Optimal Foetal Positioning

The Optimal Foetal Position is our term for the First Vertex; Vertex Left Occipito Anterior; Vertex L.O.A. The position most commonly chosen by near term babies when they are able.

Optimal Foetal Positioning, or OFP for short, is the term coined by myself (Jean Sutton ) and Pauline Scott to describe ways a mother can assist her baby to assume the best position if he/she is to have the simplest, safest birth.Today we are told that human babies always need help to be born, but why? Babies managed for countless years before midwives and doctors were involved. They know what to do, but not how to tell us how to help them.Or have we stopped listening? Parents-to-be today are bombarded with advice from all sides. Ante-natal classes teach many ways of managing labour; mothers build up an expectation of the perfect birth, but few teach about the baby’s role.

This is what optimal foetal positioning is – encouraging the baby to move into the optimal position for labour and birth.

OFP was conceived to encourage birth practitioners to view the mother’s pregnancy and the baby’s birth from the baby’s perspective.We accept that the baby is in control of the growing part, so why shouldn’t he/she largely manage the birth process? Traditional birth wisdom and old textbooks held the view that the baby’s position at the beginning of labour pedicted the result. They divided the possible positions into vertex (head down) breech (bottom first) and a few other highly unusual angles.
The most common positions came first, and the rest followed. The first choice was head down, back between Mother’s left hip and umbilicus.Vertex L O A left occipito anterior or Optimal Foetal Position. Amazingly, 75% of babies chose this position. Around 10% chose to be on Mother’s right side–this is only possible for second and later babies. That meant that only a few were facing forward,or R O P right occipito posterior, and even fewer were breech.
When mothers stayed mobile during labour, and the baby was the right way round, labour tended to start on time and proceed smoothly to a tidy birth.

If baby is to get himself/herself into the best position, baby needs mother to spend most of her time with her abdomen ( tummy ) forward, and her knees lower than her seat. Then baby will, during the last few weeks of pregnancy, be most comfortable lying with his/her back to mother’s front. Mothers aren’t keen on this, as they end up with a bulgy abdomen, a saggy back, and a “duck waddle” walk!!
Still, if they want as simple a birth as possible that’s what is needed. Today, mothers want to stay as “tidy” looking as possible for the whole pregnancy. This only happens when baby is in a posterior position (facing forward) with his back straight, or is sitting as a “bottom down” baby.

Why has the change happened? Sometime around the 1960′s, people’s lives began to change. The modern world and technology brought us comforts undreamed of, but we may have forgotten the amazing wisdom of our ancestors.Television has us sitting in comfortable armchairs instead of upright furniture. Motorcars became common. Fewer people walked or cycled to work. Modern employment needed people with more education, so girls were at school for much longer, and not looking after smaller siblings. Work changed, sitting at a desk became the norm, and as computer use spread,we spent even more time sitting. Household chores were made easier by wetmops and vacuum cleaners. No more hands and knees–no more tubs of washing!
Now many more babies had little choice but to lie with their back against mothers. One can’t lie on one’s face in a hammock. The scene is set for problems. Overdue, long and painful labours, made worse because mothers were put to bed on their backs. The cascade of intervention became the norm. The babies don’t like today’s way of birth.
When things go according to their expectations, they come out with the most beautiful triumphant look on their faces. Today, many come out looking confused, bewildered, or frightened. My hope is that if enough people understand the baby’s point of view, we will again see more of those lovely expressions. Babies are my passion. They have only one birth, and it should be as safe and as pleasant as we can make it.

Optimal Foetal Positioning is not a new concept. The origins of it can be found in old midwifery text books or by talking with midwives who trained as apprentices with older, wiser and more experienced midwives. What has changed since the days of apprentice-trained midwives, is that our contemporary lifestyle has meant that mothers are at risk more than ever before. At the same time, childbirth wisdom from our past has almost disappeared. As midwives seek independence and recognition as the specialists of normal pregnancy and birth, ways to decrease the rate of medicalised labour are in everyone’s interest. The concept of OFP is very timely in our present climate of financial restraint and increasing reliance on technology. Babies who commence their journey in the optimal position make the birth process an exciting adventure, rather than a harrowing experience for all involved.

© Copyright Jean Sutton