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 and to the front. 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 the 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. Once an epidural has been inserted the women is unable to instinctively move her body and work with her baby to rotate. The pelvic floor is also anaesthetised and loses it’s tone reducing the chance of rotation taking place.
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 (Hofmeyr & Kulier 2005) to support this notion. 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 an OA position and the OP baby is probably in that position for a very 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. You can find some 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 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; warm water; gentle sacral pressure. But, avoid applying strong pressure to the sacrum as this may reduce the space available 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. If you are unfamiliar with these techniques you can learn most of them at this workshop.
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 occurring 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.
Loved this blog!
I was already a midwife, booked to have my second baby at home (as one does!) I knew she was a deeply engaged O-P. I seriously considered – with my expert knowledge – re-booking at the closest maternity hospital due to her position. My gut feeling was that I should be fine as my first birth had been very easy and wonderful, so my head knowledge had to be ignored….
Pushing my daughter out was 20 times harder than my son had been. The urge to push from 5 cms was a real struggle, plus the back pain had me gently sobbing through the contractions (kneeling in my bath) for most of the labour.
I wouldn’t wish a POP on anyone, but the feeling that I had suceeded with my wretched knowledge, in ‘pushing an OP out, at home’ – total length of labour 2 hrs 30 – is still one of the most empowering things I have ever done. It totally changed my practice as a midwife to be far, far more positive about the power women have to cope with whatever position baby is in.
MMid(Hons) RN RM IBCLC
Thanks Eleanor – woman are pretty amazing aren’t they (including yourself)!
My first son was an OP. I had no expectations of what birth would be like and we had no idea what position he was in until after he was born. I was just happy he was head down since I had been frank breech and a c-section. I had what I would consider a pretty lengthy labor. I had roughly 16-18 hours and it was all in my back. I spent the majority of that time on hands and knees simply because I remembered my yoga instructor mentioning it would be helpful for back labor. It was intense. I am forever thankful that I used a midwife in a private birthing center for I fear I would have ended up with a c-section had I been in a hospital. My labor began on 3/14 in the morning with little “tickles”. At 8pm, after about 2 pretty intense hours of contractions I went to the center. I couldn’t bear the pain of a manual exam so my midwife sent me home thinking I wasn’t far enough along. 8am the next morning I returned to find I was 5cm. I tried the tub for a bit but it was too hot so I got out and then my membranes released. The nurse said I was pushing. I, to this day, don’t think I was. All positions out of the tub were uncomfortable but I got stuck with gravity on the bed on my back. I wish I had known more about positioning then as I would have tried harder to get in a better pushing position. Two hours of intense pushing led the midwife to start talking of episiotomy since we could see his head but couldn’t make any more progress. I freaked and out popped my son, all at once. He was born OP with a hand. I had a terrible tear too. I had no expectations of birth. It was a hard run, probably like a marathon, uphill. My body kept working, all on its own. I was there as a spectator only. During the birth of my second son, I almost didn’t even end up at the birth center. He was OA and since the sensation was so much different I hardly thought I was in labor! 5 hours of contractions and less than 30 minutes of pushing. 46 minutes before I had him I was at work! I am glad I had an OP baby first. It made me strong and even more commited to the power of natural childbirth. I will say I felt more during the pushing phase but that is probably because my nerves weren’t “deadened” from the two hours of pushing like with my first son.
Thanks for sharing your birth stories Krista!
My son’s birth was OP…totally threw all my expectations of labor out the window. I was well-educated about birth by the end of pregnancy, my husband and I had taken Bradley classes, we were booked to birth at a local birth center, but somehow I still expected menstrual-like cramps for my contractions! What I felt for the last 20 hours or so of my birth was as though someone was actually hitting my lower back with a baseball bat…and somehow not breaking my bones!…every time a contraction began…the intensity of each contraction was ridiculous. I felt absolutely nothing in my front…absolutely nothing that resembled what I had thought a contraction might feel like. In fact, when labor first started, I was sure that I wasn’t actually in labor…I kept on thinking that even when I couldn’t do anything but kneel on hands and knees during each rush due to the unexpectedness of labor being entirely in my lower back.
My labor was just shy of 48 hours. I piddled along (with very strong contractions every 5 min. or so with very little dilation) for the first 24 hours or so before my water spontaneously broke. At this point, I was exhausted, and the midwife convinced us that pitocin augmentation was my best bet at avoiding a C-section. Apparently baby was still very high, and she had doubts about my ability to push once the time came.
I agreed to the lowest dosage of pitocin which IMMEDIATELY jumped my labor to an intensity level that I absolutely could not handle. I was a (very loud) crying mess on my hands and knees draped over a birth ball once it hit my system. I experienced one continuous contraction and felt extreme urges to push despite being at only 5cm. We had the pitocin turned off, braved the shower which was a bad decision and then our midwife and labor nurse left us to our own devices once I turned down an epidural for the 100th time. (Despite, I will admit, screaming for someone to give me drugs! lol) For the next four hours we labored in a haze…I have no recollection of transition…it clearly wasn’t as awful as laboring on pitocin and began to push again after only 8 hours since our arrival at the hospital for augmentation. 53 minutes late my son was born and my midwife claimed he turned from OP to OA once his head was fully out?
All in all, I wonder how a next birth will feel to me? I might think that a OA birth is harder simply because once again, my expectation of what a contraction feels like will be unknown! On the other hand, a second OP birth might feel very manageable since I would have an idea of what to expect: long labor, back contractions, early urge to push, etc…
Wow what a challenging birth you had! I am sure you could cope with anything your next birth throws at you. A second OP baby may be very different to your first too. I have cared for a few women who always have OP babies. Often the first is the most challenging and the others rotate quicker.
i had a OA birth? im confused, u wrote that a OA birth feels all the pain in the back, but the girl above me had a OP and felt everything in her back??
i started feeling contractions at 930pm but thought they were the fake labor pains since i was 2 weeks early. got at hospital at 11pm, still in denial of being in labor. even the nurses thought so too, (i guess another girl had showed up an hr b4 me, and she was a false alarm). dr showed up at 1130pm. started yelling at the nurses, i was already 8cm. they moved me to the next room. then i was 9cm! by midnight i had my baby. i felt all my pain in my back, after 20 mins pushin, she just slipped out. 1st birth and i remember the nurses saying it was gonna take awhile and they would have to teach me to push the baby out. but after awhile, ur body just takes over. i did the 1st push and after that my body took over and pushed when it wanted to. i do remember the drs saying to wait for a contraction to push, but i couldnt. or maybe my contractions got closer together than the last time they checked? lol
overall, had a good pregnancy/labor but then again, i wasnt aware of all this other stuff. now i think i am gonna be more conscience of all this next time around, but i dont think thats a good thing.
