Is this Optimal Fetal Positioning?

Childbirth educator Pauline Scott coined the phrase Optimal Fetal Positioning to describe the work of Midwife Jean Sutton. These two women published Understanding and Teaching Optimal Fetal Positioning in 1996.  I believe OFP (as it’s come to be known by) is a break through concept. Jean Sutton brings to our awareness the importance of mother’s posture and positions in pregnancy, in labor and also the importance of baby’s engagement into the pelvis at about 38 weeks. Their book includes several tips and bits of birth stories.

Why don’t randomized control studies support Optimal Fetal Positioning when midwives and doulas do?

Optimal Foetal Positioning was “dumbed down” by public use to mean only the Left Occiput Anterior position.  Jean Sutton made the provocative point that birth seems to go easier when baby comes down from the left. There may be other reasons, but one is that babies from the left are more likely to be curled to aim the crown of the head into the pelvis. The baby from the right may rotate to the posterior in labor. I agree that this is likely to be true and even if it isn’t always true, it follows enough to be a critical skill for providers to be able to track fetal position and what to help make rotation from either side easier for baby.

Two facts will help you to understand why fetal position is important:

  1. Baby’s rotate through the pelvis to emerge from the womb.
  2. Fetal position effects the relative ease of fetal rotation and descent (including engagement).

Spinning Babies extends the concepts of Optimal Fetal Positioning (OFP) a break-through concept in childbirth.

My belief is that maternal positioning will support optimal fetal positioning when we have balance in the pelvis (including ligaments, fascia and muscles). Balance first.

We must remember that an optimal fetal position for the android pelvis may be necessary where the gynecoid pelvis has several options. A woman with an anthropoid pelvis is much more likely to have a speedy occiput posterior labor if her pelvic floor is reasonably supple, whereas women with an android may and a woman with a platypelloid pelvis does need baby flexed and from the left. See pelvic types in Birth Anatomy. Flexion is more important than position and soft tissues (Pelvic Floor, Psoas, ligaments, fascia, etc.) are often more of a determinant than the pelvic type (except for Ms. Platypelloid and the smaller of the Android Sisters).

Spinning Babies continues where Optimal Fetal Positioning pointed and adds Balance. By noting fetal position and/or the station of fetal descent, a system of protocols (series of activities) can be matched to help mother and baby. The workshop is quite useful to learn this protocol expressed as The 3 Principles of Spinning Babies and the Fantastic Four. Address the muscles and other “soft” tissues and match the technique to open the diameter of pelvic level (pelvic station) where baby’s head is staying in a non-progressing labor.

Fetal position shares a stage with several leading actors, such as Flexion, Body Balance, and, don’t forget the importance of the location of birth: the Parasympathetic State. (For those of you who speak English as a second language or only have google translate, this is a joke.)