Turning posterior baby

Anyone had any success turning a posterior baby?

Ds was rop and born posterior last time

This one so far is op for both I've tried spinning babies with no success

Do you think it's the shape of my uterus or posture that makes them posterior ?

My first was stubbornly posterior despite my best efforts. He was also born posterior (with his hand up beside his head! ouch!). My second was also posterior during pregnancy and again I tried my best to flip him. My brilliant midwife gave me this fantastic tip: once labour starts with regular contractions, get on all fours, butt in the air, arms and head down on a pillow and stay there for one hour. This seemed to spin baby into an optimal position and he was a quick and easy birth (total 3 hour labour, born 20 minutes after arriving at hospital). I wish I had known this for no 1 as I spent the first 1.5 hours of his birth walking, which just jiggled him down into my pelvis in a posterior position and he was a 10 hour labour.

Thanks ill have to try that can you do it before labour? I'm planning on being on hands and knees with head slightly down to get this one to come out slower (ds was 5mins of pushing and did fair bit if damage)

Spock was rop for ever (atleast since 20weeks) if she did move position it was to go direct op. she remained op all labour and then decided to rotate when she was crowning (holy mother of burning ring of fire let me tell you - and she had a little hand up at her head too)
anyway... I spent my labour in that upside down position previously mentioned instictively...while it didnt rotate her my labour was only 5 hours *shrugs* dont know if thst had anything to do with it.
I did try alot of pelvic opening exercises: squats, rotating my hips etc.. have you thought about acupuncture or moxibustion?

No I'm not the acupuncture type, what's moxibustion?

they use ot mainly for breech bubs but I think? there is a concoction for op bubs... it involves burning things between your toes, another acupuncture trick

Oh ok not really my type of thing

Hi Jelly,
all my three have been posterior before birth. One was posterior the day I went into labour I laid on my side in bed and rocked my hips. She flipped around and I went into labour. The next two were posterior leading up to the birth so I spent alot of time on my hands and knees, either in the bath or scrubbing the floors, worked perfectly both times. They eventually turned and then engaged in the right spot. If your baby does stay posterior Shelia Kitzinger has some great birthing positions for posterior babies, I would learn all about that then you are armed with knowledge and what to do before you go into labour. x

there is a trick you can do when in labour, ive only seen it once and the woman didn't like it so we stopped, but you need 2 other people and a big towel. they stand either side of you and lay the towel underneath your hips and when you have a contraction they lift and rock you with the towel, very forceful, like really strong waves. wonder if anyone here jas done it?

it's called rebozo. it was how I got my bub to move - from transverse to head down twice and then from breech to head down. It was a weird sensation, but not really uncomfortable. I didn't have it done in labour cos bub got himself in a good position, but in the last weeks of pregnancy.

Jellybean Saw this article and thought of you.

In Celebration of the OP Baby | Midwife Thinking

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In Celebration of the OP Baby

Posted on August 13, 2010 by midwifethinking


How many times have you heard “I had to have an epidural/c-section/ventouse/etc. because my baby was facing the wrong way”? An occipito posterior (OP) position occurs when the baby enters the pelvis facing forward with his back towards his mothers back. The back of the baby’s head is referred to as the ‘occiput’ and is in the back of the pelvis against the sacrum. Between 15-30% of babies start labour in an OP position, but less than 5% will remain in this position at birth (Sizer & Nirmal 2000). An OP position is associated with medical intervention during labour: syntocinon infusion; epidural; forceps; ventouse; c-section. This post will discuss whether an OP position is actually a problem, or if the problem lies in our beliefs about, and management of this common position.

A bit of anatomy and physiology

I’m assuming that readers of this blog are midwives, doulas, and/or birth junkies who have an understanding of the pelvis. If you don’t, it doesn’t really matter – knowing the names of the bones doesn’t help you understand how the pelvis works. Basically, the pelvis is shaped in a way that requires the baby to rotate through during labour. If you look in textbooks you will find diagrams with exact measurements of various pelvic diameters – this is nonsense as every woman’s pelvis is different. I find it is more helpful to consider that there are 3 areas of the pelvis: the brim, the cavity and the outlet. These areas have slightly different shapes as I’ve tried to demonstrate below:

It doesn’t really matter which way the baby enters the brim because once his head is in the cavity he can rotate. The downward pressure of the contractions, and the tension and shape of the pelvic floor will guide him into a direct occipito anterior (OA) position and through the outlet. A very small number of babies will rotate to a direct OP position and come out facing the front of the pelvis (see below).

