reasonable expectations of midwives

Help please, especially if you are a middie or training to be one!

I want to ask my antenatal MW what kind of things I could reliably expect my MW (whoever I get assigned) would do during labour without being asked. Is it OK to expect that a MW would assess the fetal position and recommend any kind of action / repositioning etc to get the baby into a better position? If they saw an OP baby, would they always raise the issue and do what they could (if possible) to fix it? This didn't happen in our first labour... until a shift change when I was 8cm and this new MW immediately recognised the OP problem but it was too late for her to try her tricks (something to do with a towel holding up the belly and jiggling it?!?!). We are hoping to avoid it this time. We must have gone through three MW's until the fourth did something.

I don't want to be offensive to my MW, because so far, she is great and knowledgable. I know they have more than one woman to look after, they can't be there 24-7, and sometimes they can't do anything even if they recognised the problem and might not want to dis-spirit the labouring mother with negative news, especially a first time mother.

I don't really understand how unusual OP labour / OP birth is (we had both) and whether or not it is even worth asking about or if it is something all MW's would know how to fix. Right now my birth plan says "natural, ask MW's to be proactive" and not much else. Would a student MW know this stuff?

How much attention is reasonable to expect from a MW during labour? Be honest! Because if the level of attention is less than what we desire then we need to look elsewhere for that. But good MW's are worth their weight in gold and I want to suck them for all the help I can get!

On a related issue, because I can't be farted making another thread ;) is it always possible to turn an OP baby during labour? She is already deeply engaged and ROP and I'm freaking just a little. Part of my preparing for birth with AND is working out as many of these issues before hand as I can. If we can get a good plan together I'm more confident cancelling the elective IOL.

It's very common for babies to be in a posterior position, so midwives see it a lot. Some will advise an epidural to cope with the extra discomfort of labouring with your baby in this position but most that I have worked with would start with positioning techniques for you to try in pregnancy and also for labour to get the baby turned. Some things I would ask you to try would be sitting on an exercise ball, or straddling a kitchen chair instead of relaxing on the sofa. Also relaxing on your hands and knees over a beanbag can help and if you are keen, scrubbing the floors on your hands and knees is a great trick (especially if you are nesting like crazy). for labour I would encourage someone with an OP baby to sit on a ball or lean over a beanbag and to avoid laying on their back.

Babies can be born in an OP position although it is not very common. They need a little bit more space to get out that way but some women have a pelvis that is the ideal shape for baby to get out posterior and that's just how your baby will want to come.

If you would like some extra support then you can arrange for a student midwife to follow you through and ask him or her to research ideal positions for labour and help you with this. Just contact your local university or hospital and ask them to arrange someone, most student midwives are crying out for the experience. Hope that helps :)

I don't know the answer to your first question about expectations on a midwife. I'd like to think midwives know these things and would be proactive, but my experience of hospital midwives was very handsoff - which is good... but they were so handsoff they were of no support. On analysing my 2nd birth, my private midwife and I worked out I had something like an anterior lip. Even I know I should have been up and moving and squatting to get bub through the cervix, but when I labour I don't want to move LOL. But a midwife could well have coaxed me to try different things I'm sure, as it was painful dilating and pushing at the same time!

Re the turning an OP baby during labour.. I'm assuming IOL stands for induction of labour? I wouldn't personally be confident of turning a baby during an induction, as the labour is more full on, and might not give bub a chance to naturally position himself. Plus with induction there is monitoring etc etc which inhibits mum moving into an ideal position to help bub turn.

Check out spinning babies for suggestions to try. Things like always sitting with knees lower than your hips etc. Or get scrubbing those floors on all fours ;)

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It's very common for babies to be in a posterior position, so midwives see it a lot. Some will advise an epidural to cope with the extra discomfort of labouring with your baby in this position but most that I have worked with would start with positioning techniques for you to try in pregnancy and also for labour to get the baby turned. Some things I would ask you to try would be sitting on an exercise ball, or straddling a kitchen chair instead of relaxing on the sofa. Also relaxing on your hands and knees over a beanbag can help and if you are keen, scrubbing the floors on your hands and knees is a great trick (especially if you are nesting like crazy). for labour I would encourage someone with an OP baby to sit on a ball or lean over a beanbag and to avoid laying on their back.

Babies can be born in an OP position although it is not very common. They need a little bit more space to get out that way but some women have a pelvis that is the ideal shape for baby to get out posterior and that's just how your baby will want to come.

