Research on Posterior Position

[blue daisy]

Posterior Position and the Fetus Ejection Reflex


Two facts that were the basis of my empirical attitudes [regarding posterior
position] have been authoritatively confirmed by published prospective
studies.

The first fact is that worrying pregnant women about the position of their
baby in the womb is useless. A large Australian randomized controlled trial
involving 2547 pregnant women has eloquently demonstrated that hands and
knees exercise with pelvic rocking from 37 weeks' gestation until the onset
of labor does not reduce the incidence of persistent occiput posterior
position at birth.

The second fact is that fetal position changes are common during labor, with
the final position established close to delivery. This is the conclusion of
a prospective study of 1562 women to evaluate changes in fetal position
during labor by using serial ultrasound examination. Among babies who were
posterior late in labor, only 20.7% appeared to be posterior at delivery.
Finally, when the mother had no epidural, the overall rate of posterior
position at delivery was only 3.3%, although this study was conducted in
conventional departments of obstetrics, where the basic needs of birthing
women could not easily be met. The rate was 12.9% in the epidural group.

When taking into account these two well-documented facts, focusing on the
right question becomes easy: what factors can influence the rotation process
during labor?

The answer is simple: The factors that can facilitate the rotation process
are those that make a typical fetus ejection reflex possible.The passage
toward the fetus ejection reflex is inhibited by any interference with the
state of privacy. The ejection reflex does not occur in the presence of a
birth attendant who behaves like a "coach," an observer, a helper, a guide
or a "support person."

The fetus ejection reflex can be inhibited by a vaginal exam, by an
eye-to-eye contact or by the imposition of a change of environment. It does
not occur if the intellect of the laboring woman is stimulated by rational
language (e.g., "Now you are at complete dilation; you must push"). It does
not occur if the room is not warm enough or if the lights are bright. The
best situation I know for a typical fetus ejection reflex is when no one is
around but an experienced, low profile, silent, motherly midwife sitting in
a corner and knitting.

The image of the "knitting midwife" should not be understood in a literal
sense. Instead, it symbolizes the authentic midwife as a protective mother
figure whose own level of adrenaline is maintained as low as possible.
Noticeably, when the conditions for an ejection reflex are met, most
birthing women find spontaneously complex and asymmetrical bending-forward
postures that probably play an important part in facilitating the rotation
of the baby's head.

Persistent posterior position at birth will become exceptionally rare on the
day when the meaning of privacy is understood and authentic midwifery has
been rediscovered.

- Michel Odent, MD, excerpted from "Occiput Posterior Position Should Be
Exceptionally Rare at Birth," Midwifery Today Issue 76

[Beach Mama]

The ejection reflex does not occur in the presence of a
birth attendant who behaves like a "coach," an observer, a helper, a guide
or a "support person."

Interesting article Natalie- funny how I knew Izzy was posterior all along but it didnt really bother me, although I did end up in the group induced with an epidural and then c/s

Just one thing -in the above quote, dont you want your birth attendant to be a helper??

[blue daisy]

Hey Tan

I think it is referring to your midwife or dr standing back and letting nature take its course...so there is no 'pressure to perform'...part of being a mw is knowing when to just sit and be

xx

[Beach Mama]

Aha that makes sense! Thanks!

[Roryrory]

The fetus ejection reflex can be inhibited by a vaginal exam, by an
eye-to-eye contact or by the imposition of a change of environment. It does
not occur if the intellect of the laboring woman is stimulated by rational
language (e.g., "Now you are at complete dilation; you must push").

Yep, I can vouch for that!

Soooo glad I have decided upon a birth centre and hypnobirthing for this one LOL!! having had a posterior labour it doesn't faze me (I was one of the 20-odd percent with posterior presentation right to the end) but somehow I think this time will be a bit different...

[castle]

Natalie, imho the reason that trying to change the baby's position from 37 weeks on is useless, is because that is too late to begin...I think that if it can be influenced, it's by attention to excellent posture through at least the 2nd half of pregnancy.
My 2nd baby delivered OP. I was cared for by a private midwife at a freestanding birth centre. It was an excellent birth and my first VBAC. When I arrived I was 7 cm dilated, and I asked the midwife what the baby's position meant for the labour. She was very calm and said that it would probably take a bit longer than otherwise, but that mothers generally didn't find it more uncomfortable or difficult. Her calm assurance that all would be well was the best thing for me. Obviously I had no epidural...I didn't have any epi or tear either, the birth was completely unassisted.
LOL, I think the POP had a lot to do with my son's personality. It is exactly like him to want to struggle obstinately in an uncomfortable way, and then pop out gloriously at the end!!

[blue daisy]

Hey Castle...thanks for your reply

I posted the article as it gave another point of view for posterior position...as there seem to be many Qs related to this topic, and thought it would be good to post something from another perspective

I do believe that positioning can help to reduce the occurance of a posterior position, but with practise of positioning (such as yoga) throughout pregnancy and an awareness of posture. Trying to move a posterior baby at 37weeks plus, is unlikely if this is the place bubs has settled, and especially if the mother has paid little attention to her posture and pelvic tilt throughout her pregnancy

thank you so much for sharing your experience of a posterior baby and labor...sometimes a specific pelvic shape will actually encourage a posterior position...its great that you have a positive experience to share with everybody, to show that posterior does not equal medical intervention but is still open to a calm, beautiful birth experience

and maybe you are right about posterior babies being a little stubborn my 1st was posterior (but rotated for delivery) and he is very determined

thank you again

xx yogababy

[rolymogs]

.....

[Ginger]

my bubs turned posterior on friday night....so is there anything i can do now or do i just wait and see what happens?

[blue daisy]

Turning a Posterior Bub

check this thread...hope i did it right

xx yogababy

[Trillian]

Gracie, I was just about to post in here saying that I've had some success over the past day to get this baby from ROP (back on right side) to LOA (back n left side) and ATM he is in the LOA position (the trick is to keep him there LOL). I have been doing some exercises from the spinning babies website - sitting with legs apart on the edge of the chair, keeping correct posture when sitting and using the fitball from time to time. ATM I am sitting here on an office chair with a semi reclining back, with my belly leaning against the back of the chair, keeping me forward and my legs apart (to open up the pelvis) So all is not lost late in the pg to get the baby to sucessfully change position.

[Ginger]

thanks guys, i'm moving off the couch right now and onto a chair backwards..don't have a fitball but i might set up some pillows on the ground and give that a go