Posterior Babies at labour. What can be done.

ASSISTING WITH POSTERIOR ROTATION PRENATALLY


  1. Have the mother do the "pelvic rock" exercise at least three times daily in sets of 20.
  2. Suggest that she assume a knee-chest position for 20 minutes, three times a day.
  3. Have the mother lie on a slant board (as with breech position) several times a day for 30 minutes at a time.
  4. Have the mother take warm baths and gently massage and encourage her baby to "roll over." We have found that having mother visualize her baby in the correct position and talk to her baby, telling it to move is often effective. Once, we had a particularly stubborn baby who liked the way he was lying just fine. The mother had suffered with a previous posterior labor and was very anxious about repeating it. She had tried in vain to get the baby to cooperate, so I called the dad in and said "Show this baby who's the boss!" Dad said, "Turn over, baby!" and he did!

ASSISTING ANTERIOR ROTATION DURING LABOUR


  1. When the baby has been determined to be in a posterior position, the first thing I do is have the mother assume and maintain a knee-chest position for approximately 45 minutes. Although this position is not the most comfortable one for the mother, it is very effective as the baby has more room in which to rotate. I find the mother tolerates this position well if she is not in advanced labor. We make sure that she is well supported by lots of pillows and give her lots of encouragement and emotional support. Often, contractions become more regular and more effective while in the knee-chest position, which also assists the baby's rotation.
  2. If the mother cannot tolerate the knee-chest position for as long as necessary to turn the baby, we alternate by placing her in an exaggerated Simm's position (lying on left side, two pillows under right knee, which is jack-knifed, left leg straight out and toward the back).
  3. Make every effort to avoid rupturing the membranes, as the "pillow" offered by the forewaters gives a cushion on which the baby's head may spin more easily. Furthermore, if the waters break before the baby has rotated to the anterior, sudden descent of the fetal skull may possibly result in a deep transverse arrest.
  4. If labor is more advanced when the posterior is identified, say 4 to 5 centimeters, the attendant may help by placing her hand in the mother's vagina, gently lifting and somewhat disengaging the head thus allowing it to turn to anterior, while the mother is in the knee-chest position.




EXAGGERATED SIM'S POSITION.




KNEES TO CHEST POSITION

 

Optimal Foetal Positioning was “dumbed down” by public use to mean only the Left Occiput Anterior position. 

Jean Sutton made the provocative point that birth seems to go easier when baby comes down from the left. There may be other reasons, but one is that babies from the left are more likely to be curled to aim the crown of the head into the pelvis. The baby from the right may rotate to the posterior in labor. I agree that this is likely to be true and even if it isn’t always true, it follows enough to be a critical skill for providers to be able to track fetal position and what to help make rotation from either side easier for baby.


Two facts will help you to understand why fetal position is important:

  • Baby’s rotate through the pelvis to emerge from the womb.
  • Fetal position effects the relative ease of fetal rotation and descent (including engagement).

Spinning Babies extends the concepts of Optimal Fetal Positioning (OFP) a break-through concept in childbirth.

My belief is that maternal positioning will support optimal fetal positioning when we have balance in the pelvis (including ligaments, fascia and muscles). Balance first.

We must remember that an optimal fetal position for the android pelvis may be necessary where the gynecoid pelvis has several options. A woman with an anthropoid pelvis is much more likely to have a speedy occiput posterior labor if her pelvic floor is reasonably supple, whereas women with an android may and a woman with a platypelloid pelvis does need baby flexed and from the left.


See pelvic types in Birth Anatomy.

Flexion is more important than position and soft tissues (Pelvic Floor, Psoas, ligaments, fascia, etc.) are often more of a determinant than the pelvic type (except for Ms. Platypelloid and the smaller of the Android Sisters).

Spinning Babies continues where Optimal Fetal Positioning pointed and adds Balance. 

By noting fetal position and/or the station of fetal descent, a system of protocols (series of activities) can be matched to help mother and baby.

The workshop is quite useful to learn this protocol expressed as The 3 Principles of Spinning Babies and the Fantastic Four. Address the muscles and other “soft” tissues and match the technique to open the diameter of pelvic level (pelvic station) where baby’s head is staying in a non-progressing labor.