"Optimal Fetal Positioning"

Optimal Fetal Positioning (or OFP) can help us understand what our bodies are meant to do
during labor and can lead to faster, easier labors for mothers and healthier, less abrasive labors
for babies. Instead of not interfering with birth at all, we can help labor progress when we learn
how our bodies were designed and what we can actively do during pregnancy and birth to help
speed things along.

Part 1: The Fetal Head

Position of the baby deals with the direction the babys head and body are facing. We describe
the fetal head positions as which direction of the mother is the babys occiput (or back of the
head) is facing. The most optimal position for the baby at the beginning of labor is the LOA
position (Left Occiput Anterior: the babys occiput faces the mothers left front side).
So, can a poorly positioned baby still fit through the pelvis and birth canal? Yes. Though it often
takes more time and effort, a poorly positioned baby can still fit through! Unlike an adult head, a
child up to age 8 has a skull with five main bones not yet fused together two frontal bones, two
parietal bones, and the occiput bones. The small gaps between the bones (called fontanels)
allow the skull to shift, bones overlapping bones, reducing the diameter of the skull. This ability
can allow even a poorly positioned baby to fit through his mothers pelvis.

Part 2: Moving Through the Pelvis

As the baby enters the inlet of the pelvis, the widest diameter is transverse from side to side.
The babys head will be wider front to back. So, the best way for the babys head to enter the
pelvis is in a sideways, or OT position. This means baby should be in OT during late pregnancy,
when the baby drops and settles into the pelvis.

Internal Rotation
As the baby is pushed further into the pelvis by gravity towards the end of pregnancy, it enters
the pelvic cavity. The cavity is more equally rounded, and since body movements tend to move
in a clockwise direction, the baby is rotated from LOT to LOA. Thats why LOA is the most
described starting position for labor. So, if baby entered the pelvis in the right position, then the
baby will be in the LOA position at the beginning of birth.

Emerging
Once the baby has moved through the pelvic cavity, the only resistance left is the mothers
tailbones. The pelvic outlet is absolutely wider from front to back than to side to side, even more
so because the mothers hinged sacrum and coccyx will be pushed back and out of the way if she
is allowed to labor in a position with free pelvic movement (side-lying, hands and knees,
standing, or squatting). This front-to-back opening will help urge the babys head from LOA to
an OA position (the back of the head facing the front middle of the mother).

Part 4: Putting It Together

What Ive just described is the best way that a baby fits through the twists and turns of the
maternal pelvis. The two were designed to work together in this manner and allow the baby and

the mother to remain intact. Getting a baby to this starting point is what Optimal Fetal
Positioning is all about.

Dextrorotation
Why does it matter if the baby starts in a left position or a right position? As the uterus contracts
and releases, babies are moved through the pelvis in a clockwise manner. If a baby were to start
out in an ROA position, this would mean that the baby would need to rotate all the way from
ROA to ROT to ROP to OP to LOP to LOT to LOA. Thats quite a long journey and includes a
nice length of time moving through the posterior position, which can be extra painful for many
mothers. Starting out in the LOA position means that the uterus can focus on pulling open the
cervix and moving the baby down, instead of also working on getting a baby into a good
position.

Things to Remember
One of the best ways you can help start labor off right is by paying attention to your body
movements in pregnancy. Consider the way your spine curves. Most of us are lazy when we sit,
especially if we like to sit in comfy seats such as couches and overstuffed chairs. In these places,
we tend to tilt our pelvis under our spine and curve our lower backs outwards. Because the back
of the babys head is heavier than the front of its head, gravity will pull the back of a babys head
towards the back of the mother when she is slouching or reclining. If a mother were to sit with
the pelvis tilted forward and tailbone out instead, then your body would be more upright. This
would allow the uterus to move forward, the baby to fit itself along the curvature of your spine,
and the heaviest part of the babys head would then be toward your front.

How to Get There

Practicing pregnancy exercises such as pelvic rocking on hands and knees or such as leaning
over a counter and swaying hips left to right will encourage the uterus to fall forward, will
encourage baby to enter an anterior position, and will help shorten labor while preventing the
back-labor associated with posterior positions.
1. Lie on your left side, not on your back or on your right side.
2. Keep your uterus leaning forward.
3. Remember these positions during labor, also!