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Left Occiput Anterior (LOA)

The LOA baby with normal

asynclitism before baby engages
below the sacral promontory

The left occiput anterior position is often the easiest fetal position for the start of labor. Babies
settle in the LOA position naturally when the womb is pretty well balanced. This position helps
the baby be in the smallest diameter to fit the pelvis.

The LOA baby has his or her back on the mothers left side. The baby faces between the right
hip and the spine of his or her mother.
The crown of the head is most often entering the pelvis first. This helps the baby fit the pelvis in
a way that the babys head can mold (shape) to fit the pelvis most effectively, as needed (if
needed).

Looking up from below we see the babys head

over the pelvis

The babys back can curve most effectively in this position. The baby slides down the softening
abdomen in the last weeks of pregnancy to enter the brim. The head enters the pelvic brim at
about 38 weeks in a first-time mom, perhaps later in an experienced birthing woman.

LOA position makes engagement likely. When the head settles deep enough into the pelvis so
that it doesnt bobble back and forth, it is called engagement. Engagement is easier for a baby
who has the crown of the head coming first, as opposed to the very top of the head. This will
mean that the babys chin is tucked, in what is called flexion.

Gail feels the head for engagement

The midwife palpates the fetal head and listens to the babys heart beat with a fetascope
(stethoscope). The mother feels a bulge for the babys bottom on her left. The feet stretch and
kick in her upper right. The midwife may feel the cephalic promontory on the right signifying
that the babys chin is nicely tucked (flexed).

The Left Occiput Anterior position is the most common, ideal fetal position (Optimal Foetal
Position). The label for optimal fetal position is dependent on the shape of the mothers pelvic
brim. The most common pelvic shape, gynecoid, is associated with an LOA or LOT (LOL in UK,
NZ and AUS) fetal position at the start of labor.

An OA (occiput anterior) fetal position is also ideal. The babys back is directly forward.
There seems to be little kicking, but the baby slides and stretches regularly. Fetal
movement is present, just not as easily felt as with the posterior baby that has limbs
kicking in to the mothers skin.

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