Oh no – I hope I haven’t confused you. I think you are referring to the quote: “Plenty of women with an OA baby complain of back ache in labour whilst many with an OP baby do not.” The point I was trying to make was that an OP baby does not necessarily mean back ache – although this is often a feature as women’s stories reflect. Some women with OA babies feel back ache. Each woman and baby is unique regardless of position. You did a great job of listening to your body during your birth and I’m sure you’ll do the same again – forget all of this stuff about position… which was kind of my point ; )
oh i wish someone would have known and shared all this with me during my labor!! i took bradley classes, researched and was ready and thought i knew exactly what to expect however hours into my labor my contractions were everywhere- five min apart then 30 seconds and lasting so long then short and i was sick (throwing up) which i thought this doesnt happen till transition!! but i was only a 4!! to top it off the doctors (i was at a hospital attempting a natural birth) didnt tell me he was OP…of course they wanted me to take pitocin, break my water and get an epidural but i was determined to have a natural labor…my poor husband and i were exhausted 19 hours into and we didnt understand why i was still a 4 and why my contractions were so unpredictable…so we decided to let them break my water and give an epidural…but i held strong on the pitocin (i was so worried it would lead to a c-section!) anyways about 21 hours into it they let me know he was OP which explained so much…28 hours later he was born in the OP position…and when i look back on it i know IF i had had the knowledge and support i needed we could have accomplished a natural birth, but i will with my next! Thank you for this information i hope my next is OA though!
You did well to birth vaginally with an epidural and an OP baby! Your baby may have rotated without an epidural because the pelvic floor muscles would have provided a counter pressure to contractions = pivot. An epidural relaxes the pelvic floor and the baby is less likely to turn usually ending in manual rotation with forceps – but you managed to push him out OP. Your next baby may be OA but for some women all their babies are OP because that’s the way they fit best. However, once the body has birthed an OP then next OP should be ‘easier’. I’m sure your next birth will be amazing whatever position baby needs to be in.
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Lovely post. I am so glad that you pointed out not to tell a mom what to expect with a certain positioned baby. Each mom experiences things differently!
I am going to link to this on my blog, because you put things so clearly, I think my pregnant readers will benefit.
Thanks! I don’t believe in making things more complicated than they need to be. I’m pleased you like it.
I love your blogs!!!! So simply put, but with total accuracy!!!!!
Cant ask for more than that. Someone did say I must have a certain type/size pelvis? what are your thoughts on this?
I had 2 OP births, both 5 hours long
Your babies obviously fit through your pelvis best in the OP position. There are ‘types’ of pelvises described in textbooks – ie. gynaecoid (the ‘best’), android, anthropoid, platypelloid. I don’t teach this because I don’t think it’s helpful to assign a pelvis to a woman and make assumptions about her birth. I think the important information midwives and women need is that: all women are unique; the shape and size of the pelvis is impossible to tell from the outside; the pelvis moves and changes shape in labour; babies move and shape their head to get through their mother. As you found out – the body and baby work it out themselves without labels or measurements.
Pleased you enjoy the blog!
As a doula, I have seen numerous OP babies and in so many cases, the women end up exhausted, then they are so tired they want pain relief, so the epidural comes into play and then ending in Cesareans. This has happened often. Everything is done including acupuncture, homeopathic remedies, knee-chest positions, rebozo sifting… you name it!
These have been first time moms. It’s tough to see this happening and know where it will lead, but once that woman has done her best and tried all that is available to her, then what?
There most definitely is the pressure of (in the hospital) not letting it go on and on even with an epidural in place. I have seen pitocin used and then the baby seems to be wedged in even deeper and can’t rotate… so it goes to a Cesarean.
Sometimes after all is done, these babies still do not turn and a vaginal birth is not possible.
I find myself at a loss…. we do all that is possible but these babies do not turn and moms cannot birth them sunny side up.
So, it’s not always the case that they will turn and be born vaginally. I prefer to let women know about the optimal fetal positioning guidelines and see if they can’t at least start out labor with a baby in an optimal position and then encourage them to stay that way with active labor: walking, upright positions, lunges, belly lifts, etc..
Thanks Debra
I too have seen this happen. I have also seen it happen with OA babies. And I have seen OA babies rotate to OP one they get to the ‘turning space’ in the pelvis. I am all in favour of talking to women antenatally about the position their baby is in. If the baby is OP we use rebozzo and other techniques to encourage it to turn (if the woman wants to). However, if the baby doesn’t turn it is probably for a good reason and OP is this individual baby’s ‘optimal position’. The worst start to labour is a mother who believes her body and baby are starting with a suboptimal position – how can she the trust her body to birth if it can’t even get the starting position correct? We need to be very careful about the messages we give women.
Exhaustion is a feature of many labours – we can reduce some of this by encouraging women to rest, lie down, sleep, relax in the early stages of labour. Sometimes being too active with lots of positions and stair walking etc results in exhaustion once labour is established.
Just my thoughts : )
I loved this post. My son was born OP, and I had only a few of the OP labor “problems!” You never can tell before it happens.
‘post-dates’ pregancy? Nope, he was born either on his due date or the day after, depending on which due date you use.
rupture of membranes before labour? Nope, my water broke at 9cm.
a long stop-start build up to labour? Nope. I’d had braxton-hicks contractions off and on for the last 2 months, but nothing I would call a “long stop-start build up.”
irregular contractions during labour? Nope. Very regular contraction pattern.
slower cervical dilation while rotation takes place? Nope. I was 5cm when I got to the hospital, 5 hours after my first labor contraction that woke me up, and I gave birth 7 hours later, after pushing for 2 hours. I’d call that FAST!
early urge to push? Nope. I even had a 20 minute “rest and be thankful” phase once I was 10cm.
back pain? Oh yeah. Luckily, I had 2 midwives, 2 doulas, and my husband to give me counterpressure, plus I labored in the hospital’s huge tub for a couple hours, which was amazing.
