What Would Have Happened?

**fionas** · November 9th, 2007, 10:27 AM

I think I am posting an unanswerable question here but nothing ventured, nothing gained!

Last time I had a hospital birth which I was quite happy with because I'd done lots of reading and worked out my preferences/priorities beforehand. As it turned out, I used pain management techniques until I was about 7cm, then had an epidural, then pushed for more than two hours then forceps.

As it was a posterior labour, I figure that next time if the baby is not posterior, and with the help of a doula, there's a good chance I'll be able to manage drug-free.

I'm also weighing up the pros and cons of a homebirth but want to know what would happen if the baby got 'stuck' as happened last time? Presumably, after a certain point, I would just transfer to hospital?

I know also that I should have been doing lots of stuff to persuade my posterior bub to get into a better position but, what if that didn't work?

Fiona

**Deltadawn** · November 9th, 2007, 10:44 AM

I'm not sure if having one posterior bubs means a higher risk of having another one or if it is independent of one another. I guess it would be your responsibility to advise the midwife delivering at home with you about your past and they will either advise you against having a home birth or they will have a hospital possibly on standby in case somethng was to happen??? Good question.

SamanthaP · November 9th, 2007, 11:39 AM

Hi Fiona,

I think that most babies would rotate prior to being born. The epidural you had, and as such the immobility, would have affected the baby being able to get into the optimum position for birth. At home, you won't have an epidural or drugs which limit your mobility so will likely not strike that problem again. Posterior is just a variation of normal, it's not an emergency and just because one bub was posterior doesn't mean your next one would be. Hope that helps.

**AmandaJ** · November 9th, 2007, 11:48 AM

Fiona my first DS was posterior also and I ended up with a vacuum extraction as well as an epsiotomy(sp). My second DS was also posterior but because he was my second I actually birthed him posterior as he didn't turn and all I used was gas, so it is possible to birth posterior bubs, with a bit of back pain tho.

Also if you have a homebirth, I'm sure the midwife would be able to get you in to a position where bubs wouldn't get stuck, but in that event if it happened then I'm sure that you would be rushed to hospital.

I hope that I've helped some.

hugs xoxo

**Tobily** · November 9th, 2007, 12:29 PM

Hi Fiona,

I think that most babies would rotate prior to being born. The epidural you had, and as such the immobility, would have affected the baby being able to get into the optimum position for birth. At home, you won't have an epidural or drugs which limit your mobility so will likely not strike that problem again. Posterior is just a variation of normal, it's not an emergency and just because one bub was posterior doesn't mean your next one would be. Hope that helps.

I think so too.
I have a friend in Canada who has birthed all her babies at home, and they have all been posterior. No dramas at all

**Schmickers** · November 9th, 2007, 12:53 PM

It is entirely possible to give birth to a posterior baby. In fact, there are some advantages to undergoing a posterior labour at home.

Posterior labours will last longer, because the position the bub is in means it takes logner for them to descend. In a home birth situation, you are comfortable, there are no time limits as long you and the baby remain healthy, and you and the baby will remain healthy for longer because you are able to eat, drink, and rest as you need to. As a result, it is possible to have a long and gentle labour, which is what many posterior babies need to gradually move down the birth canal and be born.

You are also free to move around at a homebirth in a way that, even in the most natural of hospital births, you are not. Homebirth midwives are adept at monitoreing your progress and the condition of your baby unobtrusively, and do not interrupt you when you are in the flow of your labour. That mobility, and the opportunity to really focus on your labour, can help during a posterior bath.

And finally - water, water, water! Posteroir labours often involve strong back pain. Homebirth and waterbirth often gpo hand-in-hand, and even if you're not planning a waterbirth, you still have a shower or bath at your disposal without having to share it with other women. Many women find water fantastic for back pain.

And to answer the crux of your question - the unlikely secnario that what, if despite all of this, you did not progress? Your homebirth midwife will be experienced and will be able to continuously monitor and assess your health, and the health of the baby. They will ensure that, if either you or the baby are getting too tired, that you are transferred to your booking-in hospital in adequate time to allow for any necessary interventions.

Hope this answers your question.

**BellyBelly** · November 9th, 2007, 12:57 PM

A study that came out recently showed that epidurals resulted in more posterior bubs so if you had a possie baby and an epi I guess it wouldn't have helped much more... but possie babies are completely birthable as schmickers said.

LivvyLouLou · November 9th, 2007, 01:36 PM

My 10 pound posterior baba was born at home in water with me in an upright postition. She turned into an anterior position, after 2 hours of labour and then just flew out like a bunjee jumper, no second stage at all. I was at home so no chance of drugs which I am so glad about, because the posterior position was more painful than either of my other 2 labours.

**~kaos~** · November 9th, 2007, 02:30 PM

I also think that if you employed a independent midwife, they would be talking to you about optimal positioning well before your due date to try and avoid any of that if possible. I am constantly amazed how often I hear about people going through the hosp system that get no information on the subject

Also, as for bubs getting stuck, My grandparents next door neighbours birthed at home (in a rural town) and her bub got stuck (I think mild shoulder dystocia) but the midwife was able to make suggestions and help manage the situation and everything was fine. I have heard about midwives in BC's managing this too without the need for medical intervention.

**Snacks** · November 9th, 2007, 06:35 PM

Are private middies equipped with emergency gear? Like forceps? I know they carry oxygen...

