Posterior labor.
Vital information for expectant mothers and fathers
( A few months ago I compiled this article for a friend of mine who just found out that her baby was posterior… I prayed a lot for her ( she had a history of long hard back labors), and she did what she could to encourage baby to turn in the optimal birth position. As a result she had her first non-back labor, and encouraged me to share this info with others. She said that many things she simply did not know, and it could have helped to prevent her hard labors before. I can not take much credit for that, as all the information compiled here was gleaned from wonderful tutoring of my midwife and instructor Lori Luyten, as well as from other sources, such as Mothering Magazine, writings of Ina May Gaskin and Robert Bradley. … )
During the last trimester it is possible to determine the position of your baby in the womb, simply using hands. If you in a care of midwife, she probably will check baby’s position at every visit during your last month. And will help you with council on how to reach or preserve best position of the baby for the birth. If you are in situation where hospital birth is your only option, you most likely get an ultrasound done to determine the position close to your due date. Often doctors will make decisions on possible course of action for your birth, based on that ultrasound.
Prayer can change the “worst” fetal position into the “best”, and is not limited by timings and circumstances. Prayers are powerful, and as we read testimonies of births, we see how time and again the Lord intervened and turned so many seemingly “impossible” situations into victory.
I hope that this compilation of helpful tips, knowledge, information on back labor, or posterior presentation, will serve as an aid in your birth journey. And will help you to have an important knowledge of your options, be aware of the things that you can do to prevent it, correct it, or work through it to the victory, as well as things to pray for, as you commit your pregnancy and labor to the Lord.
At the time of writing this article I just gave a birth to a baby, which was born “sunny-side -up” ( a nice cheery name for Posterior Presentation), and went through a battle of praying for fellow mommy who had a very difficult “back labor” which lasted 54 hours. The good news, — her healthy baby was born naturally and with my baby even though it was posterior, I was blessed with easy, smooth and natural delivery, in spite of baby’s position.
However the question is, — what if anything can be done to prevent the back labor? Since statistically most of the back labors are more painful and higher percent of these labors end in Cesarean sections , when failure to progress occurs, or when mother’s exhaustion makes it difficult or impossible to continue…
First of all, what exactly is “back labor” ?
The “occiput anterior” position (OA) is the ideal and most common position. In this position the baby’s head is easily “flexed” with his chin tucked into his chest, so that the smallest part of his head will be applied to the cervix first. The baby is most commonly “LOA” meaning his back is along your left side, and occasionally “ROA” ( back along the right). When baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, the bottom will usually protrude on one side under your ribs and you will normally fill kicks on the other side under your ribs. Your belly button will normally poke out and the area around it it will feel firm.
A less favorable position is the “Occiput Posterior” or OP. This means that baby is still the head down, but facing forward towards your tummy. When the baby is posterior, your tummy may look flatter, feel squashier, and you may feel arms and legs towards the front, and kicks out in the front. The area around your belly button may appear flat or dip into a concave, saucer-like shape, especially when you lay down. If your baby is posterior you may find that you suffer backaches during your pregnancy, but that is not always an indication of OP. You may also experience long and painful, on-again, off-again “practice contractions” as your baby tries to turn around in order to engage in the pelvis. Mothers of “posterior” babies are more likely to have long, hard labors as the baby usually has to turn all the way around to facing the back in order to be born.
Here are some additional tips that might help you to recognize possible posterior baby:
Prenatally (1):
- You feel like the baby has too many hands and feet, and the moving limbs may be easily felt and seen.
- You urinate more frequently than average for PG, due to the baby’s brow pressing against bladder.
- You may exhibit signs of a urinary tract infection, a feeling of constant pressure at the symphysis, (above the pubic bone), and an attendant lower back ache.
- It may be difficult to hear fetal heart tones, or they may be indistinct. When it is suspected that the baby is posterior, if you roll to the side, the heart tones will be more easily heard.
in Labor (2):
- You might experience a long period of irregular contractions with little or no dilation. Contractions may be more frequent yet of shorter duration than expected in early labor, eg: every three minutes but lasting only 30 seconds. This is due to inadequate pressing of baby’s head against your cervix.
- Persistent backache, which even in early labor may be severe enough that the pain of contractions are secondary.
Posterior presentation has increased drastically in the last 10-20 years due to change in our lifestyles. We’ve now accustomed reclining in comfortable sofas, armchairs and car seats. Since you are so big and pregnant in the last couple of months, you probably given the best seat at the friend’s house party or family gathering, and the most comfortable reclining seat in the car on the trips out. Some woman even trying to sleep semi-upright in a recliner chair. After all, it is so difficult to find comfortable position with this big tummy!
The baby’s back is the heaviest side of his body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower then your back, e.g. you are sitting on the chair leaning forward, then baby’s back will tend to swing towards your tummy – a GOOD position. If your back is lower then your tummy, e.g. you are lying on your back or leaning back in the armchair, then the baby’s back may swing towards your back and into posterior position – not so good.
