Updated: October 2023
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 their back towards their mother’s back. The back of the baby’s head (the occiput) is in the back of the pelvis (posterior) 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. 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 normal variation.
OP Physiology
You don’t need degree level knowledge about pelvic anatomy to understand how the pelvis functions during labour. Basically, the pelvis is shaped in a way that requires the baby to rotate during labour. If you look in textbooks you will find diagrams with exact measurements of various pelvic diameters and categorisations of pelvic types. This is nonsense because every woman’s pelvis is individual and they don’t come in ‘types’ (Kuliukas at al. 2015). The pelvis is also not a fixed structure. The bones of the pelvis are held together by ligaments that allow it to open up to create more space during labour.
I find it more helpful to consider that there are 3 areas of the pelvis: the brim, the cavity and the outlet.
The baby usually enters the brim with their head mostly facing sideways ie. transverse or oblique (to fit the shape). It doesn’t really matter where the occiput is when the baby enters the pelvic brim because once in the cavity the baby can rotate. The downward pressure of the contractions, and the tension and shape of the pelvic muscles will guide them into a direct occipito anterior (OA) position and through the outlet. However, a very small number of babies will rotate to a direct OP position and come out facing the front of the pelvis.
Of course OP and OA babies may use this turning space to do all kinds of interesting things from turning OA to OP, to rotating all the way around the back of the pelvis to end up OA. The baby will work out the best way to move through their mother’s pelvis – even if we don’t understand it. Some babies are born in the OP position either because they stay in that position, or because they rotate into that position during labour (from OA). You can watch the birth of a big OP baby in ‘The Birth of Beau‘.
Watch this movie for an overview of the normal physiology of OP labour:
Creating a Problem
An OP position in labour was not considered a problem until routine vaginal examinations began to be used to assess labour progress. Even then, obstetricians were not concerned about an OP position unless a problem occurred. Friedman (1950s -70s), famous for his research that plotted women’s cervixes onto graphs, found no difference in the length of labour when a baby was in an OP position.
However, in more recent years an OP position has been blamed for all manner of problems and complications. These unsubstantiated accusations reflect modern misunderstandings and mismanagement of a physiological variation. Let’s take a look at some beliefs about an OP position and bust some myths.
Postdates pregnancy?
There is no evidence that an OP position causes a pregnancy to go past the guess date.
Pre-labour rupture of membranes?
No evidence.
Back 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. A study by Lee, Kildea & Stapleton (2015) into back pain in labour concluded: “The assumed relationship between fetal position and back pain in labour is a dominant discourse, albeit one which is lacking in empirical credibility.” Plenty of women with an OA baby complain of backache in labour, whilst many with an OP baby do not. Unfortunately, women are told that OP labour is ‘worse’. Given the psychological and emotional aspect of pain perception, this cannot be helpful. Every birth experience 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 contraction 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.
Women with an OP baby are more likely to opt for (or be persuaded to have) an epidural. This is not surprising, considering they are led to believe their labour will be more painful and prolonged. They are also more likely to be subjected to interventions that increase pain and risk. For, example, a woman with an OP baby is more likely to be told her labour is slow and have augmentation (see below). Both medical methods of augmentation—ARM and/or syntocinon (pitocin) increase pain. Once an epidural is inserted, the ability of the baby to rotate into an OA position is reduced (Lieberman et al. 2005). The woman is unable to instinctively move her body and work with her baby to facilitate rotation. In addition, the pelvic ‘floor’ (more like a bowl shape) is anaesthetised and loses tone, taking away the resistance that assists rotation.
Prolonged labour?
Labour patterns are often different with an OP baby. This is a physiological variation and is perfectly normal. It is difficult enough for a woman with a baby in an OA position to fit prescribed patterns of labour progress and even more difficult with an OP position. There are two common differences in labour pattern when a baby is OP:
Contraction pattern
Early labour (the separation phase) can take longer to build with more stops and starts. Once in strong labour, the woman’s contraction pattern is likely to be irregular. This irregular contraction pattern may the baby more opportunity to rotate between contractions ie. while the uterus is relaxed.
Cervical dilation pattern
Women with an OP baby are more likely to be incorrectly diagnosed with ‘failure to progress’ if their cervical dilation is being plotted onto a graph. To understand why, you first need to understand how the cervix opens in labour. Below is an overview featuring an OA baby:
The key difference with an OP baby is that the cervix is not held open until the baby enters the pelvic cavity and rotates (or not). The common pattern is that the cervix appears to be not doing much while the fundus is busy forming. Then, once the baby descends and rotates, the soft and stretchy cervix gets quickly pulled over the baby’s head. The birth is often very quick once this happens (if physiology has been supported rather than disrupted with interventions to ‘speed up’ the opening of the cervix).
‘Premature’ pushing?
An ‘early’ urge to push is also a normal aspect of OP labour. As the OP baby descends through the pelvis the occiput puts pressure on nerves in the back of the pelvis creating an urge to push. This pushing helps the baby to rotate by increasing downward pressure onto the cervix and pelvic muscles because the baby can pivot against this tension. An anterior cervical lip is a normal part of all labours, but is more likely to be found if a vaginal examination is carried out in response to spontaneous pushing to ‘check progress’.
Deep transverse arrest?
A deep transverse arrest (DTA) is a rare complication incorrectly blamed on an OP position. There is no evidence to support this idea and obstetricians were trying to bust this myth as far back as the 1950s. Today most DTAs are not actually DTAs. Instead, they are a failure to wait for the baby to rotate due to non-evidence-based timeframes. Most babies will be in a transverse position at some point in labour during their rotation through the pelvis. Unfortunately when c-sections are done due to failure to wait, women are often told they had DTA. However, real DTA involves no rotation and no descent and a truly obstructed labour. This is rare.
Selling a Solution
Anyone who knows about marketing knows that first you must identify a problem, then sell the solution. An OP position has (wrongly) been identified as a problem for labour progress and outcomes. The solution being sold reflects the culture in which obstetrics developed – a perception that women’s bodies are inefficient and malfunctioning and can be improved on by interventions enacted by experts. However, today it is not just obstetrics reflecting and transmitting this disempowering message to women. It is an also common approach within the ‘alternative’ childbirth culture. The solutions being sold centre on changing the woman’s body/baby rather than changing the dominant discourse about labour progress.
Fixing women’s non-conforming bodies
Medical approach
Medical solutions to ‘failure to progress’ include trying to speed the labour up by first breaking the waters if they are still intact. This reduces the amount of fluid around the baby, reducing their ability to rotate and doesn’t speed up labour. The next step is to augment the labour with syntocinon (pitocin) which increases pain (and use of epidural) and the chance of fetal distress. However, if the mother and baby manage to cope with induced contractions, syntocinon will speed up labour. Another medical intervention gaining popularity is manual rotation of the baby’s head by putting a hand into the woman’s vagina, gripping the baby’s head and rotating it from OP to OA. There is insufficient evidence to support this invasive intervention (Phipps 2022).
Non-medical approach
Solutions offered in non-medical ‘alternative’ approaches can start in pregnancy. Blame for an OP position is placed on the woman/baby. Women are given advice about ‘optimal fetal positioning’ implying that they have control over the position their baby is in when there is no research evidence to support this notion. In fact, the little research that has been done demonstrates maternal positions during pregnancy make no difference (Hunter, Hofmeyr & Kulier 2009; Kariminia et al. 2004).
Women are told that the shape of their pelvis is not optimal due to its structure (type/category) and/or tension in ligaments or tissues. Commonly, women are told their pelvis is ‘misaligned’ requiring interventions to balance. These interventions involve someone with ‘expertise’ manipulating the woman’s body into particular positions. Or in some cases performing internal techniques during a vaginal examination. The latter has echos of medical history when physicians performed vaginal examinations early in pregnancy to assess the ‘adequacy’ of the pelvis.
Once women are in labour non-medical interventions are used to get the woman’s body to fit institutional non-evidence-based parameters of progress. Midwives, doulas and birth workers often intervene in an attempt to save the woman from unnecessary interventions. They give instructions about movement and positions, and use hands-on techniques aimed at getting the baby to rotate quicker. There are no studies demonstrating these interventions are effective for women having a physiological birth ie. without an epidural (Desbriere et al. 2013; Guittier et al. 2016; Ahmadpour et al. 2021).