I did push for 2 hours, which isn’t that remarkable for a first baby, but my son was crowned for almost a full hour without further progress. In hindsight, I should have gotten off my side and into hands and knees or squatted again, but oh well, it’s passed. My midwife cut an episiotomy, and he was born in the next contraction. He had a crazy conehead too! It had a kind of ridge from molding to the edge of my perineum and the top of my pubic bone! Even so, he was beautiful, and is now a very funny, smart, and adorable almost 2 year old!
You have proved the point that OP does not come as a set package of problems. For you and your baby it was the perfect position. As for the half an hour without ‘progress’… this probably gave your baby’s head time to mould and your tissues time to stretch. Thanks.
A friend of mine recently had a baby who was obviously OP before he was removed by c-section. Her water did break before contractions started and when she went to the hospital she was given the hospital treatment, even though we had spoken a lot through her pregnancy about waiting for labor to really start and avoiding interventions.
She was told she was in labor because she was 3cms, but we know that that really doesn’t mean anything. She never felt a contraction before she was augmented with Pitocin and then of course confined to bed. 8 hours later a c-section was recommended because “he just wouldn’t go through her pelvis”. I was just devastated! Your post really struck me because it’s so obvious to me that she could have avoided surgery (most likely- he was only 7 lbs 13 oz) if she had put more trust in her body than she did in the doctors. His head was really molded and it was pretty obvious that he was OP. Of course, I really don’t want to talk to her about it because she knows how I feel about natural childbirth (I had a very “easy” labor comparatively, but I stayed at home for almost all of my labor), and I don’t want her to feel like I am judging her.
Really I was just SO SAD that she never really experienced labor and now feels like her pelvis just isn’t big enough to birth babies…
I might just be dumb….but are the videos of the baby turning in the pelvis the same? I watched them several times and I’m pretty sure the baby is doing the same rotation to OP in both videos…
LOVE LOVE LOVE your blog! I’m going to give the link to every single doctor I work with!!
xox
Heather
L&B nurse
Canada
Sorry!
OA…they both rotate OA….no?
never mind!!! I AM dumb!
I re-read and totally get it now..
LOL
(so embarrassed!!)
No you’re not dumb : )
My son was born OP…I was not aware of his positioning until he was born. I had no back pain, labored without interventions, and the positions that are recommended to help relieve the pain of back labor and/or help with repositioning OP babies (e.g. hands and knees) actually felt worse for me during contractions. The only thing I did experience was a premature urge to push…as we were driving to the hospital in the car I felt like I needed to push (I was 9cm upon arrival at the hospital). Once completely dilated, I was able to push my son out in under an hour and a half, which, from what I have heard, isn’t too bad for a first baby or an OP baby. I am now pregnant again and am curious to see how this little one presents on the big day…
…oh and my water did not break until during a contraction when I was being checked into the hospital
Useful stuff, but the theme don’t display properly on my Powerbook…maybe you need to examine that out. Thanks, anyway.
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My 4th was OP and more back pain then the 1st 3. No management as it was a very fast labour at home. First twinge to babe in arms was 2 hrs. I spent most of it in the tub in a squat or all 4′s position. Mid-wives arrived & I decided to try the bed. He did turn while I was still on all 4′s and was born a few minutes later.
My 6th (Twin B as Twin A had just been born) was not only OP, but also a double footling breech. Unfortunately it was a hospital birth as the resident mismanaged the breech as she followed “protocol” based upon a breech that was NOT OP. I was shouting at her & the Dr. picked up on it & yelled at her. She got a tongue lashing after at which time my mid-wife stepped in as the baby was not breathing & the Dr.’s were too “busy” to notice. I LOVE my mid-wives. Oh twins were 39 weeks & 2 days & almost 6lbs & almost 8 lbs.
7th was born at home at 9lbs, 2 oz. I am not very big & have small hips & the OB I had to see due to baby being over-due said he’d not let me birth a baby over 8lbs. Funny I already had! Good thing the U/S was out by 2 lbs (as it was with all my kids…had them pegged 2 lbs smaller then what their actual weight was).
All births vaginal with no meds.
My 2nd (1st VBAC) was actually born OT. That was horrible time, he got stuck behind my pelvic bone because of course the diameter that was trying to go through was huge compared to OA or even OP. I wound up have to basically do a backbend over the edge of my bed to get him under the bone. “Normal” positions like hands & knees were just getting him more stuck.
Also, a great book if you’re worried about back labour, whether baby is OA or OP is “Back Labour No More”
Another interesting Blog post, thank you.
My daughter was OA throughout pregnancy then turned to OP deflexed during labour. Her head was never properly engaged. I had a long stop-start build up to labour (4 days) and then a further 37 hours of established labour, waters breaking about 4-5 hours after it began. My contractions were regular at first but ended up a bit all over the place, including over an hour of no breaks between contractions. Urge to push at 7cm but my midwife told me it was too early and to fight it. Ended up back at 5cm with swollen anterior lip, completely exhausted and unable to cope with the pain any longer. Transfer, epidural, syntocinon, caesarean.
I often wonder if the outcome could have been different with different support?
Hi, I have just posted my own story here. My perfectly heathy friend also ended up like you – being told not to push when she had the urge, and endep up with a caesarean. For what it’s worth, I believe in non checking for dilation and just trusting your clever body will the job, just as it does everything else – breathing, healing, sweating, emptying your bowels etc… For me, it is about deeply trusting yourself, and not somebody else to birth your baby … After all, how can they know better…!??! All the best
I look after mainly hospital-birthing women and, to try to prevent dire intervention, I generally educate them on better sitting positions to encourage the baby to OA. Much as I would love to just trust and go with the flow, I know very well that any delay or extra pain or overdue-ness will be treated aggressively by the hospital and many, many women will have caesareans or other interference and will have traumatic memories of their births.
I have certainly seen women that birth POP babies without trouble, and homebirthers can also take their time without feeling coerced but the “real world” of hospital births means I need to teach women how to make life a little easier for themselves when they go into labour.
It is really unfortunate that women have to find ways to fit themselves through the hospital system. I’m pleased there are people like you helping them to do this. Wouldn’t it be nice if the system changed and started fitting around individual women and providing safe care?