Usually the baby will take the shortest rotation into a direct OA position. So, a baby entering the pelvis in a LOA (back = front/left) does this:

Whereas a baby entering the pelvis in an LOP (back = back/left) position does this:

Of course OP and OA babies may use this turning space to do all kinds of interesting things from turning OA to OP, to rotating all the way around the back of the pelvis to get to end up OA. The baby will work out the best way to move through his mother – even if we don’t understand it.

Being born OP

Some babies are born in the OP position either because they stay in that position, or because they rotate into that position during labour (from OA). Here is a birth of a baby in the OP position and born in the caul:

Emma Kwasnica also shares some amazing photos of her daughter being born in this position. You can also find photos and film of OP births on Lisa Barrett’s website.

The ‘problems’

Labour pattern

It is difficult enough for a woman with a baby in an OA position to fit prescribed patterns of labour progress. A baby who enters the brim in an OP position may not fit quite so snuggly on the cervix and this may lead to:
◾‘post-dates’ pregancy
◾rupture of membranes before labour
◾a long stop-start build up to labour
◾irregular contractions during labour
◾slower cervical dilation while rotation takes place

These situations only become problematic when we apply generalised expectations about how labour should be to an individual woman, baby and situation. The solution is often to augment labour with syntocinon – increasing the risk of fetal distress and increasing pain ie. creating a problem.

Pain

Some women will experience pain differently when their baby is in an OP position. However, it is difficult to determine if this experience of pain is due to the position of the baby, or other factors. Plenty of women with an OA baby complain of back ache in labour whilst many with an OP baby do not. Unfortunately, women are told that an OP labour is ‘worse’, and are told horror stories like the one I started the post with. Given the psychological and emotional aspect of pain perception this cannot be helpful.

Every birth is also different. I cared for a mother during two births. Her first baby was in an OP position and she had a four day stop-start pattern before labour established. Apart from being tired she coped well with the pain throughout. Her second baby was OA and labour established quickly. She was shocked and distressed by how much more pain she experienced with her OA baby compared to her previous OP baby.

Again, it is not the different experience of pain that’s the problem, but the management of the situation. Women with an OP position are more likely to opt for (or be pursuaded to have) an epidural. Not surprisingly when they are led to believe their labour will be more painful. In addition, they are likely to end up with a syntocinon drip (see above) which further increases pain, and increases the chance that an epidural will be needed. Once an epidural analgesia is inserted the ability of the baby to rotate into an OA position is reduced (Lieberman et al. 2005). The women is unable to instinctively move her body and work with her baby to rotate him. In addition the pelvic floor is anaesthetised and loses it’s tone, taking away the resistance that assists rotation.

Early urge to push

As the OP baby descends through the pelvis the back of his head puts pressure on nerves creating an urge to push. This pushing may be the body’s way of helping the baby to rotate by increasing downward pressure onto the cervix and pelvic floor. However, this urge to push is managed as a problem, and the result is often an epidural. See this post about pushing before full dilatation of the cervix.

Blame

Women can blame themselves for their baby being in an OP position. They question what they did (spent too long in the car) or didn’t do (scrub floors). Often the advice they are given antenatally about ‘optimal fetal positioning’ implies that they have control over the position their baby is in, when there is no research evidence to support this notion. In fact the little research that has been done demonstrates that hands and knees posturing in pregnancy makes no difference (Hunter, Hofmeyr & Kulier; Kariminia et al. 2004). I have even heard of women being told that their baby has assumed an OP position because of their unresolved emotional issues!