Regardless of the type of intervention — medical or alternative — the underlying beliefs/principles are the same:
- OP is a malposition that requires intervention (the woman’s body is wrong).
- Women’s bodies need intervention to fit medical timeframes (rather than disregarding those timeframes).
- External expert knowledge and skills are more powerful than women’s body-wisdom, instincts and intuitive movement.
Suggestions
OP in late pregnancy
Pregnancy is a time to build and nurture self-trust and reinforce the woman as the expert. It is not a time to disempower her and reinforce fear and external expertise. Care providers should:
- Reinforce the woman’s trust in her body and baby, and her innate wisdom and intuition (that includes knowing if she needs help).
- Discuss the possibility that her labour may be different (not better or worse) and might not fit general expectations about labour patterns/progress.
- Remind her that the baby will turn once they get into the pelvic cavity in labour, or may even be born OP.
- Tell her positive OP birth stories and connect her with other women who have experienced positive OP labours.
Spontaneous, physiological OP Labour
- Trust the mother and her baby to birth.
- Provide an environment where she can instinctively move and work with her baby to facilitate rotation (without instructions).
- Don’t do vaginal examinations. They are ineffective at determining labour progress with an OA baby, never mind an OP one.
- Don’t tell her not to push if she is spontaneously pushing—regardless of cervical dilatation (again – don’t do a VE).
- Back pain can be relieved by a forward-leaning position (Stremler et al. 2005); warm water; gentle sacral pressure or sterile water injections (Lee et al. 2017). Avoid applying strong pressure to the sacrum as this may reduce the space available in the pelvis for rotation.
In summary
An OP position is not ‘wrong’ or a problem. It is not caused by anything the woman does or does not do. Instead, it is a common variation that occurs when a baby gets into the ‘optimal position’ for their journey through their mother’s unique body. After all, the baby has more knowledge about the interior of their 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 and women’s body-wisdom and support birth to unfold as it needs to, only intervening if it is truly required.
If you found this post interesting, you can find more of my work in the following resources:
- Dr Rachel Reed YouTube Channel
- The Midwives’ Cauldron Podcast
- Books
- Courses
- Reclaiming Childbirth Collective
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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)!
No offence but 2hrs or 3hrs is nothing!!
I went through 3 days with a posterior before wanting to die and giving up begging for a c-section but was refused and given an epidural.
For many women posterior babies don’t come in 2-4hrs! It’s days of hell
Just wow at your response Bel. Everyone’s birth experience and story is valid. Its not a competition of who suffered most. Sincerely hope you’re not a birth professional with that outlook.
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!
This is an honest report, Krista. Strangely enough this blog was making me feel like a freak – in other words disempowering me and making me feel like I had no right to feel the horrendous pain I did with my face-presentation labour. The pain was beyond my wildest imaginings, and I did end up with a (very successful) C-section, which I believe saved my and my baby’s life. I also had a subsequent child with a 6 hour labour, and it’s interesting, when you’re not exhausted your pain threshold is much higher. That birth was a dawdle. Interestingly my child who birthed easily was an easy baby and grew into a relaxed young woman. My ‘difficult’ birth child has continued to have major problems with transitions in life. Both are loved. And it was a long time ago. But please don’t try to convince us that if only we were relaxed and cared for in a given way the pain would be less. Giving birth can be painful. But it passes. And if it’s not painful, count yourself lucky.
Maggi – I am sorry you felt disempowered by my blog. The point I am trying to make is that OP does not necessarily mean more pain – for some women it might but it is not helpful to assume it will. In your case you laboured with with face presentation – this is a malposition… not a common variation like OP. It is very very unlikely that you could have birthed this baby vaginally (safely) and a c-section was a very necessary intervention.
Your comment: “But please don’t try to convince us that if only we were relaxed and cared for in a given way the pain would be less.” I am not sure who that comment is directed to but it does not reflect my beliefs nor any of my writings. For most women birth is painful regardless of how relaxed etc. she is. You might find this post interesting: http://midwifethinking.com/2011/04/09/judging-birth/ 🙂
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.
Yes, my 1st baby was ROA but turned OP during labour, and finally turned at the last minute to come out the right way around, but it was 2 hours of pushing! (7 hours start to finish, and my longest labour so far, although he started in the best position)
The 2nd and 3rd were completely OP during pregnancy and most of labour, and nothing i did from inversions to myofascial release etc changed their positions, but baby 2 was only 2hrs 20 mins from start to finish and came out with 4 pushes, finally the right way around, and baby 3 who was stubbornly OP was corkscrewing out as his head emerged,to be face down, and that labour was only around 4 hours start to finsh, even though i was only 1cm dilated still at 3hr 30 mins..the last 30 mins my cervix shot from 1-10cm and he was born quickly…
This 4th baby, is only 24 wks atm, but i can tell its currently also OP from where the hands and feet are and the fact i can never feel any of its body…yes, it will probably stay that way like the rest, but i am not going to worry about it as i know it will come out ok….
They have all been born at home and i have been allowed to do whatever i felt the need to do during birth thankfully!
Don’t fret- your body has done it all before now, and so have you, and you might be surprised how easily it manages to come out this time despite the first labour! 🙂
Just popped back again, as i am two weeks of due date for baby no 5!!!
Baby no 4 I referenced above , was OP at beginning of labour, after staying that way the whole pregnancy- I did belly lifts in the beginning of labour, sat on a birth ball and wiggled my hips and around 5cm the waters were bulging like a water balloon.
We took the midwives out for a walk in the woods next to our house to show them the glorious bluebells, my labour was ramping up and I had to waddle thru contractions…after a while they suggested we go back inside so at that stage i hopped in the pool!
Shortly after i moved into transition, and the baby was born, and came out the right way as I leaned over the birth pool.
The labour was maybe 4 or 5 hours I guess….This time I think the 3rd stage of labour was more painful than the rest!
Giving birth to the Placenta, was horrid and for that bit, I joked I wanted an epidural!!!
Baby no 5 was 2/5th engaged at 37 weeks, so surprising low i thought for a 5th baby, considering that they often don’t even engage until birth?
I *think* it may be ROA, but possibly ROP as I can still feel some movement of limbs below the navel, but not the finger pops?
I am trying not to concern myself at all with whatever position it is in this time, as none of my babies have ever been in the *ideal* position, but they all came out ok in the end!
I wonder whether the fear of malpresentation makes it worse, whereas being more relaxed about it, I am not freaking out about the what if’s but just going with it, as I don’t believe there is much else I can do at this point…
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!!!!!
I had 2 OP births, both 5 hours long 🙂 Cant ask for more than that. Someone did say I must have a certain type/size pelvis? what are your thoughts on this?
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 : )
what is rebozzo manoevre? I just attended as midwife a labour of first time mum where the baby started out positioned ROP, went around to LOT then rotated babck into direct OP. This was all with active labour i.e. constant movement , sitting on toilet, touching toes, arching her back, assuming one knee up one knee down praying position all spontaneously chosen by woman, and water and acupressure… after spontaneous rupture of membranes at 2am three hours before labour started at 5 am and getiing to 9cm 7hrs later,at midday she then went on to get regular spontaneous pushing urges at 1pm, it was never coached or forced pushing but waiting for her body to do it, and baby was never distressed. But she got to the point where she was begging me to do something,,,an anterior lip was diagnosed after an hour of involuntary pushing when she asked me to help and check her because she said about three times in a row “he’s not moving I can tell” and then demanding I do something …I got an obstetrician to OK an epidural which she was begging for (her birth plan was for no epidural) and then at 5.30 pm after resting in left lateral or hands and knees position, I got the obstetrician back in because the baby had stayed in OP deep in pelvis, and was not advancing at all, the obstetrician came in and did a manual rotation, baby arrived 18 mins later wow! Intact perineum…..This baby had been ROP most of the thrid trimester in spite of months of optimal positioning in pregnancy. The woman is really pleased with her active labour and feels she made the right decision to have an epidural becasue she could tell her baby was stuck. The baby came out after four pushes following the manual rotation I was blown away. I would like to learn how to do this technique I am sure it made the difference between her having a vaginal birth and an intact perineum, and a more operative type of delivery.