**Schmickers** · November 10th, 2007, 10:46 AM

Are private middies equipped with emergency gear? Like forceps? I know they carry oxygen...

Independently Practicing Midwives carry emergency equipment that enables them to get IV access, administer emergency drugs, such as syntocinon, and give emergency fluids in the event of a haemorrhage. They also carry oxygen, in case the baby needs oxygen support when they are born, and resuscitation equipment.

Midwives do not carry forceps because using forceps is a surgical procedure, and is performed by an obstetrician who is trained in their use. But more to the point, an independently practicing midwife is trained to recognise a situation developing where intervention, such as forceps may be necessary, and do one of two things - either manage the situation to prevent the complication, through repositioning the mother, the use of aromatherapy, relaxation or visualisation techniques, water for pain relief, or a myriad of other natural techniques, or much more rarely, determine that the situation cannot be managed at home and arrange for your transfer to hospital.

Some women may feel, after previous birth experiences, that such emergencies come on in a matter of minutes and need immediate attention. In actual fact, this is not the case; birth complications are preceded by many warning signs, and an independently practicing midwife, as part of her job, will be constantly communicating with you and your chosen birth partner(s) to appraise you of your progress. This is quite different to a hospital birth where you do not have that rapport with your midwife, and as a result they often do not communicate their concerns or worries with you until the last minute, thus giving the impression that it all fell to pieces in a matter of seconds or minutes.

paradise lost · November 10th, 2007, 07:12 PM

When a baby's head is descending the tone of the deep pelvic floor muscles help it to turn correctly into the birth canal. My early labour was posterior, but DD turned before descending. Even when babies are born face-up, still in the same OP position, the deep pelvic muscles do much to ease the head down and through the bones. When we have an epidural the tone of those muscles is greatly diminished and they cannot help the baby to turn as well - these are not the muscles at the vaginal opening but the ones higher up, inside, round the cervix. As a result of this one can suffer "deep transverse arrest" where the head is coming though the pelvic bones at the wrong angle and becomes stuck. In this situation forceps are often used to turn the head and then deliver the baby.

As others have said, without the epidural this is very unlikely to happen. You'll be able to move freely and push more efficiently if you can feel it all.

There's no reason to think the next bubs will also be posterior. Have you looked at Spinning Babies website? There are lots of tips on how to help bubs move and there's always moxibustion and acupuncture too. And if, after trying all these things, baby stays posterior, you can go into labour knowing bubs is in the best position for him/her. Babies ar smart and will always try to come out the easiest way - if baby's had every opportunity to shift and has stayed OP then that must be the best way for them to come.

I think my (UK NHS) midwives would allow one to push for 2 hours with no progress or until i asked to transfer (whichever was first) before suggesting going into hospital. They also keep you moving and changing positions to try to help "unstick" bubs if progress is slowed. Crawling on the floor is incredibly effective at unsticking babies apparently!

Bec

**mrsmac** · November 10th, 2007, 07:28 PM

My first was posterior and ended up being forceps (I didn't have an epi) but my 2 babies after that were not posterior and didn't need forceps.

**Roryrory** · November 11th, 2007, 02:32 AM

The epidural you had, and as such the immobility, would have affected the baby being able to get into the optimum position for birth.

I didn't have an epidural or pain relief to speak of (gas - hah! does nothing at 9cm LOL) but towards the end was buggered and had given up so was on syntocin to assist with pushing stage. So I was in the dumbest of positions - on my back, legs in the air, no room for pelvis to open and no gravity to assist my posterior bubba. Still managed to get him out without assistance, so I can only IMAGINE how much easier even a difficult presentation would be with better positioning and a midwife's (rather than OB's) assistance.....

And ditto what everyone else has said (thanks for the info on posterior births Michael, the more I read puts my son's birth into an informed perspective).

**Janie** · November 11th, 2007, 06:51 AM

(thanks for the info on posterior births Michael, the more I read puts my son's birth into an informed perspective).

Ditto!

**meow** · November 11th, 2007, 07:10 AM

My Mum had my sister at home and she was a 10 pound posterior baby. I don't think posterior automatically means you need forceps or anything.

**Schmickers** · November 11th, 2007, 07:40 AM

And ditto what everyone else has said (thanks for the info on posterior births Michael, the more I read puts my son's birth into an informed perspective).

My pleasure. Posterior births are just a variation along a spectrum of natural birth. Posterior births aren't even considered "high risk", although there is no doubt that they are certainly hard work.

**fionas** · November 11th, 2007, 08:40 PM

Hi guys

Thanks for all your responses.

Hoobley - I'll be reading the Spinning Babies website religiously next time around!

Michael - I don't think I could have coped with a slower labour LOL - I had 72 hours of pre-labour and went into established labour having had 7 hours sleep in 3 days so that was the main reason I had the epidural. I'm not saying the pain wasn't a factor (!) but basically I wanted a rest. Plus I'd had an unstable pelvis since week 28 and 3 months later it's still ouchy so I regard that 4 hours as the most blissful pain-free half-day of my recent life! Anyhow, I suppose my real question was how likely is it in a normal epidural-less labour that babies get stuck regardless of whether they're posterior or not? Given that forceps were invented because babies do get stuck and that until recently around 15% (from memory) of babies were birthed using forceps, it seems reasonably common? Or are you saying that in the majority of cases babies can be unstuck by using different positional techniques?

Sorry to harp on about it, just really curious! Plus I'm going to see my ob in a couple of weeks so want to ask him about it too.