Posterior position of baby is when the baby is positioned with it’s back to your back so is facing upwards. The ideal position for baby is OA occiput anterior ( head well flexed and baby looking down). However since nobody has told babies this, about 10/12% of them will be looking up at the time of birth.
It is known that anterior babies have a head well flexed and a diameter of 9cm (sub occipito bregmatic). If the baby is posterior it isn’t as well flexed so the diameter is a bit more 10.5cm (sub occipito frontal) and if the baby is totally deflexed, the head is military style then it’s is a little bigger again 11.5cm (occipito frontal).
The Wales study showed that at labour 10 to 15% of babies were OP and 65% of them would rotate to OA and a further 20% to transverse (we can only assume that to get from posterior to anterior all the babies at some point would be transverse along the way) and 4 to 5% babies remained posterior without rotating at all. This lead them to believe that babies were often not posterior when entering the pelvis but their heads rotated their way through. This was backed up in the study by ultrasound.
It is well accepted that in the hospital more women have epidurals with a posterior baby, which then moves to more instrumental births, episiotomy and more cesarean sections. This is because often a posterior labour can be longer and more painful. Time lines, augmentation and unnecessary stress can often become involved in your labour making it almost impossible to have the unhindered labour and birth you hoped for. They found poor normal birth outcomes for first time mothers with posterior labours at the hospital.
Optimal fetal positioning has long been thought to play a big part in having a baby in the “perfect position and the spinning babies website is a useful resource. Also the book Optimal fetal positioning by Jean Sutton and Pauline Scott explains all about their theory of getting the baby into the best position possible.
Rebozo is also a good technique, sitting on a birth ball and watching your posture also can help, so can moxa sticks and chiropractic; however this is only anecdotal as the studies don’t back up what we know . They did a very large controlled trial of 2547 women in New South Wales and used pelvic rocking and hands and knees from 37 weeks to encourage babies to turn. They had a control group and an intervention group. the results which said that 7.8% of women in the in intervention group ( that’s the exercises) and 8% of the control group had a posterior baby.
If your baby is posterior when you go into labour you can help rotation by being active, rotate hips, walk, climb stairs, be on all 4.s. All this can encourage your baby to turn. Avoid going to the hospital, being strapped on the bed on a monitor or having an epidural. Have an independent midwife who can give you one to one care during your labour and birth and be with you to support you in your labour and suggest the possibilities if your baby is posterior.
This clip is not as good as it could be, I was in the way somewhat. The woman has had a long labour and there was lots meconium at the birth. I am a little more hands on than is usual but she did an amazing job. Watch carefully to see the baby looking up at the birth and nicely rotating to the side before the shoulders appear. She is sitting on a bolster supported by her partner.
- Do you
Homebirth? Share this post with your friends - Recommend on Facebook
- Buzz it up
- Share with Stumblers
- Tweet about it
Related posts:
My first was posterior most of my labor and she turned in the birth canal and was born anterior.
What’s odd is that I still had back labor with my second, though she wasn’t posterior, afaik, but she was footling. Is common to have back labor with breech?
It’s not common to have a posterior breech but obviously not impossible. How did it go?
Oh it was an adventure, to be sure! I just confirmed with my dh, she was definitely anterior (he caught). Somewhere inside of myself, I must have known she was breech. I say this because I was fascinated by breech stories her whole pregnancy. I had a dream before I conceived her that I was delivering a footling breech and shortly after we conceived her I had another dream where the details lined up exactly with her birth (though in that dream she was not breech). In the second dream she was very small, a girl, and not breathing at birth. The thing I was the most conscious of in that dream was her cord pulsing between us-very, very strongly. I woke up with that sensation at the forefront of my mind and took it as a reminder NOT to cut the cord until well after it had stopped pulsing.