Suggestions

We need to stop defining OP as a problem or a ‘malposition’. It is a common variation to the more common OA position, and the OP baby is probably in that position for a good reason. When caring for a woman with an OP baby:

In Pregnancy
◾Reinforce the woman’s trust in her body and baby to birth.
◾Discuss the possibility that her labour may be different (not better or worse) and might not fit general expectations about labour patterns/progress.
◾She can try a variety of techniques to encourage the baby to turn (even though the research suggests it may be ineffective). You can find some suggestions here. However, if he doesn’t respond it’s because he has chosen his optimal position for labour. He will turn once he gets into the pelvic cavity in labour, or he may even be born OP.
◾Tell her birth stories and connect her with other women who have experienced positive OP labours.

In labour
◾Trust the mother and her baby to birth.
◾Provide an environment where she can instinctively move and work with her baby to rotate him.
◾Don’t tell her not to push if she is spontaneously pushing – regardless of cervical dilatation.
◾Back pain can be relieved by: a forward leaning position (Stremler et al. 2005); warm water; gentle sacral pressure. But, avoid applying strong pressure to the sacrum as this may reduce the space available in the pelvis for rotation.
◾If the woman requests help or would prefer you to ‘do’ something there are a number of techniques you can use to create more space in the pelvis. I have provided a list here. You can learn these techniques at my workshop… and I plan to make some movies of them to share online.
◾Occasionally, despite everything a baby will become ‘stuck’… and this happens to babies in an OA position too. In this situation more invasive interventions such as digital rotation (Reichman et al. 2008); instrumental birth or c-section may be necessary.

In summary

An OP position is not wrong or a problem. It is not caused by anything the woman does or does not do. Instead, it is a common variation that occurs when a baby gets into the ‘optimal position’ for his journey through his mother’s unique body. After all, he has more knowledge about the interior of his mother’s pelvis than we do. If we want to improve the experience and outcomes associated with an OP position we need to rethink our approach to it. Let’s celebrate the OP baby’s wisdom and allow the birth to unfold as it needs to, only intervening if it is truly required.

You can download a review of research relating to ‘management’ of OP by Simkin (2010) here.

Edited and updated: March 2013

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Thanks very interesting blog had a read of some other stuff ill have to put it on my favorites

Baby was lot then rot for a couple hrs now back to lot so that's better than op but either way I've pushed out a op before I guess I can do it again

I had two OP babies and nothing helped to turn them and believe me I really tried when I learnt DD2 was presenting (consistently) OP at 35ish weeks. I think it's just one of those things, they'll turn if they want and won't if they don't want to. I saw an amazing acupuncturist with DD2 and he honestly felt it was luck of the draw despite practicing turning techniques frequently on his patients.

DD1 was a relatively quick labour for a posterior baby, 6 hours established (8 on my watch) but an hour of pushing with no head on view. She was a vacuum delivery in the end.

DD2 was fast and furious - 37 minutes (47 by my watch though) and turned as she exited. No intervention required. The back pain was no where near as bad as with DD1 either but maybe the speed at which she arrived kinda numbed that IYKWIM.

Good luck and try not to worry. I was pleasantly surprised with my second OP birth, it was just a little too quick!

Wow taurean my first op birth was 5hrs with 5mins of pushing but I think anything under 2hrs this time and ill be having the baby at home by eek

Thanks for posting. I struggle to deal with the labour I had with DD2 (2.5 hrs) who was OP. i kept thinking I could've, should've type scenarios. I was pushing before full dilation, hooked up to syntocinon which was incredibly painful for me. Much much worse than 'natural spontaneous labour' I was seconds from emergency C sec but was 'saved' by an excruciating episiotomy.

Miss m mine was same I had urge to push before full dilation and I was hooked up to synto ouch, no episiotomy but 3rd degree tears

Both my bubs have been posterior. My Dd was born via c sect as age tried to turn and was stuck but by VBAC DS half turned during labour and the ob turned him the rest of the way manually (ouch!!) and I had 3rd deg tear with him.

my last two girls were OP right up until birth but then turned during labour (DD2 was right at the beginning of the first real hard part of labour) and DD3...have no idea but she came out the right way lol. transition with her was much longer though so I am thinking it was then that she was doing all her turning.

the best thing to avoid with an OP baby is to have your waters broken by your care-providers. baby needs that fluid to help them move into a good position for birth.