I am a midwife, was with my daughter for the three days of her early labour, with an OP positioned baby. She established her labour in a tired state but was well fed and well hydrated, happy to be in established labour. Her labour continued without drugs, she was mobile and it continued for another 24 hours, some of that time in hospital…, eventually still at 5 cms after 18 hours she agreed to have syntocinon, ten hours later she was still the same dilatation, sadly she agreed to a caesarian, the baby was very much transverse and arrested in the pelvis despite being upright, bathing, lying, all fours etc. We tried everything to allow her baby to move out or into the pelvis to her advantage for a natural birth.
My role as her advocate was to ensure she knew she had done every thing in her power to have the birth she wanted, it is sometimes a blessing that we have a medical profession that is so skilled and able to perform safe caesarian operations. We must never lose sight of the fact 100 years ago more women and baby’s were not so fortunate.
I am still a midwife (hypnotherapist) working in the community, within the NHS.
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My first son was born via c-section after I pushed for 4 hrs and my midwife finally did an ultrasound to see why he wasn’t coming out – he was OP. To my midwife’s credit, we discussed an epidural and resting, and not a c-section right away, but I was beyond exhausted at that point, and decided on the section…he also had a huge bruise on the top of his head for the first week or so from the pushing.
I recently had a VBAC w my second son – he was 10.5 lbs (my first was 8 lbs), but was OA. I think I’m definitely not shaped for OP babies!
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How interesting. 3 of my 9 babies have been born posterior. I always go “post date” and my water always breaks before labor begins, I think there might be a connection here! And FWIW, I have felt all of my labors in my back and no where else every time, regardless of baby’s position.
Wow. I’ve had 3 OP births out of 9, too! But mine were: 1 late, 1 on time and the rest early (days not weeks). My water only broke with the last child. The position was not noticed until the baby was born in all cases. Yes, I have had back pain. The pain in my last labour was horrendous and he was OP. BTW I myself was an OP birth. Strange…
Thanks so much for a very clear and balanced article. Especially for noting that there’s no evidence that one’s actions or lack of have a bearing on the baby’s position. I’ve been beating myself up for a year over whether it was my fault that my baby was in a bad position, and whether if I’d done more floor scrubbing – or, ahem, any – he may have avoided a difficult labour and eventual section.
Rachel, I very much enjoy your posts. As a student midwife (soon to be licensed midwife), I love to search out the things that most people think are “givens” when it comes to pregnancy and birth, and discover the truth. I love blogs and midwives who are willing to question the status quo, and ask “why are we doing this?” “do we really need to be doing this?” “who does this benefit?” “is this or that really true?”
You say:
“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 (Hofmeyr & Kulier 2005) to support this notion.”
I think you’re right in one sense: sometimes health care providers do give mothers the idea that “if you follow all these recommendations (get chiropractic care, do these exercises, sit on a birth ball instead of a chair), your baby will get into and stay in a perfect position”, whereas the reality is not that simple.
The Cochrane review to which you refer found that adopting the hands-and-knees position for 10 minutes twice daily during late pregnancy doesn’t prove helpful in changing fetal position from OP. That’s fine, but that fact alone doesn’t necessarily mean that mothers cannot impact on their baby’s position during pregnancy/labor. What you do for 10 or 20 minutes a day won’t have nearly as much impact on your baby’s position as what you do for the rest of the day (supposing for the sake of argument that the mother’s position can possibly have an impact on the baby’s position). Right?
I agree with you that mothers do not have “control” over their baby’s position, but I think we shouldn’t automatically discount the possibility that mothers can influence their baby’s position. I think it’s logical to suspect that poor maternal posture or habits could possibly lead to non-optimal fetal positioning. (This is not to say, however, that a mother who had good posture and good habits of being active and upright could not have a baby that was in an unusual/non-optimal presentation. We know that good nutrition improves good outcomes, but no one would say that a mother who eats well is guaranteed a good birth with a perfect baby.)
I entirely agree with you that OP doesn’t mean an automatic epidural/forceps/vacuum/cesarean delivery—I’ve seen OP babies come out without any of those! However, I’ve also seen mothers struggle to stay rested through a long prodromal phase of labor, and get part-way through labor and be too tired to go on, and end up transporting for maternal fatigue. It makes me hesitant to not look for ways to reduce the incidence of posterior babies. However, for those babies who choose to stay posterior, I’ll be totally supportive of the mother’s ability to birth her baby it it’s chosen position. It can be done!
Again, you’ve given me things to think about and ponder, and I greatly appreciate your thoughts on this topic!
Thanks for your comment Brittany. I just want to clarify that I don’t think that women have ‘no control’ over the position of their baby. As I state in my post:
“She can try a variety of techniques to encourage the baby to turn. You can find some 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 be born OP.”
I actually use the Rebozo sometime to see if we can encourage a turn. The woman might want to try and turn her baby but the key is to not create an issue if the baby doesn’t want to turn. There may be a perfectly good reason that we are unaware of. OP might be that particular baby’s ‘optimal position’.
I have also encountered long prodromal labour phases with OA babies – but they don’t get the blame for it. Another common pattern for OP is fast dilatation to 9cm/anterior lip, then slow. Re. Maternal fatigue… Michel Odent has some interesting ideas about the idea that you need energy for labour (too long to share here – it is in his book ‘The Caesarean’). I also think that doing too much and having people around in early labour can result in an exhausted mother by the time labour is in full swing. There are ways of avoiding this.
Keep thinking critically and sharing your ideas
I agree—some babies come out posterior, and do just fabulously coming out that way (and their mothers as well).
Thanks for the reminder about long prodromal labor with OA babies—point well taken! I’ve definitely seen that too.
Thanks for the resource recommendation on maternal fatigue. I’m definitely going to look at it!
And thanks for the encouragement!
I tried to go to the Spinning Babies website that you linked to and it did not work.
Thanks for letting me know – I’ve fixed the link
Thank you so much for this wonderful post! My first 4 children were LOP babies (2 in hospital, 2 at home, all vaginal without epidurals or episiotomies), and my 5th was frank breech born at home…. Perhaps it is simply the shape of my pelvis, perhaps it is simply the path laid for my children to enter the world, whatever the reason, I worked with my body, and my babies did the rest to get themselves here safely!