Hi Bronwyn
The Rebozzo is a Mexican shawl that can be used in a number of ways in pregnancy, birth and postnatally. I think you are referring to the technique of ‘digital rotation’ of an OP baby (as per the article). It is a handy skill to have but doesn’t necessarily work and is invasive… although not as invasive as an instrumental birth or c-section! It can also be dangerous. I’m pleased the woman had such a great outcome after all her hard work 🙂
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 think she was just a lucky girl. I wish I had a c section as at least I would have avoided pelvic organ prolapses as they made me push OP baby for hours! Instead I’ll have a few surgeries to correct my vagina I my life!
Hi Lula,
It’s been years since you left this reply, but I wanted to let you know that c-sections also impact the pelvic floor – as so, so many people seem to forget this. I’m so sorry you’re dealing with the repercussions of coached pushing. My surgeon did very intense and real damage to my pelvic floor and tail bone. C-sections do not guarantee the absence of pelvic floor trauma. Please do not refer to people who receive unwanted c-sections as lucky.
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.
12th months ago i gave bith to my 4th child a girl i was at a birthing centre turns out she was op they couldnt get me to the hostpital for a c-section so 5 midwifes had to deliver her her, she had the cord round her neck and with every contraction her hart stopped for a few seconds only pain killer they had was gas and air,they had to cut me bad cause i had second degree tures took them two hours to stich me up it was realy bad i normally have easy births with my three boys now im 15 wks pregnant AGAIN and im scared to death bout giving birth again..ive been spotting pick brown this wk baby is fine just got to watch for it turning red they told me…i scared i might lose my baby cause of what happened last time can you shed any light on this for me plz?
Hi Sarah – I hope everthing is going OK. It is unlikely that your birth experience will be the same. I urge you to get some support to work through what happened and prepare for this birth. Have a look at this post: http://midwifethinking.com/2010/07/29/nuchal-cords/ it may help you understand cords around necks. It is unlikely that this was the cause of your baby’s distress.
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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. 🙂
So when identifying a “left/right” position, is that according to the birth attendant/baby’s point of view? In the videos, it seems to me that the occiput is pointing to the mother’s right side? Am I confused?
Ha – well spotted. I think my computer camera must ‘mirror’ the image – my wedding ring = my left. Left/right refers to mother’s which in the pics is ‘her’ right… I’ll amend the words as they will be easier than trying to sort the movie out. Thanks for pointing this out 🙂
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!
Hi, Guggie Daly!
I hope this doesn’t feel like I’m hijacking your post, but I was inspired by your story and started writing mine. It got kind of long… 🙂
My first is 10 months, now. He had an anterior placenta, as well. I was told at every prenatal in my third trimester that he was OA, but I think ROA. Don’t most babies settle in LOA?
Anyway…my membranes released one week after his due date and I experienced the first mild, sporadic cramps of my pregnancy within an hour. The first one that felt like real labor wasn’t until about 8 hours after the membrane released.
I then had prodromal labor for about 20 hours, which was stressful to me. I felt I couldn’t quite rest, and wondered why labor was “stalled”. I worried that something was wrong. “What if we end up with a C-section?! I really don’t want a C-section,” I thought over and over. Our midwife kept assuring me that everything was fine.
She explained that prodromal labor was just a variation of normal, and that she was watching me and my baby to make sure we were tolerating it well. My husband was confident in me and our baby. He was my rock. He helped me to stay calm.
Finally, labor established about 28 hours after the membranes released. I hopped in the shower for a while, and then in the birth tub. I was still a little scared that labor would stop, again, but it never did. It was such a relief to me. I loved experiencing regular labor and I welcomed the feeling of progress.
Then transition hit a few hours later. That was pretty intense. I had this deep ache in my pelvic area. I remember getting the feeling that it was our son’s head, scraping me from the inside as he squirmed through.
It seemed to last forever, but I think it was only an hour or so. I remember feeling like he was stuck and I started panicking. I kept asking why he wasn’t moving.
One of our midwife’s assistants suggested sitting and resting my back against the birth tub. She explained that it might help to tilt my pelvis. I couldn’t imagine moving OR tilting my pelvis! I also had this preconceived notion of birthing on my hands and knees or squatting, which are both positions I had been laboring in, in the tub. I said I didn’t want to move.
Our midwife suggested I give it a try and she asked my husband to hop in behind me to support me. As soon as we got settled in that position the pushing reflex took over, and I don’t remember feeling that deep, aching feeling, anymore. It was exhilarating.
I don’t remember if pushing was painful. I know it was hard work, but I think I was deep inside my body by this time. I just remember focusing on each wave, not thinking of how many had passed or how many were to come.
Pushing, as with transition, also felt like an eternity. At the same time, I remember looking up at the clock now and again between waves and being surprised how quickly the hours were passing. I think I pushed for about 2 and a half hours.
I assumed since no comment was made about his presentation, that he came out OA. However, with so much of our labor fitting the stereotypical OP labor’s description, I’m now curious about that.
I know he had a nuchal cord. I’m not sure how many times or how tightly it was wrapped. Our midwife did not announce it, but my mom told me later.
I’m sure our midwife did not want us getting stressed about it. We were already aware that this is fairly common, but I think I did have some lingering questions about what impact that could have had on my baby. I really appreciated the nuchal cord article for explaining all about it. Now I feel completely at peace with that aspect of birth.
It explains why our baby was purple just after birth. I’m so grateful for our midwife’s knowledge! I don’t think she did anything about the cord until after he was born. He was handed to me so quickly, she must have calmly unlooped the cord because I didn’t even notice her doing it.The placenta was put in a plastic bag and placed next to our baby (intact cord and all) and wrapped up with him when we got out of the tub.
It stayed there while we bonded, he nursed, and everyone else cleaned up. Then one of the assistants came in and asked if she could do his assessments. My husband cut the cord at that time.
When I first read this article, I wanted to know our son’s presentation so I could have an explanation as to why labor was so long and transition so intense. Now, I realize it kind of proves the point, either way. If he was OP when labor began, we may fit the stereotypical labor, but the important thing is he knew just how to come out (perhaps his choice of presentation was even intentional because of the way my body is designed). Everything was beautiful, no intervention necessary. If he was OA when labor began, it proves OP stereotypical labor can occur with OA babies, as well. It would also prove a labor experience really isn’t so much about presentation as it is a baby’s unique journey into the world.
Rachel, in your experience, is it common for mamas who are able to birth an OP baby to have success laboring/birthing in a supine position? what role does pelvis shape play in the ability of labor to progress is non-recommended positions, especially with an OP baby?
I am so interested in the above poster’s comment about the relief and need to push she felt once she got into the reclining position with her OP baby. i experienced something VERY similar, but it seems like that goes against all “conventional” midwife suggestion/recommendation (everything i’ve read says that flat on your back is the “doctor” way and not a natural way, any other position is preferable- especially if baby is in a “bad” position like OP and needs to be encouraged to turn).- sidenote: I LOVE LOVE your perspectives about OP, cervical dilation, etc- so refreshing!
so, my first was OP for the whole pregnancy, tried all the “gravity” positions to get her to flip from about 34 weeks and all during my pitocin induction at 42 weeks. after an epidural and about 10 hours of labor stalling (despite continuous hands and knees positions and california rolls, etc) my midwife encouraged me to lay down on my back and sleep (GENIUS!). 10 minutes later I felt the STRONG need to push (the nurses barely believed me!). i was SO confused as ALL the recommendations tell you that the supine position is one of the WORST for labor and delivery. the nurses actually told me I needed to get up off my back and keep trying to move the baby from OP but i LISTENED to my BODY and refused to move from the position that made me feel the urge to push (i can hardly believe that i had the energy to speak up for myself since I’d been laboring continually without sleep for a day and a half). my OP girl rotated to OA as she was crowning (my mom watched and said it took about 15mins for babygirl to make the full 180degree turn). my midwife was my HERO, coached me through the whole thing, helped baby over the remaining lip of my cervix and helped me to let baby turn before i pushed her out. from the time I felt the strong urge to push until she was born was about 45 mins! after all that stalling, it seemed like the supine recline was the turning point. why would that be?
ps: FWIW, i had no back labor at all with my OP baby. mom and grandmother both had OP babies as their first too, but had back labor and ended in emergency c-sections. my midwife “saved” me from a c/s for sure. 🙂 🙂
Hi Michelle
I might write a post on ‘positions’ at some point :). Ideally a woman should be birthing instinctively with no direction, taking up whatever position her body/baby prompts her to. Once a woman has an epidural the bio-feedback is interrupted and the midwife may need to suggest and encourage movement… and use ‘creating space’ skills eg. rebozzo etc. There are benefits and risks associated with any birth position. Often the key with an epidural is lots and lots of position changes, eventually you will ‘hit’ the best one for baby to move through the pelvis. The problem with flat on back is that it reduces the oxygen supply to baby as it compresses the vena cava and directed pushing and you have a big problem. Semi supine prevents the back of the pelvis from moving backwards and the coccyx from uncurling = smaller pelvic dimensions… but some women have big enough pelvises to accommodate this. There are no hard and fast rules for birth – women are unique and so are their labours.
