Optimal Foetal Positioning‘ (OFP) is a theory developed by a midwife, Jean Sutton, and Pauline Scott, an antenatal teacher, who found that the mother’s position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. Many difficult labours result from ‘malpresentation’, where the baby’s position makes it hard for the head to move through the pelvis. Changing the way the baby lies could make birth easier for mother and child.
The ‘occiput anterior’ position is ideal for birth – it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy.
The ‘occiput posterior’ (OP) position is not so good. This means the baby is still head down, but facing your tummy. Mothers of babies in the ‘posterior’ position are more likely to have long and painful labours as the baby usually has to turn all the way round to facing the back in order to be born.
If your baby is in the occiput posterior position in late pregnancy, he may not engage (descend into the pelvis) before labour starts. The fact that he doesn’t engage means that it’s harder for labour to start naturally, so your baby are more likely to be ‘late’.
WHAT POSITION IS YOUR BABY IN?
This is important because you need to know when your baby moves into a good position, so that you can encourage it to stay there! You can learn to tell what position your baby is in, by asking midwives to show you what to look out for, and by practising feeling for the baby yourself.
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. Your belly button (umbilicus) will normally poke out, and the area around it will feel firm. When the baby is posterior, your tummy may look flatter and feel more squashy, and 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 in to a concave, saucer-like shape.
If you feel the baby move, try work out what body part was moving. Remember that heads feel hard and round, while bottoms feel soft and round! It may take a lot of concentration and trying to work things out at first, but you soon get the hang of it. You may find it easier to feel your baby’s position if you lie on your back with your legs stretched flat out.
If your baby is posterior, you may find that you suffer backache during late pregnancy (of course, many women suffer backache then anyway). You may also experience long and painful ‘practice contractions’ as your baby tries to turn around in order to engage in the pelvis.
PRACTICAL STEPS TO AVOID POSTERIOR POSITIONS
The baby’s back is the heaviest side of its body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower than your back, eg 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, eg you are lying on your back or leaning back in an armchair, then the baby’s back may swing towards your back.
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.
The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.
Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.
Use yoga positions while resting, reading or watching TV – for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)
Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright
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 (preferably your left side)
Swimming with your belly downwards is said to be very good for positioning babies – not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
A Birth Ball can encourage good positioning, both before and during labour
Various exercises done on all fours can help, eg wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.
IF YOUR BABY IS ALREADY POSTERIOR ....
First of all, don’t panic! Most posterior babies will turn in labour, but read on to find ways of helping him or her turn before.
When your baby is in a posterior position, you can try to stop him/her from descending lower. You want to avoid the baby engaging in the pelvis in this position, while you work on encouraging him to turn around. Jean Sutton says that most babies take a couple of days to turn around when the mother is working hard on positioning.
Avoid deep squatting
Use the ‘knee to chest’ position. When on hands and knees, stick your bottom (butt) in the air, to tip the baby back up out of your pelvis so that there is more room for him to turn around.
Sway your hips while on hands and knees
Crawl around on hands and knees. A token 5 minutes on hands and knees is unlikely to do the trick – you need to keep working at this until your baby turns. Try crawling around the carpet for half an hour – while watching TV or listening to music. It is good exercise as well as good for the baby’s position!
Don’t put your feet up! Lying back with your feet up encourages posterior presentation.
Swim belly-down, but avoid kicking with breaststroke legs as this movement is said to encourage the baby to descend in the pelvis [3]. You can still swim breaststroke, but simply kick with straight legs instead of “frogs’ legs”.
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