Understanding and Teaching Optimal Foetal Positioning

by Jean Sutton and Pauline Scott

[2nd rev. ed., 1996, Birth Concepts, Tauranga, New Zealand, 69 pages, paperback.]

[Review first published in Midwifery Today Issue 49, Spring 1999, © 1999, Midwifery Today, Inc. Review by Jill Cohen.]

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The way a baby is positioned in its mother's pelvis at term will have a major effect on labor and birth. It is said that up to 50 percent of babies are not in the optimal position at term. Postdates births in which the skull has calcified and doesn't mold, as well as posterior, breech, compound presentations and asynclitic positions can all inhibit the normal birth process and lead to intervention. This book analyzes at length why there are so many malpresentations of babies seen in modern maternity care. Possible answers and remedies are offered.

The book begins with an overview of the anatomy and physiology of both the fetus and the maternal pelvis and uterus as well as the various ways a baby can present. Special attention is paid to the posterior position in which the baby lies with his/her back against the mother's spine, a frequently seen malpresentation. The face presents sunny side up, requiring a larger diameter for the head to come through the pelvis. Factors that influence the occipitoposterior position—including lifestyle, placental position and the condition of the abdominal muscles—are explained.

The authors then progress to ways in which positioning can be optimalized. Improved maternal posture and proper exercise are key components. Swimming, yoga, rocking and alternative therapies such as acupuncture and homeopathics can all be used to help create effective descent of the baby.

The authors also explain positions and activities that women should avoid as they near full term pregnancy because they may encourage the baby to malpresent. This section also discusses positions that should be used or avoided during labor itself.

Keeping a watchful eye on positioning is not a new concept. In older texts it is given much credence, but unfortunately much of that old wisdom has been overlooked in modern obstetrics. This book effectively rekindles that old knowledge and puts it back to work so that a more natural, less medicalized birth can be achieved. The text is enhanced by photographs, midwives' tips and comfortable language appropriate for parents and practitioners alike. It is an excellent resource that we can all learn something from and put to use in our practice.

Reviewer Jill Cohen is Associate Editor at Midwifery Today magazine and the editor of The Birthkit.