button," she says.

Horn's persistence paid off with a nine-hour, straightforward first birth that yielded a 9 pound, 6 ounce baby. "I was told that if he'd remained in a posterior position, then I would probably have ended up with a very hard labor and probably major intervention and perhaps a Cesarean given his size," she says.

Connie Banack, a doula and childbirth educator in Camrose, Alberta, has her own success story: "I avoided the recliner that I had sat in so much with the first two [pregnancies] and leaned or sat on my birth ball a lot," she says. "If I was sitting on the couch, I didn't recline, I sat cross-legged or laid on my side. This time, instead of stalling at 4-6 centimeters, being diagnosed with failure to progress, and having a Cesarean for posterior or brow presenting babies, I dilated quickly and efficiently to 10 centimeters in 6 hours."

So you do some pelvic rocks and watch your favorite prime-time shows from the living room floor – does that guarantee an optimally positioned fetus? And even if your baby finds its way into the occipito-anterior position, are you guaranteed an easy labor and delivery?

Unfortunately, there are no guarantees. Especially not in childbirth. And while it might seem like these changes are an awful lot of hard habit-breaking work, just remember that practicing Optimal Foetal Positioning doesn't have to be a technical and stressful experience.

"With most moms, I quite simply go over the ways to improve the chances of having an optimally positioned baby," says Karen Kohls, a doula in Middleton, Wis. "Avoiding reclining, lots of pelvic rocks, avoiding prolonged squatting, becoming aware of the baby's position and keeping a low-key eye on it to see if things like prolonged car rides cause it to shift to posterior."

Becoming aware of your posture and altering a few daily activities might seem like a nuisance, now. You might find yourself applying lotion to rug burned knees. You may be so tired and achy that avoiding the fluffy couch seems like a prison sentence. But if a few months of pelvic rocks and sitting on the floor helps produce a healthy, happy baby in a simple and short birth, won't it all be worth it?

Want to see more?

• Birth Presentations and Delivery
• Avoiding Routine Interventions in a Hospital Birth
• Birth Balls: Pregnancy and Postpartum
• Just in Case: Making a Plan for Cesarean Birth