What is Optimal Fetal Positioning

Optimal Fetal Positioning (OFP) is a method of encouraging a baby into the best position for its birth. Toward the end of a singleton pregnancy, the baby typically settles head down in the womb. The crown of the baby’s head engages in the mother’s cervix, and its back is toward the mother’s front. This position is called “occiput anterior” or “anterior.” During the birth, the soft spots on the baby’s head let it form a bullet-like shape for the easiest possible trip down the birth canal and out into the world. Think of a person putting on a turtleneck sweater. If you aim the crown of the head toward the opening, the head is in the best position for fitting through the neck of the sweater.

Well, not every baby follows the plan. Some babies settle in breech position with the head up. Some settle head down but with the head tilted to one side or with the face or brow pointing toward the birth canal. And some babies settle head down but facing the mother’s front. This position is called “occiput posterior,” or just “posterior” or “sunny-side-up.” 

Many midwives, doulas, nurses, and doctors use OFP, which encourages posterior babies to rotate before or during birth so that they can be born in an anterior position. PregnancyToday.com explains the history and techniques of Optimal Fetal Positioning. Birth-Angels.com explains and also uses photos to illustrate several exercises and helpful positions to encourage OFP. Labor and birth can be much shorter and less painful if the baby can be positioned the best way possible in the womb.

Do these techniques work? Often they do, but of course there is no guarantee. Sometimes a baby will shift from anterior (good) to posterior (bad) position at the start of labor, at which point the mother and birth attendant may use OFP to try to shift it back before the birth. Some babies who start labor in a posterior (bad) position, helpfully shift to anterior (good) on their own. Some posterior babies simply will not budge in spite of all efforts to shift them. My first child was in this group. We tried using OFP, but after a long labor and an eventual C-section we learned that his arm had been held in place by a loop of the umbilical cord, so he was not going to be able to shift to a better position no matter what we tried. He was stuck, and so was I! I am glad we tried the techniques, though – they did not do us any harm, and if they had succeeded they would have been of great benefit.