You can influence the way your baby lay in your womb. Using gravity, good posture and movement you can help your baby settle into an ideal position for easier, shorter and less painful births. AVOID reclining in armchairs, sitting in the car seats where you are leaning back, or any position where your knees are higher the your pelvis.
Do what you can to avoid positions which encourage OP position. The best way to do this is to spend lots of time kneeling or sitting upright, sitting “Indian style” ( “tailor sitting”), or the hands and knees position. When you sit on the chair, make sure your knees are lower then your pelvis, and your trunk should be tilted slightly forward. Other tips for preventing a “posterior” baby are:
- If you watch TV, sit kneeling on the floor, over a beanbag, stability ball or cusion. Or sit on a dining chair.
- Try sitting on a dining chair facing ( leaning on) the back as well
- Don’t cross your legs while sitting on the chair! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have space at the front
- Don’t put your feet up! Lying back with your feet up encourages posterior presentation
- Sleep on your side, not on your back
- Keep active, walk as much as possible.
- Practice pelvic rocks on your hands and knees every day for minimum 3 times a day for 20 minutes and/or;
- Swimming with your belly downwards said to be very good for positioning babies – not backstroke. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards
- A birth ball ( stability or swiss ball) can encourage good positioning, both before and during labor.
- Get chiropractic care to keep your body and hips in good alignment.
- Keep your tummy warm. More babies rotate to OP during winter months. They prefer warmth so if your tummy is cold, they may turn their back away from it.
If your baby is already posterior you can try to stop him/her from descending lower. You want to try to avoid the baby engaging ( lowering down into; head dropping down into pelvic area) pelvis in this position, while you work on encouraging him to turn around. Most babies take a couple of days to turn around. During this time it is important to:
- If you can, get a chiropractor, who specializes in pregnancy, to help you with “adjusting”. It is much better to keep a good posture and do your best to prevent OP, rather then “treat it”. In my case, I had to have a chiropractor adjustment during early labor. Would I be in the hospital, I would be induced and probably rushed into C-section, for the failure to progress, when I was at 2 cm dilated after about 20 hours. But when midwife observed the pattern of my contractions, she realized that I had a problem with pelvic misalignment ( my back was not straight), and short visit to chiropractor, saved my labor. My ligaments pain was gone, labor immediately picked up and 7 hours later I was completely dialated and ready to push with well established labor. In my case the baby still decided to stay posterior, but it did not hinder the labor progress neither did it make the labor more difficult. Some babies simply meant to be born that way.
- Avoid deep squatting.
- Use “knee to chest” position
- Sway your hips while on hands and knees
- Try crawling around on hands and knees, it is a good exercise and it helps baby positioning
- Swim belly down, but avoid kicking with breaststroke legs as this movement is said to encourage the baby to discend into pelvis. You can still swim breaststroke, but simply kick with straight legs instead of “frog’s legs”
- Sometimes a posterior position is caused by a lack of strength in your lower stomach muscles…in this case a belly support or belly binding (a large sheet or towel wrapped tightly around the belly for support) might help.
- If it’s a cord preventing baby from turning, try perhaps rotating baby the opposite direction (for example, at night try sleeping on your right side instead of left). This can help ‘unwrap’ the baby and encourage him/her to turn.
- There is also a chiropractic technique called “diaphragmatic release” and is supposed to turn posterior babies every time. In fact it can be easely done at home.
What to do if you go into labor and baby is still posterior:
Don’t get too worried…the vast majority of posterior babies rotate during labor and those who don’t are often born “sunny-side-up”. Some posteriors actually are born precipitously with no back labor, depending on how well flexed the head is, as if saying, “Surprise! It’s my little face!” Babies come out! In fact according to statistics, the incidence of a posterior presentation occurring at the onset of labor is 15 to 30 percent, and many such babies rotate spontaneously to an anterior position, – , – like a key turning to fit a lock.
- First thing is to get into a knee-to-chest position and stay there for at least 45 minutes, or until baby turns. Be sure to have lots of pillows on hand so you can stay in this position comfortably for as long as is required.
- Sometimes doing stairs 2 at a time between contractions (with a spotter on each side!) will jiggle the baby’s head enough for it to turn or move the pelvic bones enough for baby to turn.
- Belly lifting is another technique for when baby won’t turn and dilation is slow. With someone supporting you from the back, lean back, arching your spine, and with both hands around your belly near the baby’s bum – pull up on it during a contraction. This realigns the vectors so that baby’s head will put more pressure on the cervix, helping it to dilate more quickly.
- A big pool filled with water will relieve a lot of the back pain and will help baby to turn, so plan a waterbirth!
It may be that your baby is going to stay “sunny side up” and will just refuse to turn; perhaps that the way he or she needs to be. …maybe that is the only way s/he can enter the pelvis, or it’s possible the placenta is in the way (for example, an anterior placenta may predispose you to a posterior baby) If you do end up having a back labor ( about 5.5 – 7 % refuse to turn and are born posterior), at least you’ll know you did all you could to make things easier for you and the baby.
Remember, however your birth turns out, even if it’s not the labor or birth you want, it WILL be the labor and birth you and your baby need. 🙂 Jesus will see to it!
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