Thanks so much for your thoughtful reply! Would love yo see a “positions” post 🙂
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..
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 🙂 And thank you to all the women for sharing your wonderful birth stories they are truely inspiring!
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! :o)
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!
I like this blog post. But I do have a small thing I’d like to bring up. You say:
“He will turn once he gets into the pelvic cavity in labour or he may be born OP.”
While this might be true for most babies, is it really true for every and all OP babies?
I agree that an OP baby often results in a labor that ends in early (and maybe unnecessary) interventions. Mostly because the labor is of a different pattern, and of course, because we fear the OP position.
But I think it’s also a bit dangerous to speak as though all babies who are OP can be born vaginally. I labored at home for 70 hours with my first, a baby boy, who was OP. I labored with no medication, and I did every technique to help him turn and get him out that you can imagine. All kinds of labor positions, running up stairs during contractions, walking around and around the black, laboring on all fours, castor oil, everything. By around 70 hour mark, I was exhausted, delirious, and the contractions were long. Nearly 4 minutes each (and I don’t mean they were four minutes apart. I mean the contractions themselves were that long).
My midwives and I went to the hospital where a doctor attempted to manually turn him (I was 8 cm), but he wouldn’t turn. We tried pitocin, and every time I got some, my son’s heart rate dropped dramatically. So, we ended up with a c-section.
I do think that more OP babies bring on interventions than is probably needed. And every woman should be allowed to try as hard as she can for as long as she can, safely, to birth her baby the way she wants. But sometimes, an OP baby cannot come out the natural way. I have been saddened and frustrated since my birth by people telling me that OP babies don’t need c-sections. Mine did. And there is nothing I have read about that I didn’t try to get him out naturally. I think we need fewer c-sections in our culture, but I also think that sometimes, they’re all that’s left.
Just my two cents.
Hi Ann – thanks for your two cents. Input is always welcome 🙂
Not all babies can be born vaginally regardless of position. I can relay similar birth stories to yours involving babies in an OA position ie. exhausting labours where the baby just won’t birth. The difference is that when the baby is OP the position is blamed. When all else fails (as in your case) c-section is the best option. I am just trying to avoid women heading into labour with an OP baby assuming that all is doomed. For example, I wouldn’t say to a woman with an OA baby “your baby will rotate through your pelvis during labour and he may even rotate to OP, or he may get stuck at some point and require a c-section” so why would I say this to a woman with an OP baby? The possibility of a c-section during birth is always there regardless of position… some babies will not move through the pelvis (for whatever reason). I have also cared for women like you who had a c-section after an OP labour for their first birth then went on to birth further OP babies vaginally. Their main challenge has been the fear that an OP = c-section because it did the first time. Once they have birthed again vaginally, they tend to not stress out with subsequent OP babies.
I find this article fascinating because I had an OP baby during my labour with her, but didn’t know until she was born. I didn’t have any symptoms of OP labour aside from the need to push before full dilation.
After baby was born, the midwife pointed out her pointy head and said it was because she was back-to-front during labour. I am grateful the midwives encouraged me to change positions and be more active during the process — I had wanted to stay in the bath but thankfully I ended up on my knees, leaning over the birthing ball, rocking back and forth! That, along with the pushing, helped turn my baby.
Excellent post. I was actually born occipito-posteriorly, and it was a difficult birth. I have a post scheduled for it tomorrow, for the “Blog it for Babies” campaign.
I’ve had two babies, both OP, this wasn’t a position discussed in ante natal classes so it was a shock to find that all the pain was in my spine and how severe that pain was. The pain was so bad I agreed to an epidural but got stuck at 9cm with my first child (for about 12 hours) and they had to c-section as there were signs of distress. Even then I didn’t realise that it might happen again. My second child was also OP. I held out until 7cm, doing all the active things but had to give into an epidural because the pain was so bad, when the epidural kicked in it felt like I’d gone to heaven the cessation of pain was so wonderful. In the end, after 24 hours labour, she was a ventouse delivery as the monitors went mad so they intervened. My labour pain was the worst I’ve ever experienced in my life (including operations), I know it makes things harder to try and get the baby to move, but if the pain gets that bad please let people know they shouldn’t feel guilty for not sticking it outand having an epidural. At the end of the day any form of safe delivery of your child is the most important thing.
I was also not ready for contractions up my spine for the next day or so after birth, is that common with OP births as well?
After pains are common after any birth. It sounds like your baby crushed some of your nerves during labour (hard back on head against spine) hence the ongoing back pains after birth. I totally agree – an epidural is the best thing invented when it is truly needed.
Hi, that was so interesting 🙂 Just a comment regarding letting women know about various positions and what may or may not be more painful: I understand that its unnecessary and might be unhelpful for women to know technical details about their baby’s position. But in my case, I feel that I would have benefitted. My story is that I have given birth once and had a series of wonderful midwives (long labour, so multiple hospital shifts). I did not know that the waters breaking at the start of my labour, or my baby’s position, or being on a hormone drip could all plausibly make the pain worse. I was disappointed that my birth was so long, painful, and ugly. But if I had have KNOWN, if someone had have told me, “You know what? Your waters broke early so that makes this more painful for you. You are on an oxytocin drip which is making your contractions more painful. And you baby is in a position that possibly makes this more painful for you” then I would have felt more pride/less shame. I don’t think knowing those things would have made me capitulate; in fact I think it might have helped my husband a bit, too, because he’s actually more worried about me giving birth again than I am. He actually thinks my birthing experience was the worst experience of his life.
I am so sorry you felt ‘shame’ about your birth experience 🙁
It seems you were not adequately informed about what was happening. Without adequate information you cannot give consent – so legally you experienced ‘assault and battery’ (http://midwifethinking.com/2010/09/15/information-giving-and-the-law/). The information you should have received is:
– Waters breaking early = labour can be more intense and the baby is less protected from contractions ie. may not be able to withstand many hours of very strong contractions.
– Baby’s position = I’m sorry but I wouldn’t tell you that the baby’s position would make labour more painful… there is no evidence to support this claim and many women find OP babies less painful than OA babies… it is very subjective and I would not be telling you what you should/will experience. However, I would tell you that this position may change the pattern of your labour and you are less likely to match the ‘hospital prescribed’ pattern.
– Oxytocin drip = see this post for the information you should have got: http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/
Out of the three factors involved in your labour, the last one (oxytocin drip) was most likely the one that caused you the excessive pain. The contractions you have with this drip are awful. Personally I would be asking for an epidural before anyone started an oxytocin drip on me… although there’d have to be a very good reason for me to agree to have one – but I am lucky to have all the information that is often with held from women.
Your next birth will be different and you may be surprised at how much ‘easier’ it is if you avoid the drip.