In the end, I went into very early labor at 35 weeks. I know that most people would say that if I didn’t have a baby until a week later, it wasn’t labor, but I say pooey on them. My body doesn’t know what the textbooks have to say about labor and all I know is that I had regular (if infrequent) strong “real” contractions for a week. They never went away, though at times they would space waaay out. They had a pattern but were gentle, as far as contractions go, but definitely with that cervical pulling sensation I associate with early labor. Lots of bloody show for several days until that stopped (for two days). On the morning of day 7 (which was exactly 36wks) I lost a huge amount of bloody mucous. I also began active labor (I woke up that way around 6:30 am). Labor was rough but good, if that makes sense, lol. I did have a lot of pain in my back and a tremendous amount in my cervix. My water broke about ten minutes before she was born. I felt her (just like in that second dream) come down all at once and slam into my perenium. It felt very different from what I remembered with my first birth so I asked dh to check and see what was presenting. He told me later he silently freaked out when he first looked because he *though* he was looking at a foot next to her head. But no, it was two feet and a butt, lol. After he told me that, she actually kicked her own feet out- I didn’t push and wasn’t even having a contraction. I couldn’t help it, I laughed. She/the Spirit had been trying to tell me for months and well, I wasn’t listening. I pushed her out to her armpits in one push and then…nothing. I tried standing, squatting, leaning over, all fours and she just wasn’t budging. I started to pray, loudly, asking what it was I was missing?! She punched me in the birth canal and a lightbulb went off in my head “Duh, her arms!” I asked where her arms were and everyone in the room said at once “Still inside”. Ok, so I asked dh to pull them down. This is why he was so sure she was anterior because he definitely had a front row seat! He swept her first arm down across her chest and the second followed on it’s own volition. She was born one push later.
She was quite floppy (though she did kick her foot, which is funny in retrospect…this child loves to kick, even now) and not breathing, though pinking up nicely. It was neat watching that, it blossomed out from her navel like a flower. Her eyes were closed and she really looked very like the baby in my dream except that she was so covered in vernix that in the video (which was very poor quality and bad lighting to boot) she looked grey. She was not and in fact, the first time I watched the video I freaked out, lol, because she looks dead. She definitely wasn’t. I draped her over my arm, face towards my elbow and her rear end slightly elevated and began to rub her back. I started talking to her, telling her that I loved her and calling her by her name (Abigail). I invited her to stay and flipped her back over and sucked out her mouth and her nose. She sneezed but made no other efforts to breath. So I sucked out her nose again, once, twice and after that she was really telling the world how much she didn’t like that! “Ok, ok, I’m here just don’t do THAT again!”
Having no clinical experience to speak of, I’d say her first apgar was a 6 or a 7 and her second was a 9. She weighed 4lbs 10oz and so naturally I was very concerned about her ability to breath and her little heart and all that. She had no cyanosis, though, no retracting and no grunting…not even a gurgle. She was a healthy as could be, despite her size and she grew like a weed. At one year, she had quadrupled her birthweight. It’s funny looking back because my first was only 6lbs 6.8oz (born at 40wks gestation) and she was rail thin right up until she was 9mo old and even now, at almost 4, she’s very light (31lbs). But Abigail was downright chubby by 5mo, lol. Little rolls every-where and I still have to carefully clean out underneath her chin because of her little fat rolls. I love it, lol.
Anyway, that’s the condensed version of her birth. It turned out wonderfully and overall, I think it was an easy birth, though I had a LOT of pain in my cervical area for months after she was born. I felt a bit like someone had taken a baseball bat to my girlie bits. I’ve been told that’s not uncommon but I wish I had known what to do about it at the time.
Abigail is 14mo old, now, getting into everything and figuring out walking. She’s a delight and my dh and I have been really enjoying watching our girls play together.
That video was absolutely amazing. Seeing her head turn was so beautiful.
My first was back labor. I woke up with birthing waves at 5am, and didn’t actually start feeling pain or discomfort until about 2 or 4 pm.. I wasn’t really aware of time. Then he was born at 10:26pm
Home birth, and only once during transition did I ask for some advil or “something”
I had bruises on my back though the next day from the constant kneading and rubbing I was telling my support team to do.
Oh also, have you heard of using the belly lift technique to help with back labor?
Thank you so much for your fantastic story Rebekah.