If you would like some extra support then you can arrange for a student midwife to follow you through and ask him or her to research ideal positions for labour and help you with this. Just contact your local university or hospital and ask them to arrange someone, most student midwives are crying out for the experience. Hope that helps :)

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That helps heaps! I have a student MW but I wasn't sure if I had the right to expect her to do that kind of research for me.

Our last baby really was born OP (not just labouring OP) so it was difficult. But part of debriefing has been understanding that sometimes no one is at fault, my MW's weren't at fault, I wasn't at fault... etc. So having a healthy expectation is helping to avoid the "blame game / depression / perhaps it was my fault" thing after this labour (if things don't go perfect), if that makes sense?

I would feel empowered if I knew I could trust someone / something to turn this bub, but still working on that.

I have been to a fair few births now where I could see the baby was posterior, the labours tend to be very similar, slow and spurious, waters might break but slow to get going, trademark back pain... but the midwives couldn't tell bub was OP or said they they weren't, only later to find out that they were. Even in my own sister's labour, I was fighting so hard to stop them doing one of their 'routine' internals as I knew bub was OP and she wouldn't be as far along as she thought she would be and it would very likely set her back a great deal. Also another midwife suggested pushing when it was not appropriate - OP babies can make women feel pushy too soon. Ive only attended probably one or two labours where babe was OP and mum didn't have pain relief. It can be done, for sure, but it can be more tiring and painful than other labours. So, given the midwife may not even pick it up, your best bet is to educate yourself. Plan an active labour, learn as much from the spinning babies website as you can and do things for OP that will help your labour anyway. Rest when you need to rest, but like the others have said, choose forward positions where you can, give stairs/steps a go during your labour, walk where you can and move that pelvis! Rolls on the ball (or off!) - all these things help a labour anyway.

Acupuncture may help your babe turn too.

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I don't know the answer to your first question about expectations on a midwife. I'd like to think midwives know these things and would be proactive, but my experience of hospital midwives was very handsoff - which is good... but they were so handsoff they were of no support. On analysing my 2nd birth, my private midwife and I worked out I had something like an anterior lip. Even I know I should have been up and moving and squatting to get bub through the cervix, but when I labour I don't want to move LOL. But a midwife could well have coaxed me to try different things I'm sure, as it was painful dilating and pushing at the same time!

Re the turning an OP baby during labour.. I'm assuming IOL stands for induction of labour? I wouldn't personally be confident of turning a baby during an induction, as the labour is more full on, and might not give bub a chance to naturally position himself. Plus with induction there is monitoring etc etc which inhibits mum moving into an ideal position to help bub turn.

Check out spinning babies for suggestions to try. Things like always sitting with knees lower than your hips etc. Or get scrubbing those floors on all fours ;)

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Most of my hospital MW's were very hands off, but maybe that was partly our fault, because we bought a doula with us and asked them to let nature take it's course. This time the emphasis is on being proactive and hands on.

I think the same happened with the actual birth, they were very hands off with the peri and this time I am asking them to be proactive and hands on.

IOL is induction, and I'm also slightly concerned that if the IOL involves ARM that it will be even harder to turn this baby so I'm fighting to find a non-IOL way to feel in control.

Maybe it is just me but I often research things for my follow through women out of interest for my own career and so that I can fully support them. It can't hurt to ask, she will probably enjoy learning more about OP babies. However if your last baby was born OP then maybe that is how your pelvis is shaped so baby might not turn before birth.

May I ask the reason for your elective IOL?

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I have been to a fair few births now where I could see the baby was posterior, the labours tend to be very similar, slow and spurious, waters might break but slow to get going, trademark back pain... but the midwives couldn't tell bub was OP or said they they weren't, only later to find out that they were. Even in my own sister's labour, I was fighting so hard to stop them doing one of their 'routine' internals as I knew bub was OP and she wouldn't be as far along as she thought she would be and it would very likely set her back a great deal. Also another midwife suggested pushing when it was not appropriate - OP babies can make women feel pushy too soon. Ive only attended probably one or two labours where babe was OP and mum didn't have pain relief. It can be done, for sure, but it can be more tiring and painful than other labours. So, given the midwife may not even pick it up, your best bet is to educate yourself. Plan an active labour, learn as much from the spinning babies website as you can and do things for OP that will help your labour anyway. Rest when you need to rest, but like the others have said, choose forward positions where you can, give stairs/steps a go during your labour, walk where you can and move that pelvis! Rolls on the ball (or off!) - all these things help a labour anyway.

