Optimal Foetal Positioning: Why Your Baby’s Position Matters for Birth

Even if your baby is not in the optimal position in the weeks approaching your due date, there are many ways that your healthcare team can support you through the birth process. The key is to stay informed, and to work closely with your midwife to find the best solutions for you and your baby. In this article, we’ll look at how to encourage your baby into the occiput anterior position, the role of yoga in helping your baby to move, and what your options are if your baby just won’t budge.

Babies can position themselves in various ways within the womb, and understanding these positions can help you and your healthcare team to prepare for birth:

• Occiput anterior (OA). This is the ideal position where your baby’s head is pointing down and they are facing your back. This position aligns your baby’s smallest head diameter with the birth canal, making labour easier.
• Occiput posterior (OP). Also known as the ‘back-to-back’ position, where your baby’s back is against your back. This position can lead to longer, more painful labour and may require additional interventions.
• Transverse. This is where your baby lies horizontally across your abdomen. This position usually necessitates a c-section as your baby cannot be born vaginally in this orientation.
• Breech. This means that your baby is positioned with their feet or bottom pointing down. Depending on the specifics, a vaginal breech birth may be possible, but often a c-section is recommended. If you want to birth breech then find out the facts here. 

It’s normal to feel concerned if your baby isn’t in the optimal position. Remember, many babies move into the optimal foetal position on their own, especially as labour approaches and babies can be born breech! Be sure to discuss any worries you might have with your healthcare provider, who can guide you towards the best course of action.

Having your baby in the optimal foetal position can significantly affect your birth experience. When your baby is positioned head-down and facing your back, labour is often shorter and less complicated. Here’s why this position is beneficial:

• Easier passage. Your baby’s head aligns with your birth canal in a way that allows the smallest diameter to pass through first, reducing resistance and facilitating a smoother journey out into the world. Your baby is also putting more weight on your pelvic floor which releases more oxytocin – opening your cervix at a faster rate. 
• Reduced labour time. Babies in the optimal foetal position are often born quicker, as their alignment helps to speed up the natural birthing process.
• Lower intervention rates. There’s a reduced likelihood of needing interventions such as forceps, vacuum extraction, or a c-section when your baby is in the occiput anterior position. If interventions are necessary, they tend to be simpler and less disruptive to your birth plan.

You can take several proactive steps during pregnancy to encourage your baby into the optimal position.

• Stay active and upright. Remaining upright and moving your body regularly can help your baby to get into the right position. The “UFO” principle (upright, forward, open) is a handy reminder to adopt positions throughout the day that are upright, forward-leaning, and open at the pelvis where you can.
• Use a birthing ball. One way of practising the UFO principle is by sitting on a birthing ball. This can promote good posture and pelvic alignment, helping your baby get into the best position for birth.
• Avoid reclined positions. Try to minimise time spent in reclined positions such as slouching on a sofa or in the bucket seats of cars, as this can encourage the baby into less favourable positions.
• Engage in biomechanics for birth. Techniques like forward-leaning inversions, side-lying releases, and using a rebozo can help position your baby optimally. A rebozo is a traditional Mexican woven cloth used to help relax the uterine ligaments and muscles, assisting the baby to rotate into the best position for birth. If you do decide to try any of these techniques, it’s important that you always perform them with the guidance of a doula or trained professional. For more information on biomechanics, you can visit Spinning Babies.

Incorporating antenatal yoga into your pregnancy care routine can be extremely effective when it comes to promoting optimal foetal positioning. This is because, when taught by a qualified antenatal yoga teacher, yoga has the power to:

• Open your hips and pelvis. Yoga poses that involve being on all fours or squatting help to open your hips and pelvis, giving your baby more room to move into the right position.
• Introduce active birth positions. Practising yoga helps you to become familiar with active birth positions and promotes flexibility and strength, making it easier to move instinctively during labour.
• Enhance mind-body connection. Yoga fosters a deeper connection between your mind and body, sharpening your ability to respond to labour cues and manage pain more effectively.

Not only is antenatal yoga a gentle and effective way to stay active throughout pregnancy, it also helps to prepare your body and mind for labour. Consider joining an antenatal yoga class or following online sessions that focus on poses beneficial for pregnancy and birth. The pregnancy yoga at Butterbean is a great place to start, led by birth expert and antenatal yoga specialist Lucy. 

If your baby is in a breech or transverse position, it’s natural to feel a bit concerned. But the good news is, your healthcare team will be trained in the art of safely delivering babies regardless of what position they’re in. Here are some options that you can consider if your baby doesn’t move into the optimal foetal position on their own:

• External cephalic version (ECV): This is a procedure where an obstetrician manually turns your baby to a head-down position. It’s generally performed in a hospital setting under close monitoring. It’s worth flagging that this procedure does come with risks which include your baby needing to be born via emergency cesarean. Ask your midwife for the facts before you accept. 
• Vaginal breech birth. Depending on the specifics of your baby’s position and your overall health, a vaginal breech birth might be an option for you. Be sure to discuss this thoroughly with your healthcare provider ahead of time, so you can understand the risks and benefits associated with it.
• Planned c-section. For transverse or certain breech positions, a planned c-section may be recommended but not mandatory. Research surrounding planned c-sections for a transverse baby is weak and out of date. 

For further reading and resources about optimal foetal positioning, you can explore these helpful links:

• Pregnancy yoga at Butterbean. This online yoga course provides expecting parents with a gentle daily practice. It’s tailored towards centering your mind ahead of birth, assisting with foetal positioning, and improving your birth experience.
• Spinning Babies. Created by midwife Gail Tully, Spinning Babies promotes a physiological approach to birth, and offers techniques and tips for optimal foetal positioning.
• Biomechanics for Birth by Molly O’Brien. This platform offers in-person and online courses that teach about the biomechanics of birth and how this can encourage your baby into the occiput anterior position.

Optimal foetal positioning plays a crucial role in facilitating a smoother, less complicated birth experience. But despite your best efforts, sometimes babies just don’t end up in the optimal position. If this is your experience, the most important thing is to be informed of your options and keep an open dialogue with your midwife. 

Trust in your body’s natural ability to birth your baby. Even if things don’t go quite as you planned, your ability to adapt and respond to your circumstances, with the support of your medical team, can still lead to a positive and empowering birth experience.