Thanks for this blog. My water started trickling on a Friday as you describe in another post. I was told when I went to the hospital that it was not amniotic fluid (but most probably was, IMO). Contractions never picked up a predictable pattern–would keep missing criteria for hospital admission. Sunday morning about 2 AM contractions became painful but still did not meet criteria. I became worried at this point that water seemed to be trickling, but was told it wasn’t AF, and that contractions were painful but not following a pattern. Called Dr. and went to the hospital on Sunday around 9AM. Dr. decided to do AROM since at this point it had been more than 24 hours in his opinion since water broke. I was definitely not informed of advantages and disadvantages of this and was told that he didn’t hear an objection so was doing it. Contractions still didn’t progress at 1 PM and was still in pain. I was not allowed to eat and they did continuous fetal monitoring so I could not move around. I asked to take a shower to help relieve the pain and relax but found this impossible with an IV in my hand. At this point, I asked to go home but was told they wouldn’t advise it. This is when things definitely got worse as I could not naturally do anything to relieve my pain and felt starving and could not eat. The doctor then realized the baby was OP and hadn’t progressed so started pitocin and an epidural since I was hysterically crying from the hunger and pain. I felt there were no other options at this point. Baby was born about 10 PM with only about 20 minutes of pushing. I sustained a 2nd degree tear and received stitches. I also had a fissure and was in excruciating pain with every bowel movement for about 2 months. Fast forward a year, and I just realized that i have a cystocele. I suspect that I had this after birth since I never felt that things felt normal since delivery. I finally decided to research the healing process and what could possibly be wrong since it had almost been a year. At my 6 week follow up, my OB told me I was healing well and did not see this. I’m just curious to get your opinion on all of this and am wondering how you would have handled a situation of water trickling for a few days and if this would have been viewed as normal or a problem in your eyes. Perhaps my body was pushed too quickly to have the baby and was not ready yet?
I can’t say what I would have thought or have done without being ‘in the situation’. I can comment on some of the points you raise in your post…
– It sounds like you had a hind water leak ie. amniotic fluid was escaping from a hole behind the baby’s head and the fore waters were intact… otherwise the Dr could not have done an ARM on the fore waters.
– Once the intervention began ie. the ARM the ‘institution’ took over management of your birth. You can’t start intervening then stop – this is not safe. So, I am a little confused about why they then sent you home. They had broken your waters and put fingers and an amni hook into your vagina (infection risk). You should have been informed that if the ARM did not initiate labour there would be a recommendation for further intervention ie. syntocinon drip.
– If you do not have adequate nutrition prior to and during early labour your body will not labour effectively. I can’t believe that in this day and age with the evidence available that women are still being starved during labour.
– The cystocele most likely had nothing to do with the interventions in your labour. Many woman experience pelvic floor issues following pregnancy and birth – even with gentle births. You can heal and improve your pelvic floor with good nutrition and exercise.
– The ‘trickling’ water for a few days on it’s own is not a problem. If other things were happening – feeling unwell, high temp, concerns about baby, meconium or blood in the fluid – then it could become a complication. I wouldn’t ‘handle’ the situation – it would be up to the woman to weigh up the information according to her individual situation, feelings and wishes and decide what she wanted to do do. Wait or have her labour augmented: http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/
However, once you start interfering you must to continue to monitor and interfere because you have opted out of a physiological approach and into a medical one.
Not sure if I answered your question/s 🙂
Thank you so much for your reply. I am very grateful to have your opinion on my delivery. I very much wanted a natural delivery but as you said the “institution took over” and I completely agree. Like many other mothers, when told your baby is in danger, you undergo procedures you wouldn’t ordinarily have. In my case, I was told the policy for my doctor was 24 hours after the water broke, the baby must be born due to an infection risk. I guess I called my doctor on Sunday morning because I felt my contractions were not following a pattern and was concerned with the fluid trickling and didn’t know what it was. Had I known that it was the hind water leak and the risk of infection was virtually non existent and that the stalled labor was ok, I may not have called him. It was my first baby and labor so I had no means to compare, despite my child birthing class and other research with books and DVDs. It was actually very hard to find information about the hind water leaks online at this point. When I was in labor, of course I had no choice to listen to my doctor and didn’t have other resources. If I had to do it over, I probably would have remained home as long as possible and relaxed as much as I could have and nourished myself and got into comfortable positions to deal with the labor pains. I did want to make sure the baby was ok though. There were no concerns otherwise.
The hospital did not really allow me to leave in the middle of my labor after the AROM but this was my request and shows where I was emotionally at this point. They did eventually supplement with Pitocicin. I did not feel comfortable with the interventions given but was scared of infection otherwise.
I also can not believe that women are being starved while basically running a marathon. My OB said that many women go into labor not wanting an epidural but wind up with one. After giving birth, I asked him what other option they have when they are starved, asked to run a marathon and strapped to a bed or chair. He didn’t have a good response.
Hi, I found that a really interesting read, thank you.
My son was delivered in the OP position, but was in the OA position at the start of labour, so nobody realised. I did suffer with back contractions but that wasn’t until 33hours into labour (43 in total) and at that point I believe my baby was still OA.
During second stage labour my baby became lodged in an awkward space, a consultant was called and upon examination, I was set up ready for a forceps delivery, still at this point my baby was still thought of as being OA and I was told he was going to be a baldy. I somehow managed to avoid the use of the forceps and pushed him out myself, with just the help of an episiotomy.
My midwife was shocked to discover that he was OP on delivery with the cord wrapped twice around his neck. He also had a full head of hair!!! My midwife and i came to the conclusion that when I was examined and told he was a baldy..it was his forehead the consultant feeling, as he was in the OP position at the point.
That was my first experience of labour and although I don’t have anything to compare it to, I do believe I did not suffer any more than a woman delivering a OA baby. To add to it all my son was a very healthy 4.22kg/9lbs 5oz and I am a size 8 frame. However if I am ever lucky enough to do it all again, and deliver a OA baby, I may just change my mind.
Just to add the hardest and most unpleasant part of my experience was the sheer exhaustion, I did not sleep a wink or manage a mouthful of food without vomiting for the full 43 hours. During labour my body went into overdrive and I “dealt” with it, but after the adrenalin had worn off I was on a different planet, still unable to sleep, having to cope with a new baby and the hormone let down was horrendous. It lasted a week, and for me that week was worse than child birth itself. But this is something I am guessing most mothers go through.
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I just wanted to add that there are at times true medical reasons why a baby is born OP. My son was born OP simply because he absolutely, positively could not turn. He was born with an extremely short umbilical cord, so short in fact, that it had to be cut to get him all the way out. The labor was excruciating and so I asked for help. It was int he hospital all all the positions that felt good to me were denied by them. In the end, I asked for the ventouse (vacuum.) I think though, my pain was increases, not just from him being OP, but the stress of my life at the time and not being allowed to work with my body and my baby.
Hi i had a op back to back birth with my 4th baby now I’m having my 5th baby I’m 38 weeks pregnant and this one is lying across the top back under my ribs and feet down two nights ago I had very bad back pains like back labour since then my belly button as gone really sore I can’t stand anything touching it and it’s red just above it my baby is very active but never lies in the right position and im not big with this pregnancy so why does my belly button hurt so much? Thanks for reading 🙂
Sarah you need to mention this to your midwife of care provider. I’m not sure what is going on without seeing you. It sounds like your baby is transverse and if your belly button is red and sore it may be infected.
Ok thanks Ive got a scan today so I will tell them I got told it could be cause my placenta is lying at the front of my womb witch puts u at higher risk if u need to have a c section is his true
Hi, my mother had 2x OP babies delivered by Keilan’s forceps (not sure of the spelling – high rotational) and the 3rd by elective ceasarean. She was told the shape of her pelvis was not conducive to natural childbrith. I had a deflexed OP baby first time and the consultant had a long battle in theatre before delivering her with ventouse. She was shocked initially and didn’t breathe for 8 minutes. I am now pregnant again and wondering whether a) the shape of my pelvis and b) a degree of CPD as I’m small, baby likely to be around 9lb, means that I am likely to have a battle again. My parents are medical and think I should opt for an elective ceasarean – anyone have any thoughts?
Hi Elisa
You birthed a baby through your pelvis and vagina. There is nothing wrong with the size of your pelvis 🙂
You may have a pelvis that is shaped in a way that required the baby to move through it in an OP position. Therefore, you may require care givers with patience and acceptance that your labour pattern may not fit the prescribed one. An elective c-section is not indicated given your history. Even if a future birth ends in a c-section (which I doubt very much) it is better to have laboured for both you and baby.
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Thank you for this. My daughter was OP, first baby, home birth planned with a pool in the living room. I had no expectations so never considered the “back-to-back labours are worse” stories. My waters partly went (fore waters – never really got an explanation of what that was at the time, I understand now) on the Sunday afternoon, labour/contractions didn’t start until the Monday evening around 5.30pm, 10-15minutes apart, a lot of discomfort around my lower back, like a band. 2 hours later they were less than 5minutes apart and that’s how they stayed all night (I spent most of the night in the pool) until the early hours when they were less than 3minutes apart lasting around a minute. Had a couple more hours of that before I needed to push. All through it I was very inward focussed (had learnt some self-hypnosis and breathing techniques in pregnancy), I didn’t want to be touched, just wanted to know my husband and the midwife were there and were letting me get on with it. Absolutely hated the couple of times I had to get out of the pool, go upstairs, and have an internal examination.