I plan to share this informative post with my fellow Student Midwives as a discussion on LOP babies recently came up in one of our classes.
My second born (a son) was born OP. WOW! It was painful. My labor was pretty normal, and only in hindsight did I realize the contractions were a teensy bit more crampy, but that was all. I never even mentioned it aloud to my husband or midwife. Once I began pushing, however, things felt completely differently. It was horrible to push. I still think I might be traumatized by the whole thing. For weeks afterward all I had to do was think of the pain and I would cry. It hurt really bad. It felt like he was trying to emerge through my rectum, not my vagina. Bad. He had been having decels for a while and he had his cord wrapped around his body several times. I am not sure if he would have turned OA. That being said, when I was dilated to ten, I was instructed to purple-push because of his decels. So maybe he would have turned still? Who knows. All I know is that he was my hardest baby to push out (did I mention it hurt??), but he is my easiest in real life. ;o)
Thanks for sharing your story. I’m surprised you were asked to purple-push because that kind of pushing causes decels and reduces the oxygen to the baby. Did you push him out OP?
Yes, he was born OP. He had been having decels off and on for a few hours. My midwife didn’t know he was OP until he was born. He was very much anterior during prenatals exams, so I never even gave it a thought. And the midwife is known for checking and then having clients push as soon as they are dilated to 10. I didn’t realize this at the time though. Just thought it was the decels.
Wow you must have a good pelvis to birth him OP! Most decels are a normal physiological response to something ie. cord compression or head compression. They are very common as the baby moves through the vagina because of the head compression caused during a contraction.
It is most certainly something I hope to never need to do again!
This post has really opened my eyes about a lot of what happened in my labor. Baby was OP but it wasn’t known until she was born because she had been in a great position at all my prenatal appointments. My water broke before labor really started (which then put me on the clock of course, however, I refused all augmentation and refused to be admitted to the hospital until I was in labor), it was slow to pick up (24 hours after my water broke before active labor hit though I had been having irregular contractions prior but couldn’t convince the midwife of it), I felt the urge to push before being fully dilated (around a 7) and was directed by my midwives not to push for 4 hours until I was fully dilated and then it took another three hours for her to actually be born. I ended up on my back pushing despite not wanting to be that way and every part of my body screaming not to be that way but I managed to scootch my pelvis almost completely off the end of the hospital bed and rocked it back and forth with every contraction completely intuitively. She was eventually born vaginally with no pain meds or augmentation or infection. I was told we ‘beat the odds’. I don’t think we beat the odds so much as I was informed.
I already knew that if I ever have another I was not going to allow any vaginal exams while in labor (I didn’t allow them until I was in active labor since my water had broken) because I just couldn’t take being told not to push if I wasn’t fully dilated, when I had no control over it. It’s good to read this and now have the knowledge that following the urge to push even if not fully dilated isn’t a bad thing.
On another note, I’m curious what you think of stitching tears before the placenta is delivered. The midwife that was on call (brand new to the practice, first day, never met her before) and ended up attending my birth stitched me up before the placenta delivered. I ended up never being able to deliver it and an OB had to manually extract it. I don’t think the stitching directly caused it but I can’t help but wonder if it played a part because something was being done to my body and that may have interfered on a physiological level. I was also exhausted do to the long labor and pushing and I think my uterus was just done (I vaguely recall not feeling any contractions during the end of pushing and “lying” saying I was so I could keep pushing). Everyone I’ve talked to has said they’d never heard of stitching before the placenta delivered so I was just curious what others thought of that.
Hi Jo
I haven’t seen anyone suture before the is placenta delivered. With active management (ie. injection and cord traction) the placenta is usually out within minutes. With a physiological birth you can wait for an hour or more so I guess if someone was heavily bleeding from a tear – possibly. But you could apply pressure instead. I would imagine that being sutured would interfere with the release of oxytocin required for placental birth. Suturing (if needed) can wait.
I would be interested if others also had this experience?
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Hi All, my baby was born at home, nearly unassisted, after 19 hours. The last few hours were very tough – incredible back pain, tiredness, hunger and heartburn. Despite having read a lot on birth, I didn’t have an idea what OP was, and so just thought this is how labour was. He was born in a perfect condition (first Apgar 9), and I was over the moon. All that pain was soo worth it, and when the natural happy hormones kicked in I felt incredibly high. Physically, however, I couldn’t even move or sit up – literally the back pain had paralysed me for some minutes. I think immediately after the birth my body went into some kind of hibernation mode where my mental processes shut down for some time, and some of my memories of the the 1 hour after birth period are blurred.
For one reason or another, I had called the midwife last minute, so she only spent 1 or 2 hours with us. I had never met her as she was one of a team which we joined later in the pregnancy. I didn’t allow her to do much, apart from checking the hearbeat of the baby. She also gave me some instructions towards the end, after the head had crowned, such as ‘you need to push now as the baby won’t like sitting there’. I must say, these little things felt very intrusive, and even the heartbeat monitor was imposed on me – I had absolutely no need to have it done. The back pain was so tough all my mental and physical funtions were trying to handle the situation, and talking to someone and refusing their (well meant) advice and offers was very exhaustive at that time, minimising the time I could be resting in between contractions.
The point I want to make is, the whole time I hadn’t checked for dilation so never knew and never really pushed – my body pushed the baby out. I was there but it was my body performing the birth. Had the midwife or doctors been there, I would have received a ton of advice, information and offers relating to an OP baby. All of this is unncesessary and only impedes and slows the birth down, since the baby needs to be birthed either way, so knowing that some technicalities are against you can be very unhelpful from a psychological point of view. I believe that unless something is very wrong, which mostly isn’t, the baby will birth itself safely, if only we technical humans allow it. It had grown perfectly from nowhere, so why wouldn’t it make the last tiny bit of the journey? Babies are so clever…
As a PS … I have absolutely nothing against midwifes – I just know that, for me, birth is a very spiritual, inner and sacred event, and I prefer to do it alone. However, I did have some bleeding afterwards, and my midwife and her assistant were invaluable in the 3rd stage. As I’ve said, my recollections are somewhat hazy, but I do know that I kept on bleeding. And I remember that they emptied my bladder with a catheter, and gave me an injection into the thigh to birth the placenta. I also took some cayenne pepper drink, which I had prepared for the case of a bleed. All of this, or some of this, helped and it stopped. My boy is a very happy and smart 2-year-old now.