Mommymichael We do belly lifts, and hip lifts. I use a rebozo too and that is very sucessful during labour. Did you use them?
Just tuned in and couldn’t resist a comment. I work in a frantic tertiary hospital where patience is thin on the ground and most OP primips go “overdue”,get induced, epiduralled and pulled or cut. So in an effort to reverse this horrible trend, I simply nag my mums to death about correct sitting from the moment we meet. Rather than having to do desperate turning exercises just before (or in) labour most mums attain OA babes (if not, there’s often a good reason)and have undrugged happy births. I forget who taught me (i owe her a great debt) but the sitting is simple – at all times keep knees lower than hips and wide apart and the pelvis will naturally tilt forward in the lordosis way which facilitates OA and a flexed head. Also helps with nagging lower back throughout pregnancy.Cheers all!
Alison thanks so much for your reply. I agree with you, good posture can help sitting on a birth ball ensures good posture. However babies have always come out in a posterior position. I am 41 years old and was born at home direct OP. It is more important to know that babies can be born without there only being one completely correct position.
In order to reverse the horrible trend in induction epidural, forcep,ventouse and episiotomy, find the right care provider and just say NO.
You are so right Lisa, but as you know, our inadequate care scenario in a typical hospital means little time, less education and not much leeway for women of all sorts of backgrounds to gain the confidence and support to say NO! Having had a history of 4 terrible births of various sorts (all OPs in hospital) I had my last babe at nearly 40 y.o. at home with a patient midwife and my own confidence in the intrinsic rightness of unhurried birth (baby turned to OA in the end) so I know it can be done with sensitive support. BTW I’ve been devouring this blog and loving it. Thank goodness you are all out there.
That NSW study is interesting, they only did the all 4s from 37 wks onwards. That may too late. I remember reading somewhere that OFP is more effective when it is practiced from 26 wks onwards, and for more than 30 minutes per day. Women are capable of birthing OP babes and I agree, the rotating, stairs etc helps a lot. I also like the whole spiralling concept, that belly-dancing-like motion with the hips – seems that many women instinctively move this way. But hey if OFP has any effect and can help avoid OP and increase the chance of AO then I say go for it, it can’t hurt, it’s nice during pregnancy anyway – and it might help. I’d rather do the extra exercises in pregnancy than do the extra work in labour.
I would love to see the Rebozo in action, Lisa do have any vid of that? More skills we need to learn.
Love your blog Lisa, it just took me ages to figure out how to comment! (Now you’ll never get rid of me LOL!)
Hi Julie, sorry I have no video just the pictures you see on this blog of the Rebozo. I’m not one to be over the top about OFP however as you rightly say whatever can make the difference is worth trying. I just hate the thought that woman often feel that only OA is perfect and right and nothing else is really possible.
Being born Direct OP myself at home I feel like flying the flag for OP babies as a perfect birth possibility.
The most memorable OP birth I attended was about3.54 yrs ago. Primigravida at term. It was when our birthing services had just been suspended by the loss of our last GP OBs to private practice. We had to go with our women up to Atherton hospital. I came on shift to be asked to got to Atherton to take over as the midwife had to take her cousin to the airport 1.5 hours drive away.
I met M as she started pushing. She pushed spontaneously and in a few positions for 3 hours and declined all offers of help that the doctors spoke of and finally pushed out a very moulded baby, about 3.5 kg with a small tear.
I will never forget her.
PS, I caught her last baby and she is in my clinic and nearly due with the next.
Cheers
Judy
Hi there! I found this blog post really fascinating, as I seem to naturally ‘grow’ my babies in the posterior postition, and have birthed two OP babies now with only gas, minimal intervention and short labours(4 hours and 7 hours). I’m 39 weeks pregnant with my third, and yes, it’s another OP baby! I wouldn’t know what to do with an anterior one! The student midwife wrote ROA on my notes last week, but after a prod and a poke he is definitely face up and turned slightly, she must’ve felt him incorrectly. I have knees crossed at the front and feet poking out either side.