Had the urge to push around 6am, didn’t know whether I was supposed to or not and had to ask the midwife because of earlier comments during an examination about how dilated I was (I was never told that you’ve got no choice in the matter of pushing once you’re body’s in charge!). By time 2hours of pushing had rolled by I was exhausted. I didn’t know what to do any more, the midwives (there were two by then) tried me on my hands and knees but I don’t really remember much in the way of other suggestions. I could feel my daughters head move right down with every push but she wouldn’t stay and after each contraction she went back up, I was more and more tired and more and more disheartened. I started losing focus and felt like I was losing control. I made a comment on how tired I was and how I couldn’t do it and after they’d listened to my daughters heartbeat they decided the best thing would be a transfer to hospital. 45minutes in the ambulance lying on my side and I’d lost all sense of control, I needed gas and air for the journey and just breathed it constantly rather than with each contraction (they were rolling one to another by that point anyway), my husband had to follow the ambulance in the car, I just wanted him there. I was doing a pretty good impression on a cow in heat for much of the journey with the bellowing noise I was making!
By time I got to the delivery room I was anxious, pretty out of it from the G&A, and just wanted it over so did the “I don’t care any more, cut me open and get the baby out” routine. I had a vontouse assisted delivery (my husband *just* made it into the room in time – he got stuck behind a tractor on one of the rural lanes!) and afterwards, based on the marks on her head it was clear to see my daughter had almost completely turned around from her OP position. For a long time I felt I failed, and like in your article I was convinced it was my fault due to spending so much time in the car (had an hour and a half commute to and from work through most of my pregnancy). Plus, after my daughter arrived I was exhausted and still pretty ‘stoned’ from the G&A and not that interested and I don’t feel I ever really ‘bonded’ with her when she was a baby (even with the breastfeeding which has only just stopped now she’s nearly 4 years old). I had PND in the end (various reasons behind it) and it’s been a long journey.
We’re now planning on trying for our second but I already feel more educated and better informed – and developing a slight obsession with birth and the birth process!
I have to correct myself – it was hind water that went not fore. I remember seeing the midwife on the Monday morning and her saying that if labour hadn’t started within the next 24 hours that she’d have to send me for induction. Even with feeling like I did, I was still relieved that labour started by itself as I really didn’t want to be induced.
My second daughter was OP, born facing up, I didn’t know she was OP (her head was engaged posterior, but her spine was rotated so it kind of faced outwards) but the labour was very different and much much harder with her than my first OA daughter. With my first the pain was much more manageable, active labour was shorter, pushing felt great (like the pain of pushing your body to the limit running a race, rather than with my second, which felt like the pain of tearing your bones apart), I pushed for 10 mins with my first, 45 with my second (which was still pretty quick I guess esp. as she never turned). The prospect of birthing another posterior baby terrifies me (I am 21 weeks pregnant with my 3rd). Having said all that though, both my babies were completely natural births, my first in a birthing centre and my second at home, with loving family around and a wonderful experienced midwife, so I can’t really complain, and I know that even if I do end up with another posterior babe my body can birth her. I do have a lot of fear about it happening again though, and I am not sure how to work through that (apart from spending my entire third trimester crawling around the floor on my hands and knees).
I’m not sure you need to work through your fears… They are perfectly normal following your experience. You are an amazing woman to have birthed an OP baby!
I have looked at your creating space checklist & thought it would be a good reference in the future. My only problem is that I don’t know what some of the postitions are. Would you possibly have images of these different postions?
Hi Tisha
The resource was designed to be used in workshop sessions… where everyone gets a chance to learn and ‘feel’ each skill/manoeuvre. I am planning on creating a visual or video based version in the future – so watch this space. I just have to finish writing a thesis first! 🙂
I just wanted to say thank you for writing this post. I ended up with a cesarean birth because my daughter was OP. Lots of contractions with little progress. I had hoped for a home birth with my midwife but after a day and a half of labor my midwife could not find my cervix…she said because it was so posterior and I was still in early labor. (Is it common to not be able to find the cervix with so many contractions?) I was worried what active labor might be since these contractions were intense and I was starting to bear down with each contraction. I had also been throwing up a TON and was exhausted. However…I feel like if I had had some encouragement I might have stayed home and been able to birth naturally. As it was, I transferred to the hospital, got an epidural and after several hours of pushing baby wasn’t happy and we went in for the surgery. This post has cleared so much up for me in my quest to process my experience…especially the part about having an early urge to push. I think this is what got me worried while I was in labor since there is the idea out there that its bad to push before being complete (although I don’t believe that now). It really got in my head. Thank you, thank you, thank you!
I’m pleased the post helped you explore your birth experience further 🙂
Hi,
This is a fascinating page. As the “founder” of Optimal Foetal Positioning” I am constantly dismayed at the way it is mis-interpreted. From baby;s point of view, his/her journey is in most cases much easier when in the OA OL position. The contraction pressure is down his back, and he is able to tuck his head out of the way. An OP baby has the pressure through his spine, neck and lower skull—Professor Green has good drawings in an Introduction to obstetrics–a New Zealand nursing textbook. I think that it is important to know a foetal position, as there are so many ways to make the labour more manageable for mother and baby. It is always sad when birth becomes an endurance test. There are no medals for birth heroics,
A baby in the OP position has his shoulder on the “wrong” side of mother’s sacral prominence, and this makes moving down and round much slower. Activity should always be in response to specific pressure—just moving is a waste of time.
My first baby took from Thursday 11am when he ruptured his membranes,to Monday 4.30 to get himself born, as I’ve a platypelloid pelvis and he couldn’t get in. Once in, he fell out while I’d fallen into an exhausted sleep. (1957) Things were different then .I think there is a real need for some way of “debriefing” mothers after a traumatic birth, as so many carry rhe mental and emotional scars for years.
Optimal Foetal Positioning is not always the best, but knowing where her baby is and how to help him allows plan A and B to be ready so that there is no sense of failure if the “system” takes over.
I have also found partners are much more comfortable helping when they know what is going on.
Best wishes Jean Sutton
Thank you for your comments and insight Jean. They are much appreciated. I attended one of your workshops many years ago as a student midwife and still have a signed copy of your book 🙂
This is probably off topic, but is it considered a natural birth if the membranes are stripped of if the membranes are stripped AND the water is broken? All three of mine came early with these methods and I have always considered them natural. I just want to make sure!
Thanks!
Laura H… in Japan…
‘or if’ not ‘of if’…
You define your own birth experience – your perception is the only important one 🙂
I consider stripping the membranes to be an intervention. A physiological birth occurs without any intervention. I don’t usually use the term ‘natural’ because it is difficult to define and sometimes nature is pathological. As long as you are happy with your birth and made informed decisions it doesn’t really matter what other people think or say.
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I just want to witness that I homebirthed my 3rd child which was over 13lbs. I have 8 children all together and blessed to have a wonderful and very competent midwife.
Thanks for this
Thank you. I love this!
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Great post, thanks!
Thank you so much for your posts – particularly the 2010 Krista! It has taken me 3 yrs to build courage to read my notes from my first birth (too easily shaken when I think of the experience!) as the only thing I recall afterwards is being verbally told was baby was OP, and I went to 9 cms very quickly. I’ve always felt I didn’t handle the ‘normal’ birth process well, and being rural, required a helicopter called for tx to closest hospital. Fortunately I gave birth as they were trying to transfer me (I was in no mood to be moved!) and avoided what I am told was to be a C section on arrival. I now read my notes and see I had an Anterior Lip and this was probably not helping through-out the drama (?!) Now preg with #2 I hope this goes as well as most others #2 have! The posts have made me feel better, rather than teary everytime I think of the 1st experience. In your experience, is the likely hood of another A/L or OP high? I feel more confident now seeing OP can be delivered semi-comfortably – ideally without the A/L. I’m still wanting a drugfree birth if possible – but the 1st time round I would have taken anything handed to me! Thanks for your blog – I wish they covered these things in more detail at ante-natal classes, instead of filling young mums heads with crazy new trends and fads. I felt this was all very hush hush before and after #1.
