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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 its come to be known by) is a break
through concept. Jean Sutton brings to our awareness the importance of mothers posture and
positions in pregnancy, in labor and also the importance of babys engagement into the pelvis at
about 38 weeks. Their book includes several tips and bits of birth stories.

Why dont 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 isnt
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. Babys 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 babys head is staying in a non-progressing labor.

Fetal position shares a stage with several leading actors, such as Flexion, Body Balance, and,
dont 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.)

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