Happy birthing to everyone!!!
Thank you. Your story highlights that often advice, assessment and intervention is done for the benefit of the midwife/care provider not the woman. And it can actually interfere with the woman’s own instincts.
Wow I am just amazed watching this little girl just blink and shine with the glory of being born. What an amazing video and an an outstanding birth. Truly just wow I haven’t enough words to express how amazing this is. Maybe just amazing is it. Love it!!!!!! I cried the whole video!!!!
I appreciate your blog
I teach Bradley classes and I’ve just had way too many moms labor for days and have the baby subsequently get hung up on the pubic bone resulting in a cesarean. It breaks my heart when this happens. Twice this year it has resulted in a homebirth transfer. So I’ve become one of those types who preach annoyingly and often about “optimal fetal positioning” during class. Lots of pelvic rocking and mindfulness of the position of the pelvis during pregnancy.
Thank you for this post. It has helped me anticipate the birth of my next child, due 1 week from now. My first was a very long drawn out home birth of an OP baby. The first 6 cm were very slow coming, extremely painful but I spent the 40+ hours attempting to get my daughter to turn. She did and I swear to God labour didnt even hurt after that. But as this brilliant post suggests, she flipped back to OP once I was fully dilated. I pushed for 3 hours and eventually she popped out, face up with nuchal hands!
Now that I am pregnant again and “due” in a weeks time I have been told this baby is also OP. Prior to this s/he had been breech. Beggars can’t be choosers, right? Haha. So to my absolute terror I have been frantically trying to find a way to “optimally position” this baby so I don’t have to suffer like what I CLEARLY remember with my first. I did harbour a lot of upset in regards to the birth for a very long time (the delirious exhaustion, the tearing, the hemmorhage etc) But then I found this post and it occured to me; I spent 40 HOURS…. 40 FREAKING HOURS…. trying to turn my first OP baby. Sure it worked, but obviously not for long because she still chose to come out OP!
I think it is very important to get the word out that sometimes posterior IS optimal and shouldn’t be messed with. I’ve done it once before, at home without interference, and I’ll do it again.
Thank you for allowing me to gestate in peace with this knowledge!
Great post. I am wondering your thoughts on an OP and Bandl’s Ring? I’ve had 3 c/s, I’m pretty sure all were for OP now that I look back (though no OB told me the position). I did attempt to VBAC with the last 2. My last one had the OP labour pattern that I had experienced before and I got to about 5 cm before I caved for the epidural, the pain was so great. When I agreed to the c/s they found a Bandl’s Ring and now looking back on pictures I can definitely see where her head was hitting the brim of the pelvis. Have you ever seen this in your practice? I sometimes think about having another TOL but I worry about the same thing happening again. Though the next time I will see a chiropractor to help with pelvis alignment and such. Your thoughts?
No really sure without having been there and seen it… Did any of your babies actually enter the pelvis and get to the ‘turning space’? A chiropractor will be able to tell you more about your individual pelvis and whether there are any adjustments that could help. Having had 3 previous c-sections you will have to fight to be able to birth instinctively in a hospital setting.
Thank you so much for this article!!
My first boy was born “sunnyside up” and no one knew until he was born! The OB nearly jumped out of her chair when she saw him come out. I had tons of back pressure, but they offered me an epidural a few times which I never accepted because I never felt I needed it. My labour was short and fast (hard labour was 2 1/2 hours, one hour of that was pushing) and though I never felt it was painful, it was intense. I did have an early urge to push though. They were having a hard time getting a heartbeat on him when we arrived and though all I wanted to do was get up and move, they wanted two solid minutes of heartbeat readings before they “let” me get up. I never did get out of that bed though and I think he may have turned had they let me. My OB said at my checkup after that considering he was OP and my labour was fast, next time I had a baby and I even *thought* I was in labour, that I should run to the hospital! My second was fast too, though not OP this time.
This was a great article to read! Just wanted to tell my story so others can know all labours and births are different! Not all OP labours are painful or cause problems.
Thank you for this post! It has got me thinking about my two births. My two labors were so similar. I don’t know if my 1st son started out OP or not, but looking back on it, we had some of the ‘symptoms’ of an OP labor. He was born OA though. I had a total of 48 hrs of labor for my first son. Went into labor at 10pm on Monday night, contractions were strongish but completely manageable went into Dr to find out I was 4cm and she told me to go to the hospital but labored at home for 24 more hours, getting little to no sleep with contractions only every 10- 30 minutes. Finally gave up at 9 am on Wednesday and went to hospital (6cm) where they broke my water, waited, then got pitocin,and finally gave birth at 9pm after 1.5 hrs of pushing and other than pitocin, no intervention.
My second son I was expecting to go somewhat smoother. We chose to deliver at a birth center for #2. My water broke Friday night, contractions started around 6pm Saturday night. Strongish, again, but not constant and not picking up to the 4 minutes apart time frame. I got a little sleep Saturday night, but contractions were intermittent but strong. Went into birth center Sunday morning and I was 4cm (again!), labor was stalled, no consistent pattern only this time my water was broken and it had been over 24 hrs. Ended up doing lunges up stairs, walking, squatting, and stomach binding (anything other than going to the hospital). With much effort, we did get contractions strong but it seemed I had to force them. Got to 6cm, but then stalled again and tried all sorts of laboring positions. It was like an iron man competition. Finally squatted in the shower and felt the urge to push but it took 1.5 hrs of pushing for #2 and I had to deliver sitting upright on my husband, rocking back to make my pelvic opening widest possible. Finally delivered him at 9pm Sunday, about 44 hrs of labor total, so 4 shorter than #1, but since we didn’t do pitocin this time, took a lot more effort! He was born LOP (not sure what the L stands for or if I got confused). My midwife said 95% of moms would have had to have had a C section as his head was turned up, he was almost 10 lbs(9 lbs 14 oz), and he was in a terrible presentation.
We’re hoping to have a third (in a couple years). From reading your article it sounds like some women labor that way – do you think we can expect a similar birthing pattern for our third? That something about my pelvis means my labors will be slow? The midwife who delivered me said I had a huge pelvis – further confusing me as to why it seems so difficult to get my kids out? I wouldn’t change my births for anything, though I must admit some jealousy of women who have lightning quick labors when mine seem to be some epic saga!