I commented previously about my first birth being OP and a not-so-great experience. Well, my second was OP as well, just over a month ago, even though I used various methods to avoid it. Daughter number two didn’t present as OP until she started to engage at 37weeks so I’m going to make the assumption now that it’s due the to shape of my pelvis. My second labour and birth were completely different to my first. With my first, once contractions started they were close together, regular and intense throughout. With my second, my contractions never really developed a regular pattern, were fairly widely spaced and because of that didn’t feel so intense. In both cases I had back pain but my second labour was much more manageable, and actually enjoyable.
Both times I planned a homebirth – with my first after a couple of hours pushing I was too exhausted and had a transfer for a ventouse delivery at hospital, all of which was fairly unpleasant and mildly traumatic. With my second, after an hour or so of pushing I felt great, still full of energy (though it was hard work), smiling between contractions and chatting with my husband and midwife – however I decided to request a transfer just in case I did need assistance as I didn’t want to reach the point of exhaustion again and wanted to feel like I still had choice and control. The ambulance for the transfer arrived, I got out of my birth pool, and as I went to get into the ambulance realised the back pain had stopped. My daughter had turned and I gave birth to her naturally just as we pulled up in the hospital bay! My first daughter was a long and exhausting 17hours of ‘active labour’, she was a ventouse-assisted delivery and weighed 8lb 1oz. My second daughter was a 4.5hour ‘active labour’, I gave birth without assistance, and she was 9lb 8oz; a surprise for my midwife as I was measuring on the 50th percentile all through my pregnancy – even though I kept saying my baby would be a lot bigger than they were estimating and said I’d be heading towards a 10pounder (I could feel how big she was inside me).
My second OP labour and birth was manageable, positive and empowering – all those key words that get thrown around 😉 And I’m glad – glad that I had the labour and birthing experience I did because heartbreakingly my second daughter was stillborn (no reason why, no signs of distress, no issues with the cord etc she passed at some point in the last half hour before she was born) and having had the labour and birth go so well, I find her loss easier to deal with.
Thank you for returning and telling us your second birth story. I am sorry that you lost your daughter 🙁
Just reading this post now, three years after you originally wrote it. Interestingly enough, I delivered a brow presentation posterior baby at home almost exactly a month after you posted this. He’s almost three now.
I never knew he was posterior through my labour. The midwife doing most of the examining was a student, and didn’t pick up on it either. He was baby #5 for me, and he was the easiest labour ever. I was at home in my own bath, breathing through the contractions, and joking with the midwives in between. I couldn’t believe that I was already 10cm when I was checked and given the OK to push. (at my request) The only time we had an indication that something wasn’t right was when I started to push and nothing happened. I pushed for about an hour, changing positions, trying this and that, and nothing changed, until finally the supervising midwife said we’d better transfer to hospital. That made me mad enough to give a final HEAVE and he made it around the pelvic bone and out. No tearing, lots of bruising for him and me, but all in all, a fine delivery.
Just thought I’d share my story and support your position that an OP baby doesn’t have to be bad at all, or mean terribly hard labour. Every woman is going to be different.
Thanks for your writing also – I love reading your posts!
My 3rd baby was a homebirth persistent OP position, 10 pounds 11 oz. Left me feeling traumatised for some time after. However I did opt for a homebirth with my 4th baby, had a lovely quick straightforward birth. I have since done my midwifery training and have been able to reflect upon this in a more positive light and realise that with the support of two fantastic midwives I was empowered not to go into hospital for an epidural during the transition stage. A a result I am fairly certain that I avoided the cascade of intervention that I so often see with O P babies in the hospital setting. Feel very proud now, and more grateful than ever to those midwives who trusted in my ability to birth my baby.
My third baby was OP and was born face up. For me it was the easiest of births, she was born within ten minutes of me having the urge to push without any assistance and only minor grazing. I had a lovely midwife who, never for a minute, gave me the impression that I wouldn’t be able to birth this baby when the consultant wanted me to have ELCS rather than VBAC as second had been a footling breech.
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God I love this. I talk about this all of the time when I teach doula training and prenatal classes. I use your blog as a resource a LOT and am stocked to have found this post! I hadn’t seen it before!
Reblogged this on doula huna – mind body soul and commented:
To be perfectly honest, I was pretty smug about my son’s position throughout pregnancy. From pretty early on, he had been laying LOA (Left Occiput Anterior). We had been working together, I had spoken with him and visualised the optimal position and I had spent plenty time on my hands and knees.
40 weeks arrived and right on cue, he flipped OP! Immediately I was doing everything I knew of to help him move back to LOA. 40weeks and 3 days and my labour started with an OP baby. I instinctively started to do many of the things listed in this amazing blog post, In Celebration of the OP Baby. I had the urge, um, correction, involuntary pushing and was told I was going to hurt my baby and myself if I continued. It was literally out of my control and while I was pushing I was screaming that I was not in control. Eventually, I was told to go onto all fours and put my bum in air. This certainly helped with my “urge” to push as pressure was taken off my cervix but it was also the very first time in my beautiful labour that I started to doubt my body and myself.
If something I was doing completely naturally and instinctively was harming my baby, then could I be trusted? Did my body really know what was going on and what to do? I felt disempowered and that wasn’t necessary.
Reading this post was like a breath of fresh air and a huge sigh of relief – my body HAD known exactly what to do AND I was doing a beautiful job. It is my hope that everyone working with labouring women read this post- a woman’s bodymind really does know what it is doing, even if our understanding of it is slow to catch up (or specific knowledge is isolated to a medical event as opposed to a natural physiological event).
All in all, I had an amazing labour and gentle water birth. If there is a next time, I hope to remember this blog post and take solace in that my bodymind knows exactly what it is doing. I certainly draw on this very personal experience when I support a birthing goddesses in my practice.
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I wish I had read this a long time ago. I went into labor with my daughter in OP and she remained that way throughout, and my labor fit your description well – water broke early (small tear, apparently, since it seemed to re-seal), which started the clock, so we tried everything to get labor started, including castor oil, which sent me into 7 hours of extremely painful 1.5 minute long, 1 minute apart contractions, for lasted for 7 hours then stopped. Tried castor oil again the next day with same result. Finally, my midwife broke my water again and contractions started for real but never fell into a regular pattern, just excruciatingly painful, with vomiting at every contraction, for another 36 hours. All that and still 4cm. So: Transfer. Pitocon. Epidural. Finally made it to 8cm after 64 hours, but my beautiful OP baby was tiring, and I was now suffering badly. I was completely delirious, unable to focus my vision, and convulsing so badly with the vomiting that they had to sedate me to do the c-section. The sedation was, truly, a blessing; the suffering stopped and I was able to be present to see my beautiful baby born. I just want to add that my complete faith (ala Ina May et al.) that I would birth my baby naturally caused me a tremendous amount of suffering afterward – it literally never crossed my mind that I wouldn’t have a natural birth, and a c-section was a complete impossibility. Had I recognized that the birth was ultimately not in my control, that my excellent diet, my yoga, my 3-mile daily walks and 100% commitment didn’t “guarantee” a natural birth, it would have made acceptance of what happened a lot easier to handle. That said, I’m grateful for the humility and compassion I gained through my experience. And, of course, my lovely daughter.
To clarify: we waited 24 hours after my water broke to try castor oil (after also trying acupuncture), and labor lasted 64 hours total from first contraction to c-section. Never did enter “active” labor, in so far as contractions were never regularly spaced.
Unfortunately when you try to get the body to do something it is not ready to do, regardless of whether you use medication, herbs or ‘natural’ remedies the result is often a cascade of intervention. No amount of preparation safe-guards against this. Thank you for sharing your story. Birth is about growth… and I am pleased that you experienced personal growth.
My child was an OP. I entered labor fully expecting to walk into the hospital, give birth, and wander back out completely unscathed with my newborn in tow. This didn’t happen. After many hours of hard labor and no dialation, it ended in a C-Section. Articles like this frustrate me, because the subtle implication is that the surgery could have been avoided, and that a mother that ends up with a C-Section did so willingly and/or gave up too soon. Would I choose to have another C-Section? Absolutely not, unless there was no other option. It was the most physically painful experience of my life – recovery was no picnic. Do I think women should be able to schedule a C-Section simply due to convenience? No. But I do, given my own experience, believe that there are certainly situations that make it necessary.