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That also helps! I made it to transition (was in transition for 2 hours) before I needed pain relief, and that was because they were forced to start the synto according to hospital guidelines and I was so bloody exhausted I didn't fight it. So I have some confidence that my pain tolerance is high enough to endure a normal labour and I'd gnaw off my arm to get this bub LOA before onset of labour, then I'd cancel the IOL for sure! Thanks for the help re positions, we will try these things, but it's so hard to keep in mind when the pain keeps building and you want to trust someone else to guide you and kinda let go of that "thinking" and just zone out...

Doula? Student doula? Thats what doulas do. Help you with things like this :)

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Maybe it is just me but I often research things for my follow through women out of interest for my own career and so that I can fully support them. It can't hurt to ask, she will probably enjoy learning more about OP babies. However if your last baby was born OP then maybe that is how your pelvis is shaped so baby might not turn before birth.

May I ask the reason for your elective IOL?

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The reason for the IOL is pure anxiety. I think there is some truth in pelvis shape determining that the baby will be born ROP and that synto from the very beginning would at least shorten the labour. I feel like I could endure a 6-8 hour induced labour but not another multi day marathon. My concern is that the multi day labour will crack me mentally (for various reasons) and that's not a good place to start with a newborn.

What would you do with an ROP baby that refused to budge? Is there anything that would stop labour being so long and painful again? I don't know of anything but I'm not a doula or MW.

At the moment I'm planning on tackling my antenatal MW at the next appointment and discussing a plan that involves going into labour spontaneously and asking for augmentation early if it looks like a repeat rather than IOL. I don't really want the IOL I'm just paniking and looking for anything to get me out of a repeat labour.

for an OP baby that wouldn't shift I would recommend sterile water injections, and labouring on all fours. Labouring in water (again on all fours) is great and above all relaxing with the contractions and letting them do their work. If you need pain relief to do that then so be it, the key is to relax as much as possible.

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for an OP baby that wouldn't shift I would recommend sterile water injections, and labouring on all fours. Labouring in water (again on all fours) is great and above all relaxing with the contractions and letting them do their work. If you need pain relief to do that then so be it, the key is to relax as much as possible.

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I had sterile water injections last time and also used the bath, what I didn't try was optimal positioning like on all fours. But I was just so exhausted that by the time we realised the problem I'd been up 48 hours already. My MW has suggested that if this bub is OP and I need an epidural again, she will position me on my knees leaning over the bed and get DH and my SMW to hold me there. Actually, she plans on doing that (with my express pre-agreement of course) regardless of what happens in stage 1. If anything I think pushing an OP baby out flat on your back has to be the worst thing ever (a wider part of the head coming out of a narrowed pelvis) so I'm pleased she at least has a plan for stage 2 if things go pearshaped. Just need to deal with stage 1!

I want to have the guts to cancel this IOL!

I guess it's the problem with most modes of care in Australia - it's a bit of pot luck as to who is there on the day. I'd certainly expect these things from my midwife, but probably not if we were going the hospital route again without our own midwife. Not because they won't do it - they may - but because I couldn't be sure till we asked, if that makes sense.
A doula can certainly help you with ideas and support through the labour, too.

Maybe try not to get too hung up about where your baby is. Babies can be in 'good' positions or 'bad' positions but it doesn't always correlate to the labour and birth. But, having said that, maybe try stairs, lots and lots of stairs. :)

It sounds like you are very well able to labour under difficult circumstances - I hope you breeze through this time.

ETA - just a thought. augmenting a difficult labour due to malpositioning may not shorten it, but make it less endurable.

Thanks MadB :).

Just out of curiosity, do you (general, everyone reading) think labouring women expect too much if they want their MW to act like a doula would? I suspect it would be unrealistic in Australia at this time.

I don't know the answer to any of your questions... but I just wanted to say.....

OMG! I can't believe you are 32 weeks already!!!!!!

:leap:

Not if you have your own midwife. Probably with a regular hospital one who is having to take care of other women at the same time and may not have had an opprotunity to get to know you.

Not an answer to any of your questions, but just wanted to say I laboured and birthed an OP first time around, and was worried that would be the case second time. It seemed to start of that way (SROM, nothing for a while, back pain) but I don't know if it was the many stairs I walked trying to kick start thing, or labouring standing up, leaning on the windowsill, but DS birth was totally different-much easier and much shorter.

