baby's position neither anterior or posterior - is this good or bad??

[shellshell]

Hi all,

I just had an obstetrician appointment (33.5 weeks) and I asked him about the position of my baby, as I have an anterior placenta and doing everything I can to avoid a posterior baby. He said bub's head was "well down", but the baby was neither anterior or posterior - it's back was to one side. He also mentioned that the back would (or should?) "swing".

Is this good news or bad news? Is it still a harder labour if the baby's is on one side at the start of labour, rather than being anterior?

I have put so much effort into trying to get the baby into the best position over the past 3 weeks... ever since I learnt about the posterior association with an anterior placenta. I am feeling a bit deflated that he didn't say it was anterior... among other things that happened in the appointment ... :-(

Thanks,
Michelle

[blue daisy]

Hey michelle

an anterior placenta does not mean your baby will naturally adopt a posterior position

also most babies start in a lateral (back to your side) position in labor and rotate to an anterior position as they enter the pelvic cavity

so this is normal news

x

[Tobily]

I was going to say the same as Natalie....most commonly babies will start labour with their back down your left side.
As they head south they will "swing" as your obs put it anterior. So all good for you.

I totally understand your paranoia though, my second bub had an anterior placenta and I obsessed about his position from the day I found out....and having the placenta in your front makes it that much harder for you (or anyone else) to palpate his position with your hands which is really frustrating!

[shellshell]

Thanks ladies!!

That helps me feel reassured that at least something is going right with this whole pregnancy thing... (long story, but had a horrible time at the obstetrician yesterday for other reasons).

Michelle

[Karina]

Just out of curiosity, what happens if bub doesnt actually move into an anterior or posterior position during labour? If they stay in a lateral position? Would they get stuck? Or would they just not get down into the pelvis?

Sorry, not hoping that on anyone, but I was just curious!

[Trillian]

Michelle, it isnt' a problem at all, if babys head is well down its a good indicator that bubs will be able to descend nicely into the pelvis for birth. One thing to remember though is if baby is positioned with its back on your rightside (ROP), they have to turn nearly a full circle to get to an anterior position as they usually always turn in a clockwise fashion. This means that they have to be briefly in a posterior position (OP), then LOP (left occiput posterior) before moving to LOA (left occiput anterior)with their back on your left before finally anterior (OA). Almost all babies will get themselves to the right position either just before or during labour. So it's not a big thing to worry about, especially if bubs is already LOA they don't have far to go kwim?

Karina, If baby stays in an unfavourable position for birth, it can increase the likelyhood of them getting a bit stuck or having shoulder dystocia. With my last birth, he stayed in a posterior position for most of the birth until the very last minute when his head turned anterior, but the rest of him stayed in a lateral position and he did have shoulder dystocia which meant that his shoulders were stuck and needed to be manouvered out so his body was basically born in a sideways position. Thankfully there was no need for instruments to get him out. So it can be done, but it is hard work that's for sure. There is no doubt in my mind that had he been my first baby instead of my 4th that I would have been in big trouble for sure.

[blue daisy]

hey Karina

great Q!

if a baby does not rotate to an anterior or posterior position in labor, their head is unable to negotiate the pelvic cavity and be birthed...this is known as an obstructed labor or a deep transverse arrest. Baby may not engage in the pelvis at all, and this may be due to a true cephalopelvic disproportion, or will start the descent into the pelvis only to become stuck. This can sometimes happen if the baby engages with their head at an angle (asynclitic) or with a hand to their face (compound)

the babies head is too big in the lateral position to fit

in this instance the mother would require a c/s

as Sherie indicated a laternal position of the shoulders increases the risk of shoulder dystocia...and this is why it is so important for the accoucher (whoever is birthing the baby) to have a hands off approach until the shoulders rotate thru the pelvis (restitution)

again if this did happen, and the shoulders where in a lateral position in the pelvis, the midwife would first get the woman to bring her knees to her chest to 'open' the pelvis and with a second midwife applying pressure to the pubic bone to help release the shoulders. If this did not work, the options are limited, and some force will be used to get the baby out and instruments can not be helpful in this instance, its all hands. You may have heard of some babies that are born with a broken collar bone...this is a weak point and allows for the shoulers to be birthed

long answer

xx

[Trillian]

Natalie, that's exactly what they did to get Alister's shoulders out. Also lucky that he didn't get a broken collar bone.

[Karina]

Ahhh ok thnks for that.

I remember being told Claire wasnt in a great position when I was pushing, and they had me on my back with my knees right up on my chest, which didnt help much at all. They then got an ob in who put his hand in me to move Claires head. Luckily no instruments needed though. Apparently she was trying to come out with the side-back of her head first rather than her crown. Once the ob had done his thing, she came out just fine. The midwife advised the ob that Claires position was "LOA".
I'm just wondering what that means?
Was it that she didnt turn?
Or am I just unco at pushing?

[blue daisy]

LOA

means baby's back is lateral lying, but the occiput (part of the head) is in an anterior position...this is a normal position

its sounds like she may have entered the pelvis with her head at a slight angle (asynclitic), causing her to get a little stuck, hence why your knees to your chest to open the pelvic cavity up as much as possible to move her through

does not matter how great you push if the baby is in an awkward position in the pelvis, as they wont budge, its about the mother moving around and trying a variety of birth positions to try and get the baby to birth

x

[Karina]

Ahhhhh Thanks Natalie. It would have been nice for my midwife to tell me that at some point (even after her birth) but no, she took off pretty quickly and never came back to me, so I never got the chance to talk to her about it.