Learning about the position of your baby can be daunting and even confusing.
I’ve been a midwifery educator for many years, and have explained baby positions to pregnant women and partners, as well as to midwifery students.
Believe me, it sounds way more complicated than it actually is. Once you understand what these words mean it will be easy peasy.
When talking about the different positions babies might be in when entering the pelvis, think of the acronym ‘ROA’ (right occiput anterior) as being symbolic of pregnancy.
The ‘O’ is the baby and is inside the ‘R’ and ‘A’, which relate to the woman.
Let’s delve a bit more into right occiput anterior (ROA) and what it means when your baby is ROA.
What does right occiput anterior mean?
From what we’ve just learned ‘right’ and ‘anterior’ relate to the pregnant mother’s pelvis and ‘occiput’ means baby.
The occiput is the back part of your baby’s head.
Anterior refers to the front part of the woman’s body.
Right refers to the mother’s right side.
So the right occiput anterior (ROA) position means a baby enters the mother’s pelvis with his back towards the front right side of her pelvis.
Imagine the woman’s pelvic brim (seen from the top) as a clock. Her pubis is at 12 o’clock and her spine is at 6 o’clock.
A baby who enters the pelvis in a right occiput anterior (ROA) position means baby’s back is towards the mother’s right front part. So baby’s back would be at around 1:30 in that hypothetical pelvic clock.
Right occiput anterior (ROA) presentation
Presentation and position might sound quite similar but there’s a big difference between the two.
Presentation refers to the part of the baby in contact with the woman’s cervix.
It can also mean the lowest part, if nothing is inside the pelvic space – for example, when the baby is in the transverse position, lying horizontally across her womb, there’s no part inside the pelvis at all.
Presentation refers mainly to when the baby is head down or breech.
Positioning refers to which side of the baby’s body is, in relation to the mother’s body.
That’s why we talk about right, left, anterior or posterior positions.
A ROA presentation means a head-down baby whose occiput/back is towards the mother’s front right side of her hip.
Other fetal positions
Let’s quickly run through some of the other positions babies get themselves into in the womb.
Left occiput anterior
Anterior LOA is the mirrored position of ROA. The baby’s back is at 10:30h instead of at 1:30h in ROA position.
Both positions are ideal positions for the baby to be in when labor starts.
You can read more in Left Occiput Anterior | What It Means When Baby Is LOA.
Right occiput transverse
The ROT position is when the baby enters the pelvic brim completely sideways, facing the left hip of the mother. The baby’s occiput is on the mother’s right side.
Left occiput transverse
This is where the baby is facing the opposite way to the right OT. The baby’s face is towards the mother’s right. The occiput is on the mother’s left.
Right occiput posterior
In this position, the baby enters the pelvic space facing the mother’s front-left. The back of baby’s head is between the mother’s spine and her right hip (4:30h in the pelvic clock).
Left occiput posterior
In the LOP position, the baby’s occiput is at 7:30h, so the baby is facing the space between the mother’s pubis and her right hip.
Direct occiput anterior
The direct position refers to the anterior-posterior diameter, when the baby is directly facing 6 o’clock or 12 o’clock.
Direct positions can’t be achieved when the baby first enters the pelvic brim (the highest part of the pelvic brim, in the image above).
It can only happen when the baby’s head is well down the birth canal, usually when labor is well advanced and birth of the baby’s head will happen quite soon.
During labor, or even during the last weeks of pregnancy, when a baby is in a head-down position, she enters the pelvic brim or inlet (the top part) in a transverse position or left/right anterior/posterior position.
As labor advances and the baby descends through the birth canal, the baby negotiates the tight space.
Direct OA is the optimal position babies achieve right before birth. The baby is facing her mother’s butt/spine.
Direct occiput posterior
Direct occiput posterior is achieved by some babies at the end of labor. This position is where the baby’s back is in line with the mother’s back.
Although some babies can be born in a direct OP position, most won’t be able to, and many mothers need assistance with forceps or a c-section because of this.
Read about posterior babies and how to avoid labor with a baby in an OP position in Posterior Baby | What It Means And How To Turn Baby.
Non head down positions
As already discussed, a position refers to where the baby is in relation to his mother’s pelvis and, for this to happen, the presenting part must be inside the pelvic area.
For example, if a baby is in a transverse presentation inside the womb, the position has no relevancy as the fetal position is horizontal.
Only about 0.2% babies are still in transverse in the later stages of pregnancy.
When the baby is presenting breech, it’s the baby’s lower area (butt or feet) that are inside the pelvic space.
In these positions, the ‘O’ for occiput is changed to an ‘S’ for sacrum (the back bone of the baby’s bum, just below the spine).
With our imaginary pelvic clock we can work out the way baby is facing in relation to the mother’s body.
Occiput anterior vs posterior
There’s a big difference in the way the baby enters the pelvic space.
An anterior position, with baby’s back towards mother’s front, is always the optimal one.
When babies are posterior, LOP or ROP, many different problems can arise. Birth becomes more painful and the chances of needing a c-section are increased.
LOA vs ROA
If you search the web for information on fetal positions, you will find a lot of questions like these:
- How to turn a baby from ROA to LOA?
- Why is left OA better than right OA?
- Is ROA position bad?
Rest assured, the ROA fetal position is as good as the LOA position.
It’s believed the left anterior position is ‘better’ because, in most women, the uterus is slightly larger on the left side, so babies look for the most comfortable space.
If your baby’s position is ROA she’s still in an optimal position to go through the birth canal.
How do you know if baby is in anterior position?
When baby is in the optimal ‘A’ position, the pregnant belly has the typical round and solid pregnancy shape. It’s the baby’s back that gives it that shape.
When the baby’s back is towards the mother’s back, her limbs are at the front where the mother will feel most of baby’s kicks.
As a result, the belly looks bumpier and a hollow space might be seen around the mother’s navel.
How to get baby in right position for birth?
Getting your baby in the right position before labor starts, or even during labor, is important.
Not only will it have a great impact not only on the baby’s delivery but, more importantly, on the birth experience a woman has.
Be sure to read 8 Signs Your Baby’s Position Is Affecting Labour to understand more about this.
Knowing how to get your baby into an optimal fetal position is very important for labor to run smoothly and to keep pain to a minimum.
Optimal Fetal Positioning – How To Make Birth Easier is a ‘must read’ to help you prepare for a positive birth experience.
As a midwife, let me tell you that when baby is in the optimal position, both bodies will work, in tune, to meet up earthside in the best possible way. It will be absolutely worth it!