Optimal Fetal Positioning is a theory coined by New Zealand midwife Jean Sutton and childbirth educator Pauline Scott. The theory goes that babies inherently know the best and safest positions for them to be born. Pregnant people can do a lot of little things throughout pregnancy to create as much space and less tension in the bony pelvis, soft tissue, connective tissues and muscles around the womb to encourage baby settle into the best position for birth. The most ideal position is the Occiput Anterior (OA) position and it’s variations of Right OA and Left OA. This position is head down, with baby’s face directed to the pregnant person’s tailbone in the womb. This is usually the most optimal, easiest way physiologically for babies to be born.
Optimal fetal positioning adopts various therapies, stretches, physical and mental techniques to encourage the baby to move into the safest and best position for them to be birthed. When babies aren’t in an optimal position it can be for a variety of reasons and sometimes create a longer more complicated and uncomfortable birth for you and for baby. Some of the more common are an unbalanced pelvis, sedentary lifestyle, and lax pelvic floor muscles. There are some simple ways to prepare your body and help your baby in to the best position for them, and you for comfort in birth.
Stretch and squat. Various stretches like squatting, cat-cow or sitting in “seiza”, Japanese sitting with knees apart to allow for the belly to hang forward. Don’t shy away from using that Japanese-style toilet. This position of squatting helps to open up the pelvis and give more room for baby to wiggle into the best position for them.
Do your Kegel exercises. Enough said!
Fix the way you sit. In the beginning of pregnancy, it’s not as critical to be sitting properly. Once 25 weeks in pregnancy rolls around it is a great idea to bust out the yoga ball and sit on that as often as you can all the way into labor. The idea is to “sit on your sits bones”; the bony part of your bottom and refrain from sitting back on your tail bone, which causes your pelvis to tilt back. This creates less room in the pelvis and womb for baby to find an optimal position for birth.
Employ some complementary therapy. Chiropractic, cranial-sacral therapy, physical therapy, osteopathic manipulations, massage therapy, acupuncture, acupressure and reiki can all help in balancing the pelvis, release tensions and blockages in the body for proper, optimal function and healing.
Mind power. Mindfulness, meditation or prayer. Taking a few quite minutes a day to relax and tune into your body and baby to connect in a positive, meaningful way. It may sound silly, but try visualizing and talking to your baby about how you want them to be born. Your baby loves to hear your’s and your partner’s voice’s during those times of bonding. Babies are so much smarter than we give them credit for.
What can you can do now if baby is breech (not head-down position) or isn’t in the optimal position when labor starts?
There are lots of things you or your care provider can try before labor to encourage baby to move in to a better position for birth. Some do-it-yourself examples, with your providers approval, would be a forward-leaning inversion, side-lying release, or breech-tilts. A midwife or an obstetrician may find that a pregnant person and baby being breech is a good candidate for External Cephalic Version (ECV or Version). This procedure is done by the provider as they manually move the baby from a breech or transverse (side-ways in the womb) to a head-down position. During this procedure the baby is being monitored closely for stress.
In labor there are even more positions, techniques and stretches for a person with and without pharmaceutical pain relief to encourage labor to progress smoothly and for contractions to settle into a good groove and regular pattern.... which is a good thing! Every productive contraction brings you one step closer to meeting your baby.
Talk to your provider. They really are at the forefront of your health, safety and well-being. Talk to them about your concerns or wishes and work together to find common ground. If you’re not sure about a procedure, medication, etc, you have the right to ask questions, seek out a second opinion or request a different provider at any time.
Taking an in-depth, comprehensive childbirth education class will be supremely beneficial. The instructor will likely go over optimal fetal positioning and so much more. It is one of the best investments for learning about the processes of pregnancy, birth, infant-feeding, what to expect in the weeks postpartum and adjusting to life with your baby.
Reaching out to a birth doula in your area may be a great choice for you also. Birth doulas are non-medical support persons that have extensive training and knowledge and empower families with the resources, educational information and techniques for a more comfortable, informed and satisfying birth experience. They also may assist in spiritual needs and decision-making support before, during and after your baby is born.
Keep in mind that no stretch, therapy, class, procedure or person is guaranteed to work Sometimes babies just won’t budge from breech or a less optimal birthing position, in that case you and your healthcare provider will put together a plan for the safest birth experience for you, and your baby.
Krystle is a birth doula living in and serving the Yokosuka, Japan area. Her words to live by as a mother are “whatever keeps the kids alive and me sane” and to being a doula; “feel hearts, hold hand and hug hips”. She freely volunteers her time and love for educating families as a Breastfeeding Counselor and the first International chapter leader for the organization Breastfeeding USA. She loves her Husband for putting up with and encouraging her to follow her heart with her work, the art her children make her, all things Disney and London Fogs.