O.F.P.

Stands for Optimal Fetal Positioning...

Last night, I read a little book written for midwives (no friendly layman's terms here--thanks to Dictionary.com, I learned what multigravida means) about the best position for a baby to be in in order to have the least painful, quickest, and safest (i.e. least likely to result in a medical intervention) birth possible. The nice thing about the book was it's very small size. I'll spare you the technical terms (since I certainly don't have them memorized) and just tell you that it's head down (duh) and baby's back against mom's front left side (centered between bellybutton and left hip)

A professional can tell by palpitation of your uterus what position your baby is in, but if you want a clue, you're hoping for the heartbeat to be heard on the lower left of your bump, so if your doc (or other care provider) puts the little Doppler microphone up high or on the right (and finds the heartbeat he or she is looking for), you may wish to try changing your baby's position. Also, If you feel a lot of movement up front, (or, I would assume, on your left) your baby is probably not optimally positioned. There was also some detailed information about the shape of your bump, and I get the feeling the cute, basketball-under-your-shirt look is what you're going for. Flat on top or in front indicates a less than ideal position.

When do you need to worry about this? Around the time your baby "engages" (which means lowers himself (or herself) into your pelvis in preparation for being born) This can happen as early as 6 weeks before birth, especially for first-timers. It can happen as late as when labor begins for those who have been there, done that. However, since the positions and activities for achieving OFP aren't all that difficult, it seems like a good idea to begin thinking about this around the 34 week mark, especially if your goal is a natural, intervention-free birth at a hospital, as much of the time, you are on your own as how to actually accomplish such an anomaly.

The bad news: A lot of what you may be doing each day could be contributing to poor positioning. lounging (leaning back past 90 degrees) on the cough or in the Lazy boy while you nourish your baby with high-calcium, high-protein snacks such as Haagandaz bars and bowls of ice cream (oh wait, that's just me?), abdominal exercises, and even squatting pre-labor can contribute to poor positioning. There's also lying and sleeping on your back--but most mainstream pregnancy guides advise against this already. As a good rule-follower, I'm sure you aren't doing this, but I am. Every morning (and every time I wake in the night) I find myself on my back, despite having diligently positioned myself on my left side the last time I fell asleep.

I've been lounging...well, whenever I relax, since childhood, and I find myself wishing to relax more and more as pregnancy progresses. Just a few weeks ago, I patted myself on the back for borrowing (and exercising to) a prenatal exercise DVD that includes quite a lot of squatting and abdominal contractions (basically pulling in your abs, since sit-ups aren't advised during pregnancy).

Lounging (and lying or sleeping on your back) is bad because gravity works to swing your baby's back against yours. If your baby remains in this position, you will have painful back labor at the very least, and the babe may get stuck when trying to exit through your pelvis. Differing angles cause sizes and shapes of baby's head and your pelvis to not match up in this position.

Ab work (or previously well-toned abs that have retained their tautness) is (are) a no-no because they tend to narrow the lower part of the uterus (the uterus itself is not exercised or changed by ab work, but rather the area the uterus resides in shrinks) which will discourage a baby from placing his head down...since his feet fit much better there.

I'm not quite so clear on why squats are a bad idea--and I know for sure they're a good idea during labor. But, it has something to do with the angle of the spine to the pelvis. Modified squats (wall squats, that keep your back straight and at a 90 degree angle to your pelvis) are okay. Did I mention this book, though blessedly short, was rather hard to read? Hence, my lack of full understanding regarding the "why" of this particular point.

All of this might explain why Peanut was head-down 2 weeks ago, and at my appointment this past Monday had decided to be head-up instead. Of course, even though he was head down last time, his heart beat was still on the right... so that's better than breach, but not great.

Lessons?

Sit leaning forward, or at the very least, straight up and down. Easier to do if you scoot all the way to the edge of the couch or chair and place your feet at least hip-distance apart. Or, kneel, lean forward, and support yourself with something (like a Pilates ball) above waist-height.

Don't do ab work. :( I guess I'll just have to wait until postpartum to firm up.

Do wall squats or climb stairs to keep those thigh muscles strong enough for upright positions in labor. Don't do regular deep squatting (squats that keep your rear higher than your knees are okay).

And...as you've heard time and again, don't lay or sleep on your back. Instead, choose your left side, legs comfortably bent, with your top knee crossed over the bottom one and resting on the mattress. Or, if you can afford the luxury, and desperately miss sleeping on your stomach, as I do, buy a Baby Wink pillow.