Optimal Fetal Positioning
The 3 P’s (Passage, Position, & Power)
Three factors greatly influence the ability of the baby to be born through the pelvis. The first is the passage or the shape of the pelvis. The second is the position of the baby in the womb. Lastly, the power of the contractions to move that baby through the passage.
Gynecoid is the most common pelvic shape and is also the most favorable. Gynecoid is described as round, shallow, and open. Android is a heart-shaped pelvis, anthropoid pelvises are oval, and platypelloid resembles a side-lying oval. Remember pelvic shape alone does not determine how one can give birth!
Optimal Fetal Position
The left occiput anterior is the most common fetal position and is often referred to as the “optimal fetal position”. This position is when the baby is head down with their back along the mother’s left side. This allows the baby to navigate the most common pelvis shape (gynecoid) more easily. An OA position is also optimal positioning for the baby, this is when the baby’s back is along the midline of the mother’s belly. However, babies can and do come out in many different positions!
Ways to Encourage Optimal Fetal Positioning
Utilize Spinning Babies' daily exercises: https://www.spinningbabies.com/
Forward-leaning rest positions
Good posture (shoulders back, feet planted, and neck/ back straight)
Good body mechanics during the day
Breech Baby
Breech describes a fetal position where the head is up and the rump is the presenting part. Most babies turn their heads down by 36 weeks gestation, by term, only 3.7% of babies are in the breech position. Breech babies can and are born vaginally, although there are additional risks associated with this type of delivery. Oftentimes more advanced skills are needed.
Ways to Turn a Breech Baby
Visualize the baby turning its head down
Knees-to-chest tilts with abdomen massage to encourage turning
Use sound or light to encourage the baby’s head downward
Moxibustion
Acupuncture
Chiropractic Care
Homeopathics 200C Pulsatilla
If all else fails, the external manual version might help turn a breech baby. This is a maneuver where either a physician or midwife lays hands on the pregnant person’s belly and manually attempts to turn the baby. The steps to an External Manual Version are as follows:
Your midwife will likely encourage you to increase fluid intake 24 hours before.
Once the time is for the appointment, you will be asked to empty your bladder and lay down on your back.
A pillow or bolster may be placed under your rump to elevate and encourage your baby to come out of the pelvis.
Before the midwife attempts to turn the baby she is going to listen to their heart rate to establish a baseline.
Using her hands the midwife will apply firm pressure on both sides of your baby and begin to turn them.
During this process, the baby’s heart rate will be listened to periodically.
References
Frye, A. (2010). Ensuring a Vertex Presentation at Term
In Frye, A. Holistic Midwifery, Vol. I. (pp. 801-811). Portland, OR: Labrys Press. (in Course Modules)
Left Occiput Anterior (LOA) https://www.spinningbabies.com/pregnancy-birth/baby-position/other-fetal-positions/left-occiput-anterior/
Why This Is Not Optimal Fetal Positioning https://www.spinningbabies.com/why-this-is-not-optimal-fetal-positioning/
Al Hajjar, A. (2018). Baby’s passage through the pelvis. YouTube. https://www.youtube.com/watch?v=loNSO2WgCtA&t=6s
Breech Image. Retrieved from https://teachmeobgyn.com/pregnancy/fetal-abnormality/breech-presentation/.
