Optimal Fetal Positioning and the Spinning Babies® Approach
Published Date:September 2, 2026
By Ali Weatherford
Optimal Fetal Positioning (OFP) is not something that most people think about when preparing for labor and birth, but it can have a profound impact on outcomes.
What is OFP?
Optimal Fetal Positioning is a term originally coined by team effort. Pauline Scott began using the phrase to describe the work of midwife Jean Sutton. Together they authored the book, Understanding and Teaching Optimal Foetal Positioning published in 1996. There has been a lot of controversy surrounding this topic since then. Some people think it implies that there is one best position for babies in birth. What is most true and widely accepted is that optimal positioning depends on a lot of things. What is optimal for one person might not be optimal for the next. So, when I’m talking about OFP, I’ll be using my own interpretation of the work that has been done. I think of OFP as an approach to birth that is informed by the baby’s position relative to the birth parent’s body. Based on that, a birthing person may need to change their own position or move in certain ways for their own comfort, and also to help optimize the baby’s position.
Most babies getting ready for birth will get comfortable in a Left Occiput Anterior (LOA) position. This means that the baby is:
- Head down
- Spine at the front of the belly and slightly off to the left
- Facing toward the mother’s back and slightly to the right side
- Back of baby’s head toward the left side of the parent’s pelvis
Anatomy
Your anatomy can definitely have an impact on the baby’s position. In a pregnant body, there are a lot of anatomical obstacles. A baby needs to conform to their surroundings. That includes the container they are in (the uterus), the bones they have to get around and through (the spine and pelvis), but also a lot of soft tissue like muscles, ligaments, tendons, and fascia. There is a sort of standard anatomy that usually makes babies take a particular position and path, but there can be a lot of variations. Some people might have a differently shaped uterus or pelvis, but even if those parts of your anatomy are standard, you might have tight muscles or fascia, or overstretched or tight ligaments or tendons.
The Uterus
The reason that most babies end up in the LOA position is suspected to be, in part, because of Right Obliquity of the uterus. That means that most people have a uterus where the top left is rounder, and the top right tilts down at a steeper angle. It’s not perfectly round and symmetrical. Sort of like this shape.
This basically means that a baby’s bottom more easily and snugly fits up into the top left of the uterus. That rounder shape means the baby’s back can easily curve into the left side as well. A curved spine is ideal because it encourages a baby to tuck the chin. Try it! If you curve your spine out, your chin naturally wants to tuck. With a tucked chin, the narrowest part of the skull (the crown) points down into the pelvis. With the narrowest part of the baby’s head moving down, the baby can most easily move and engage in the pelvis. But not every uterus is shaped the same, so some babies will get into the ROA position, but other positions can also work.
The Pelvis
The shape of your pelvis may also help decide the best position for the baby. The majority of women have a gynecoid pelvis. That means the pelvis inlet (the way the baby goes in) is round and pretty symmetrical. Some people have a more heart-shaped or oval-shaped pelvic inlet. Depending on the shape of the pelvis, a baby might need to be in different positions to get in, and through, most easily.
The Soft Tissues
If you have very tight muscles or ligaments, and tendons that are too tight, or too loose, this can also make it more difficult for a baby to get into an optimal position. For example, it’s not uncommon to have very tight psoas muscles.
These muscles connect to the top of the femur bone at the bottom, thread up through the pelvis, then connect at the lumbar spine at the top. They’re large, strong muscles, and they sort of make a girdle around the uterus. If they’re very tight, they can decrease the space a baby has to move around. Many of us have tight psoas muscles, especially if you spend a lot of time sitting. It can be a tricky one to stretch.
Why Anatomy Matters?
The anatomy lesson is to show you that there are so many factors that can affect a baby’s position in the womb and how they move and descend for labor and birth. When a baby encounters obstacles, although they can move and redirect, it might mean that labor takes longer and could be more painful.
What Does Spinning Babies® Say?
The Spinning Babies® approach takes all of this anatomy into consideration. Their work has been to discover how to help laboring people move their bodies to help babies move the way they need to for birth. I have done two Spinning Babies® workshops and the information was so eye-opening. We learned how most babies can move quickly and easily through most bodies. We learned about how to know if your baby is not in an ideal position, and even what position you might be able to suspect. And finally, they showed us how to help manage labor when a baby is not in an ideal position. There are countless movement strategies, touch support, and positions to try. We learned where to start depending on the situation and how the labor is progressing and feeling.
What Can YOU Do?
There are so many resources on SpinningBabies.com. I encourage everyone to take a look! There are plenty of free articles and guides to look at. If you really want to learn a lot, and prefer something more structured, you can purchase courses for parents. If you don’t want to spend a lot of time or effort to learn all the details, I think there are a few very basic lessons I can share that I take away from learning the Spinning Babies® philosophy.
- Do plenty of nourishing movement during pregnancy. I love to recommend a good prenatal yoga class, because it will help stretch and strengthen you in the ways that might be helpful for OFP and birth.
- Watch how you position yourself during pregnancy. If you find yourself sitting most of the day, try different positions. You can elevate your bottom on your chair so that your thighs angle down, and your knees are below the level of your hips. This can help elongate your psoas muscle. You can get a standing desk. You can be in a hands and knees type position with your arms resting on an ottoman for some time while you’re watching a movie instead of sitting on the couch. Do some squats every day.
- Get a doula. You can probably even find a doula who is trained in the Spinning Babies® approach or has taken a workshop. Doulas often know how to help based on what you’re experiencing during labor. They will encourage you to change positions and move your body.
- Ask if your hospital has provided any Spinning Babies® training for their labor and delivery team. The two workshops I participated in were hosted by hospitals we partner with, so I know that their staff were also getting the training!
- And maybe most importantly, during labor, listen to your body. It will probably tell you to move and change positions often. You probably won’t know exactly where your baby is or how they’re positioned at all times, but you can know that if you’re doing a lot of movement, you’ll probably hit the right position eventually! A lot of times, changing positions will also make you feel better and keep your labor progressing.
References
Right Obliquity – Fetal Positioning – Spinning Babies
Baby positions in the womb before birth | NCT
Spinning Babies® Approach: A Way to Promote Fetal Head Rotation During Labor?