You have a wonderful pelvis – two babies have been born through it, one in an OP position that requires a little more room (which you made). There may be something about your unique pelvis that encourages your babies to make use of the space by being OP. Who knows. Your next birth may be similar or very different. As for ‘slow’ – what is slow? Your description of a ‘stalled’ labour sounds like the pattern I see at homebirths a lot. We all get some sleep and food and wait for labour to gear up again. It is not a problem – it is the way some labours are and normal for many women. The ‘L’ stands for ‘left’ so your baby was facing up and to the right with his the back of his head the ‘occiput’ ‘O’ in the back of your pelvis to the left. Some women who have quick, powerful labours would be jealous of your ‘slow’ labour.
Thanks for such a great post! My first son was OP and my birthing time was definitely interesting. I had planned for a home birth and there was no way I was transferring to the hospital.
I basically had constant back pain for 63 hours straight (before I transferred), with at most 30 second breaks here and there and hardly felt anything up front. I was very knowledgable on birth (I am now a doula and childbirth educator) and nothing that myself or my doula did would help relieve the constant pressure. I was in a great mind set for most of my birthing time and at 60 hours my MW finally came over and I agreed to be checked to find out that I was only 2 cms. This was an emotional time for me and my doula provided great support. After having a shower and trying some accupuncture to encourage him to rotate I decided to transfer to hospital. I had not been able to sleep and knew that it was time to make that decision. At the hospital I received an epi and oxytocin and birthed my son within 5 hours. At the very end he turned from OP to OA while I was pushing. Although it was not the birth I imagined, I believe this experience gave me strenth to make some big changes in my life and will make me a better doula. I am now expecting my second child and will be having a hands free home birth 
My son was born “sunny side up” and let me tell you, it was the worst thing in the world for me. He was stuck (supposedly), so the doctor had to use a vacuum to get him out. (I think the doc was just trying to hurry… I had only pushed 25 minutes by the time he got the vacuum out.) My poor baby had a horrible bloody, bruised cone head for weeks, and I sustained a 4th degree tear from it. I dealt with excruciating pain for SEVEN months (it felt like I had shards of glass in my rectum, I went to the doctor seven times during that period, but every single OB/GYN I saw in my group assured me it was “normal” to feel that way for so long after a 4th degree) until it developed into a fistula. I had to have a fistulotomy at 9 months post partum. During surgery, the surgeon also had to repair posterior and anterior fissures that I had sustained during birth that never healed. I’m scared to death to get pregnant again… the surgeon recommended I have a c-section should I ever get pregnant again, as did a my new OB/GYN, so I don’t risk a repeat 4th degree or fistula. I don’t want a c-section though. I thought I was prepared for birth… I had done all the research, hired a doula, made a birth plan… and it was all for nothing. I would love to have another baby, but I am scared to death of a repeat of what happened last time. I feel hopeless. I feel like any OB/GYN would recommend a c-section, and a midwife might say I should try a natural birth- but what if it happens again? Can it be prevented? I can’t go through this all over again, and I don’t really know where to turn…
I am sorry that your birth experience was so damaging. The position of your baby was not the cause of your perineal/pelvic floor injury. It is well known that the biggest risk factor for an extensive tear is a forceps birth. 25 minutes is a very short time to decide a baby is ‘stuck’. If you have another baby only you can decide the best way to do it. There are no guarantees either way so you need to do what feels right for you. I hope you can work your way through this.
Thank you, I appreciate that. My former OB told me that the baby’s position is what caused the damage… of course I’m sure he would never want to admit that his intervention (vacuum) after a mere 25 minutes of pushing was the actual cause. Also, my mom had a 4th degree with me (30 years ago) after three hours of pushing with no forceps or other interventions, not even any pain medication. (OUCH) Her doc threatened to use forceps if she didn’t “hurry” to which responded she would kick him in his face if he did. So since it happened to her without forceps or vacuum, I was wondering if genetics could have a factor in tearing (skin elasticity).
Skin/tissue can be influenced by genetics and nutrition so this may also be a factor in your experience. It is difficult to say. I would guess if your mother had an Obs she would have been birthing on her back – another risk factor for a tear.
Oh JM, that sounds really intense. No wonder you’re feeling afraid. I too was very scared of having another baby and birth after my first daughter was born. For different reasons, but it prevented me from having another baby for four years. I too thought I knew a lot about birth before my daughter’s birth, I thought I was well prepared….and if left unhindered I think we would be fine, it’s more the interventions that are the problem. Nothing is gauranteed in birth, but there are definitely ways of reducing the risks of some damaging procedures. One really great thing to do is to get to know your care provider one on one. Make sure that they know you. Ask them lots of good questions about their practises so you know if they really do trust in a woman’s ability to birth her baby. Perhaps you could contact a well respected, local independent midwife, meet with her and discuss your fears. There’s some fantastic books available to gain knowledge of the birthing process and the ‘interventions’ that can lead to a mismanaged birth.
Your body has an incredible capacity for physical healing, so on a physical level your body will be ready to birth again. your skin can stretch, given the time it needs and you can birth a baby if that’s what you choose. Working through our emotional healing is more important than the physical healing I believe. Birth trauma wounds can run deep
I don’t agree with everything on this particular website, but they do have great info for working through birth trauma http://www.joyousbirth.info/birthtrauma.html and here’s a ssupport group too http://tabs.org.nz/whatis.htm .
Much love to you as you go on this journey
Thank you so much for the information and links. And you had some great advice; I will definitely be following it! I’m so sorry that you had a traumatic experience as well.
It sounds like you felt a lot of the same things I felt/am feeling. I hate that so many women go through awful experiences during what should be one of the happiest times of our lives. It’s been nearly three years for me and I’m still trying to work through it. Thanks again, I appreciate your response. 
This was a good introduction to the OP baby. My first baby I think turned from LOP to LOA but after engaging the head. I had a very long, irregular labor with a very long pushing stage and she arrived asynclitic w/ a forehead presentation. My second baby was consistently ROP. Labor was smooth and much shorter (7hrs total). I experienced an early, inescapable urge to push around 7cm. My body basically vomited him out. Neither birth was severely painful, no back labor, no back pain, etc.
Both babies also had anterior placentas.
