Optimal Fetal Positioning – How To Make Birth Easier

Optimal Fetal Positioning - How To Make Birth Easier

Have you heard about optimal fetal positioning but not sure what it is?

Are you worried about your baby’s position and how it could impact on your birth?

Optimal fetal positioning is an important topic for pregnant women to learn about.

Optimal Fetal Positioning – How To Make Birth Easier

Fetal position can impact how labour progresses.

On one hand, that wouldn’t be a problem. Given time and support, you will birth your baby.

However, since most births take place in hospital settings, time and support may not be available. 

Even during pregnancy, women are made to feel they’re doing something ‘wrong’ if their baby doesn’t get in a good position and stay there. 

Consequently, it’s ideal for babies to achieve a good position for birth for many reasons.

Not the least making birth an easier journey for both mothers and babies. 

What Is Optimal Fetal Positioning?

It’s important to understand the origins of optimal fetal positioning.

The term, created by birth educator Pauline Scott and midwife Jean Sutton, describes how women can help their babies to assume the best position for a safe and straightforward birth. 

Jean noted most births go easier when babies begin from the left occiput position. Over time, this has turned into a belief this is the only optimal fetal position, despite Jean never making this claim.

Optimal Fetal Positioning For Birth

To be born, a baby rotates and descends through the pelvis.

Baby’s position influences how easy the rotation and descent will be.

Ideally, your baby lines up to fit through your pelvis as easily as possible. 

This is the Left Occiput Anterior position (LOA). 

To be in this position, baby needs to be head down, with his back on the left side of the front of your tummy. His face is pointing midway between your right hip and spine.

In this position, the baby’s head is easily ‘flexed’, i.e. his chin tucked into his chest. The smallest part of his head presses down onto the cervix first.

Most babies assume this position in preparation for birth. But there are many factors which influence your baby’s ability to settle into this optimal position. 

What Affects Baby’s Position In Utero?

Bear in mind your baby not being in the LOA position doesn’t mean there is something ‘wrong’. 

However, our lifestyles do have an enormous impact on our bodies and this can affect how women carry their babies and give birth.

For the past 70 years, we’ve become increasingly more sedentary. We sit down for long periods and aren’t moving as much. 

Today, our sedentary lifestyles mean babies aren’t being encouraged to find the optimal position for birth. 

Sitting back or slouching on comfortable sofas nightly is one of the bigger culprits of creating less space for babies to find their ideal space. 

Many pregnant women who work are sitting for long periods of time. We might be more aware of the importance of health and exercise but few of us have the time to actually engage in it. 

During labour, women are encouraged onto a bed where she naturally lies on her back, despite her great discomfort. This position is better for care providers to see what’s happening and women accept it as normal.

And with so many labours being induced, it’s little wonder babies aren’t able to find their way into a good position easily. Induction requires constant fetal monitoring, usually while a mother is lying on her back on a bed.

Inductions also increase the likelihood a woman has an epidural, as the pain of contractions is intense and relentless. Having an epidural affects how she can work with her body, as she is lying down and unable to move.

How Does Baby’s Position Affect Labour?

A baby in an optimal position is able to tuck their chin, which helps them to fit into the pelvis. The head ‘leads’ into the cervix with the smallest diameter to fit through. 

This isn’t to say it’s impossible to birth babies in other starting positions. Except transverse (cross lying) and some breech positions, most babies will still be rotate for birth but it can mean labour is longer. 

For more information about fetal position and the impact on labour, read 8 Signs Your Baby’s Position Is Affecting Labour

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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 (back against your back), your tummy may look flatter and feel more squishy. 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 into a concave, saucer-like shape.

How Do I Encourage Optimal Fetal Positioning?

The baby’s back is on the heaviest side of its body. This means 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 slouching in armchairs, reclining on a car seat, or anything where your knees are higher than your pelvis.

The best way to do this is to spend lots of time kneeling upright, sitting upright, or on hands and knees.

When you sit on a chair, make sure your knees are lower than your pelvis, and your torso tilts slightly forwards.

For more information on optimal fetal positioning, be sure to visit the Spinning Babies website.

Recommended Reading:

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  1. Spinning babies has no evidence based research behind it. While I agree that there are ways to sit or move that are supportive, there is no real guarantee or way to ensure fetal positioning. Moms to be, don’t think you’ve done something wrong if your sweet baby is OP.

  2. Sandy,

    Gail Tully is a certified midwife. There is a lot of science that goes into the study of midwifery. I suggest looking at these references to see at least some of the science behind it.

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  3. As a doula I often refer to Spinning Babies and Gail’s techniques have helped many a posterior baby reposition. Of course babies can be and are born OP, and it’s not mom’s fault, but a little attention to posture in the last few weeks of pregnancy can go a long way.

  4. Thank you for great article.I’m 31 week and my baby lies transverse.I have also low lying placenta.What I can do to encurage him to spin head down?

    1. No one says proven – whats said is it helps. It wont be perfect for everyone but if it can impact some its helpful. And if it can, why not try, its not hurting anyone. Whats wrong with you ladies? Cant stand being told not to be lazy in armchairs? 😉

  5. I am currently 34 weeks with my second. My first labour was 28 hours with a LOT of back pain and this was due to baby being OP – she was also born 9 days late. After reading this article it all makes a lot of sense to me and I will be spending these last few weeks following these tips in hopes it doesnt happen again. I just wish someone had told me this the first time round!!

  6. I have a question. Would anyone possibly able to help in my research as to the causes of OP babies? My daughter was in a car accident at 26 weeks, everything was progressing smoothly with her pregnancy and 10 days after the accident she was told her baby was OP. My question is, has anyone have any documentation supporting that the car accident could have been the cause of this? She carried her baby full term plus 2 weeks at which time she was induced and after 4 days and 2 epidurals later she had a c-section. That is a long story short of course, but we are trying to prove to the insurance company that the fact her baby didn’t turn was due in part or in full because of the car accident. Thank you in advance for any help or documentation anyone may be willing to share. Dawn Smith

    1. Sorry to hear of the car accident. I believe the biggest reasons for suspected OP are lifestyle issues (more sedentary), placement of the placenta and uterus or pelvic shape/abnormalities. I am not sure if you would find anything about a car accident being the reason for a baby being OP, because I am not sure if it’s been studied. If I find anything out I will reply again.

  7. Thank you Kelly! Anything would be helpful that could possibly link the car accident to the OP position. I am not finding anything either, the only supporting evidence I have is that there was no mention of the position being OP until 10 days after the accident. Thanks again! Dawn

  8. I had two posterior labours. The first I was regularly sitting in a recliner during pregnancy. So the second pregnancy I completely avoided the recliner and made sure I sat as suggested in the article. But I had a second posterior labour anyway. So if there’s a third time around i think I’ll just sit however I feel like ha ha. luckily I had amazing midwives and I had two natural births, although I had to abandon home water birth both times to birth in hospital, but they were natural so I’m grateful for that. Both times I didn’t dilate enough and had laboured too long to stay at home.

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