Optimal fetal positioning: A movement-based ACHP

Human labor is most efficient when the fetus is head-down and facing the mother's back, with the back of his head—the occiput—in the anterior position. However, some 15-30% of labors in the U.S. begin with the fetus in the occiput posterior position. This causes prolonged, painful labors that are 11 times as likely to end in cesarean delivery. In 1994, a midwife from New Zealand proposed a program of exercises that she called “optimal fetal positioning” (OFP). OFP was based on both knowledge of pelvic anatomy and results from observational studies indicating that the fetus' position could be changed by changing the mother's position. OFP consists of a series of exercises and postures, to be practiced by the mother during the third trimester, with the goal of ensuring that her baby is occiput anterior at the start of labor. Midwives in Oregon have been advising their clients to practice OFP for several years; we conducted a mixed-methods study to learn what they are telling women and how well they think OFP works. We will present detailed results from in-person interviews and a subsequent web-based cultural consensus modeling survey. Based on our knowledge gained from midwives, we are now collecting pilot data on the effectiveness of OFP in pregnant women. Women enroll prior to the start of the third trimester, participate in two 7-day OFP/physical activity recalls at 30 weeks and 35 weeks, and then fetal position data are obtained from midwives after birth. We will present preliminary findings.