Good luck, hope all goes well for you.

Re the mw being like a doula question - I had dd in a public hospital. The mw only had me to look after and it was back when they were trying to recruit nurses back into public hospitals by doing short retraining courses so I had an additional mw who was coming back to work in her 50s after having her children. She was so fantastic and so supportive in every way, not just doing her job. Long story but I ended up with a c/s under ga right when her shift was ending but she came with me to theatre as dh could not as it was a ga. I remember her being in recovery and she was still at my bed when I woke at 6pm so she had been there 11 hours just for me. I really think she would have a personal connection with lots of her patients.
Conversely I have met women in other areas of my life who are midwives and thanked my lucky stars I did not have them! I suspect women who go into midwifery because they love babies may not make great doulas but women who go into it because they love helping other woman would make great midwives.
Perhaps a little off topic but in the public hosp I went to the midwives did 3 month rotations through 4 areas, antenatal clinic, scn, labour rooms, wards so potentially while labouring you could get a midwife who would much rather have been in scn. So not sure that would improve care.
So after that lOngwinded ramble, I say no, not too much to expect but I would definitely not rely on it.

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Re the me being like a midwife question - I had dd in a public hospital. The mw only had me to look after and it was back when they were trying to recruit nurses back into public hospitals by doing short retraining courses so I had an additional mw who was coming back to work in her 50s after having her children. She was so fantastic and so supportive in every way, not just doing her job. Long story but I ended up with a c/s under ga right when her shift was ending but she came with me to theatre as dh could not as it was a ga. I remember her being in recovery and she was still at my bed when I woke at 6pm so she had been there 11 hours just for me. I really think she would have a personal connection with lots of her patients.

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That is awesome. Some MW's are really worth their weight in gold.

I cant answer any of your questions. But i laboured and birthed an op bub with no pain meds. I was induced and i think that in some ways may have been why bub was that way. If i could do it again il take the pain meds and be more aware of what i could do. Moving around will help so if you can ild give it a try. best of luck hun.

pls excuse the spelling mistakes on my galaxcy

I'm on my phone at the moment so can't give as detailed response as I'd like.

If you're worried about a posterior labour, forget about the labour for now and start practicing positions to promote OFP now.

I recommend getting on the Spinning Babies website and reading about what positions you can adopt now in order to get a baby in a good position for birth.

If you can find an antenatal Doula who has experience in using a Rebozo, that's a step in the right direction.

As for induction of labour, if anxiety is the reason, induction is not the answers. Working through the cause of you're anxiety is what's going to help.

So I guess what I'm trying to say is try not to preempt a posterior LABOUR and start focusing on a pregnancy that doesn't promote a posterior baby.


As for the Midwife, our policy is that the midwife is supposed to do an abdo palp every 4 hours to assess fetal position and decent. However, it can often be quite difficult to assess women who are in strong active labour.

In saying that, as others have said, a good midwife can identify a posterior labour by not even touching the woman.

I think to avoid any confusion or disappointment, listing in your birth plan your concerns regarding a posterior labour, is the best bet.

If you do decide to go ahead with the induction, being very clear about this point prior to the induction starting is important.

Hope that helps some :)

Good luck!
xx

Maybe you need to get yourself doula? They can be the support you need when you feel out of control etc? Xx

I had two posterior labours and births. I tried everything to turn DD2 with no luck. DD1 12 hr labour with pethedine forceps and episeotomy (sp?) DD2 5 hr labour no drugs, no intervention and although intense it was easier.
I was really nervous but with the bath, being on all fours and as active as possible seemed to work. Goodluck!

Hey hun..

Both of my babies have been posterior... DS was hard and a traumatic birth - won't go there!! DD however had an awesome MW through the birth centre who helped me through my fears and I read a lot to get my head in a better space had acupuncture .... So DD birth was 2.5 hours, 2 hours labouring well and then the last half hour in the bath believe it or not on my back (but suspended in water - ahhh bliss) when she was born looking up at me - we were all surprised!!! We didn't know she was Posterior (though explains the back pain!!) and she was 9lb2! I had no grazes or tears ....... And yes I am sure this one will posterior too!! But hey I know I can do it again!!


So I guess what I am trying to say read and ask your mw lots of questions that is what they are there for!! Try get into a good head space- YOU CAN DO THIS HUNNI!!!