I’m pregnant w/ my 3rd, in ROP position and yes, with an anterior placenta. I think my babies and my body seem to know what to do together!
Thanks for this post, I’ve been banging on about this for years!!
I’ve had two OP labours….1 POP, not sure about the other as it ended in surgery. I’ve also had one OA labour.
My first daughter, largest of all three at 9lb13oz, was OP. I prelaboured for a day and a half, had a doula present at home some of that time. Went to my local birth centre, had a trigger happy midwife who wanted to do all kinds of things rather than just observe. It was hard work but I was doing fine. One thing led to another and I was coerced in to AROM and that’s when it was agony! I gave up…after so much fighting for my rights I was done….transferred to hospital, stopped myself from pushing, went in for surgery and they had to pull her out with forceps due to her being so far down my birth canal. It’s a loooong story and in the end was very traumatic for my daughter and I.
My second daughter, smallest of the three at 7lbs3oz, was POP. I was SO afraid of having another OP labour that I tried all the OFP techniques…spent hours on my hands and knees etc…but nothing worked. Two days of on again, off again prelabour that resulted in me being very tired….but still very determined! My dh and I kicked labour in using sex and an orgasm….not all that pleasureable after two days of prelabour!! 10 minutes later and I was in active labour. This time I was staying home. Had my dh and two friends there who boiled water for hot towels for four hours straight. This was bliss!! The heat on my back helped so much. I was in the quite, candle light of my loungeroom. It was hard work still, but noone was there trying to put their hand inside me. Noone talking to me through contractions. Noone timing anything. Noone telling me how I should birth. It was pure instinct. My daughter was born, in the water, sunnyside up. I was very fearful of her getting ‘stuck’…it was totally irrational….and consequently tore both ways with my almighty pushing. She had a very swollen nose too. This birth was the easiest of my three births and a beautiful lesson for me in how ‘different’ doesn’t always equal ‘worse’.
The difference in how I coped, how my labour progressed and everything was HUGE! Being at home, surrounded by people who loved me and trusted in my ability to birth was amazing. Such a contrast to my first OP labour.
Thank you for this post! I’m 20 weeks along and 2 weeks ago my midwife had me scared into thinking that I needed to start turning my baby NOW or else I’ll have a transverse/breech baby. I knew what she was saying was ridiculous, but I had nothing to back it up. Of course, she also admitted to me that she had a high c-section transfer rate too. She’s no longer my midwife.
The first birth I attended as a community midwife in Amsterdam, just one day after being licensed was a OP baby. A 1st year midwife student was with me, doing an internship, she had never seen a baby been born and was very excited. When we arrived the lady was pushing and we just had time to get everything I needed out of my bags because a few minutes or was it seconds(?) later a healthy baby boy was born, to my big surprise facing up (OP). He looked his mother in the eyes while she held him and supportend him while being born! It was the most amazing and quickest OP baby I have ever seen. The 2year old sister and father were sitting next to the mother and she was just smiling… I remember whispering to the student that I was astonished with this speedy OP baby. I just wanted to share this story, since it was a OP baby that was born without any complications
Sometimes things happen against all odds!
This post is just what i needed to hear..
And thank you to all the women for sharing your wonderful birth stories they are truely inspiring!
Im currently 38weeks pregnant and my baby is in OP Position, I was so worried that this labour is going to be so much more harder then my first. But this has really inspired me and taken my anxieties away, My baby might turn be even if i do go into labour while is in OP position i know i can get through it
A number of my babies (I have 5, and am expecting #6) have started labour in the OP position. I never had back labour or long labour. My third baby flipped very quickly (I felt it happen) immediately before I began pushing, after 2 hours of active labour, at home. My 5th (my first boy!) was born as a brow presentation posterior. I had a very quick and easy labour in the bath at home with him (1.5hr), but then had a very hard time pushing him out. We tried many different positions, and nothing budged for an hour. It wasn’t until after his head finally emerged that the midwife realized what had happened. (my midwife had just said “maybe we should think about a transfer”, and I got mad and pushed like crazy, and there he came!) I understand that that particular presentation is one that often leads to a c-section (according to Ina May) but I thought I’d put it out there – it can be done!
)
My Son is now 16 weeks old. He was OP but no one told me what to expect with that. it so happens at my 37 week appt i was 7 centimeters dilated had no pain no idea really! he was born that night after 4 hrs of intense labor and 2 of pushing. not once did my midwives mention epidural or anything! i now realize i am blessed for that!
I have had two OP babies. The first was an 8 hour induction. I just assumed all the interventions, etc kept him that way. My second who was always LOA during pregnancy, turned OP sometime during labor. For awhile I thought I would do everything I could to make our next one be OA. I have since found out that I have a large cyst on my sacrum and it dawned on me that maybe the reseaon my babies were both OP was because that was the only way for them to move down and through the pelvis!
Also, my second OP baby was a 3.5 hour homebirth!
I gave birth to my daughter via C-Section. A lot of things went ‘wrong’ with my pregnancy. According to my doctor, I was 40 weeks in and she was too big. If we waited any longer she would be too big to deliver naturally, since I had established that’s what I would prefer from the beginning. I agreed to induce labour ONLY because my doctor reassured me that I could go natural. We started at 6:30 AM on a Thursday. 13 hours of ONLY back labour with no medication, my cervix wasn’t dilating more than 6, and the doctor was pressing for C-Section. I declined, and asked for Nubain to try and relax my body into working. I lasted 3 more hours, and only that long because I begged the doctor to let me wait longer. He finally decided it was ‘necessary’ because she was facing the wrong way and it would hurt her to come that way. So, I was given the epidural and cut open. It was the most horrendous experience, and I, my step mom (who was acting as my doula) both cried our eyes out. I only wish I had seen this article before I gave birth. I will make sure to show this to all of my friends to make sure they don’t have a problem with it.
I am sorry that you were not supported to birth your baby, and instead persuaded to have surgery. Your baby was not the ‘wrong’ way or ‘too big’. An induction is anything but ‘natural’ and you should not have been led to believe that an artificially induced labour would be ‘natural’ (see my post on induction).
I thought that waterbirth video looked familiar – Lila and I had the same midwife and she was in my childbirth education class! This video was shared with our class’s Facebook page following the birth. SO cool to see it here!