Optimal fetal positioning (OFP) is the term used to describe the best possible position for a baby to be lying in, prior to labour commencing.  The optimal position for a straight forward labour and birth is left occipito-anterior (baby lying on the left side of the uterus).  50% of babies present in this position.  Of the other 50% some may have a medical reason affecting the position the baby chooses to adopt in the pelvis i.e. placenta praevia, breech, fibroids etc.  However, a large percentage will be vertex presentation (baby is head down in the pelvis) in the occipito-posterior position, where women will experience prolonged labour and agonizing backache.  The outcome may be caesarean, forceps or ventouse delivery.  This is where the use of OFP in late pregnancy can help to increase the rate of uncomplicated natural births thereby enhancing the birthing experience for all those involved.

 

How to encourage OFP during late pregnancy

Regular use of upright and forward leaning positions from 34 weeks onwards will encourage the baby to get into the best position.  When the pelvis tilts forward, it allows more space for the wider diameter of the baby’s head to enter the pelvic brim and room to flex the head on to his chest.

 

Therefore:-

• Sit with knees lower than hips, with back straight as possible.  Use pillows or cushions under the bottom and in the small of the back.
  

• Sit to read on a dining chair with elbows resting on the dining table, knees apart, leaning slightly forward.
  

• Sit facing chair back and resting arms on back of dining chair.
  

• Kneel on the floor over a large beanbag or floor cushion to watch TV or on all fours.
  

• Use an office stool or Pregnancy Comfort Rocker (check internet for availability).  Make sure knee pad is wider than seat to allow knees to be kept apart and hips to turn outwards.
  

• When driving, a small cushion can be used to lift the bottom, hence ensuring that the hips remain higher than the knees.
  

• Swim with abdomen forward.
  

• When resting/sleeping, lay on your side, preferably left, with a pillow between the legs, the top knee resting on the bed.
  

In case of a persistent posterior position, sleeping on the front stomach is recommended with the support from pillows and cushions by creating a hammock on the bed.

When having Braxton Hicks contractions it is ideal to use forward leaning postures as this increases their effectiveness with regard to helping the baby manoeuvre himself into the optimum position.

 
Do not:-

• Relax in semi-reclining positions that have your knees higher than your hips.
  

• Take long trips in cars with bucket seats.
  

• Sit with legs crossed.
  

• Use squatting as an exercise in late pregnancy as this may force the baby’s head into the pelvis before it is in the correct position.

 
Some useful positions during labour

Some of these positions can work well in the pool
 

• If possible stay on our feet, leaning forward and rocking hips side to side/up and down with each contraction.
  

• Keep your bottom wiggling during each contraction.
  

• Lean forward over beanbag.
  

• Hang onto something with arms well above waist height (I.e. partner’s neck, shelves in HBC rooms) and let your body sag, turning knees outward.
  

• Sit your partner on a chair, kneel on the floor knees apart, and lean on his thighs.  (Convenient for him to rub your back).
  

• Get on all fours either on the bad or floor.
  

• If you are on the bed, lay on your side.  Preferably on your left.
  

• Try to avoid lying on your back in a reclining position in bed