I am sorry that this post touched a nerve for you. The aim of the post is to provide information so that women do not assume that an OP position will result in intervention and/or c-section. As you can see from the comments many women experience positive OP labours.
C-sections are necessary in some situations regardless of the position of the baby. A woman with an OA baby may end up with a c-section in the scenario you experienced. My point is that it is not necessarily the position of the baby. For example the fact that a baby does not turn during labour may be a symptom of something else going on… rather than the cause.
I am not against c-section – this intervention is necessary and saves lives. If you read my post on Judging Birth http://midwifethinking.com/2011/04/09/judging-birth/ you will see that I do not wish to make women feel guilty for how their labour unfolds or the choices they make.
Fair enough, but the risk of infection from a ruptured sac is real, and I was already into my third week post-term. That said, if I could do it all over again, I would have chosen pitocin over castor oil to induce labor, and would still have chosen the risks associated with induced labor over the very risk of infection from waiting with a ruptured sac (I was also Strep B positive). But yes, if my sac hadn’t ruptured and I hadn’t been Strep B positive, I would have let labor start on its own.
You had a number of issues going on and your actions are totally understandable.
The point I was trying to make was that regardless of preparation, birth takes all kinds of unexpected pathways and women often find themselves making decisions and heading down paths they did not anticipate. This is part of the birth process.
Like so many, love your blog. I do appreciate how this post empowers women to believe that OP birth works too! I do question a couple of things: 1: Mechanisms of labor: In my home and birth center practice, I always trust the LOTs entering labor more than the ROTs. They seem to rotate simply OA and make life straightforward for all, while in my experience ROTs often do the long arc and may give their mums a rough time in the process. You implied that ROTs tend to short arc and my experience is…. only sometimes. 2: While I know that the research states that postions, rebozos etc are not proven to be very effective at rotating, I find that a variety of things can work pretty well a lot (but not all) of the time and I am suspicious of that research. Do you think it’s really any good? Looking forward to reading your response.
Thanks for your questions… I’ll do my best to a answer them:
1. I don’t believe in ‘mechanisms of labour’ – textbook ideas about what happens in birth were written by men who considered the body as a machine (hence mechanism) and studied women birthing in unnatural positions and environments. In my experience most babies descend and rotate through the pelvis but do this in many ways depending on a range of factors (mother’s position, mother’s anatomy, where the placenta is, etc.). I haven’t noticed a difference between LOT and ROT and have seen many LOT babies do the long rotation. I’d also be reluctant about pathologising ROA or ROT positions like OP has been in the minds of women.
2. Research is biased and limited in what it measures. As you can see from the post I do use a number of techniques that can provide an environment of a baby to rotate, shift, whatever, and teach I these at workshop (see the link to a checklist). However, I am reluctant to use them unless the woman requests and I really do feel that the baby needs to shift soon. These techniques are interventions and must be used cautiously. Particularly at a homebirth where you are limited re. managing any complication you create via an intervention. I have observed some success with using rebozzo etc with ‘apparently’ assisting rotation… however, I will never know if the baby would have turned anyway. I have had more convincing success with rebozzo to get the baby out of the pelvis (to come back in aligned) in cases of asynclitism – with almost immediate effect and quick birth following the intervention. However, some women like you to try ‘everything’ when their baby is OP and their labour is long – and I’m happy to do this regardless of whether it ‘really’ works or not. 🙂
Thanks for your reply…. Of course trust and patience work because babies generally have reasons for what they do and figure things out pretty well.
Hi Rachel
I just wanted to say thank you for sharing all your thoughts and experience in your blogs. I stumbled across your website recently after giving birth for the second time, just wanting to come to terms with giving birth again – not that either birth was particularly traumatic, but it is such an emotional and life-changing event that it takes a while to process!
My first son was an OP presentation and I did spend many weeks afterwards feeling that it must have been my fault somehow, and perhaps if I had done things differently during the last weeks of my pregnancy then I could have saved us both the interventions and upset during the birth (the doctor decided to manually rotate him as there was evidence of foetal distress, and then help him out with forceps, leaving me with a third degree tear). So it is enlightening and liberating to think that OP presentation is just another type of ‘normal’ and perfectly natural despite most people referring to it is as the ‘wrong way round’!
My second son was not OP but was such a quick labour that it completely threw me off balance and made me panic because it was so different to my first labour. So reading your blog about acknowledging and accepting fear as part of the birthing process was also a revelation and helped me better understand my experience.
Overall I have found your attitude towards labour and birthing mothers a revelation and so different to the attitudes I encountered during my antenatal classes. You have inspired me to want a different kind of birth experience if I ever have another child – although with a 2 year old and a two week old, this is quite a big IF!
Thank you 🙂
Thank you for this post! I didn’t realize that I was harbouring some feelings of responsibility for my OP deliveries, and reframing it as optimal positioning for a mother’s unique body makes me feel so much better.
For my first delivery, we didn’t know he was OP before labour began (on its own, without water breaking, 10 days early). Like others, it was long, erratic and difficult at points. My main issue was that it wasn’t really progressing or regulating. After almost 24 hours I went for an epidural as I was getting exhausted and frustrated, and knew that we’d be trying some pitocin to regulate things. While it helped intensify the contractions, they were still very irregular. After 12 hours of pitocin the on call OB was also involved (I was under the care of a midwife) and he told me to start pushing to see if I could get him to descend (he was still pretty high up at 36 hours – around -2 if I remember correctly). He gave me a half hour deadline, otherwise we’d be headed toward c-section (what pressure, right??). The pushing worked and got the baby to descend more, so he gave the green light to continue. Three hours later, my first son was born – face up, as he never rotated. Ultimately I was satisfied with the birth, and having it result in a vaginal delivery felt like a pretty big triumph given the circumstances.
For my second labour, I had mild contractions which eventually led to my hind water breaking. Although not in active labour, we headed to the hospital a couple of hours later to receive IV antibiotics as I was GBS+. Active labour started shortly thereafter, lasted two hours and was extraordinarily intense (very quick dilation). I pushed for 20 minutes and he shocked us all by being born face up like his brother! We had no idea that it was another OP birth as everything progressed so differently, and so quickly. This one was intervention-free. I will admit that the descent/crowning was absolutely excruciating – I figured it was just because – well, it’s renowned to be painful. However, my midwife assured me that the combination of the back of the head grinding against the sensitive rectal nerves and the wider surface area passing through could have indeed been more painful than an average birth. Regardless, it was over quickly and we did get a kick out of his surprise face-up greeting to the world.
Interestingly enough, when I got an IUD placed between pregnancies, the doctor asked me apropos of nothing if I had had an OP delivery. I said that I had, and she guessed that was the case due to the positioning of my pelvis and said that I had a higher likelihood of subsequent OP births. She was right, but I was relieved to find out that it didn’t mean that I would have another intervention-heavy, super long and difficult second delivery.
Thanks for sharing your experience… your babies were in the perfect position for your pelvis 🙂
This is very dangerous… Yes women have been giving birth successfully for thousands of years but women have also been dying in labor for thousands of years. I’m very happy for those who are able to have thier child without any comlicatiobs but ignoring the potential for them is irresponsible. I was sold the very picturesque version of labor. My pregnancy was normal and I was booked in to the birthing center. I dreamed of using the pool instead of an epidural for pain. My midwife failed to notice that my baby was in OP and I laboured through 48 hours of labor feeling like I was being stabbed in the back with a hot knife before syntosin and an epidural were suggested. Another 10 hours and I was finally dilated & pushing but she got stuck in the canal and they had to use forceps. Even with the episiotomy I had a third degree tear and lost 3 litres of blood! And spent 5 days in the hospital recovering and then had to go back a week after with a fever. I was relatively lucky (there were still some pretty serious repercussions afterward) but it could have been worse. Medical intervention is necessary sometimes and telling pregnant women otherwise is horribly misleading and dangerous!
Intervention is necessary in some cases – not sure where I’ve suggested that it is not. It is a shame that your midwife did not pick up on your baby’s position, and considering the length of time you were in labour used some techniques to assist baby to rotate. This may have helped you avoid the epidural, syntocinon, episiotomy and forceps. Unfortunately an epidural reduces the chance the baby will rotate as it reduces the tone in the pelvic floor.
You might find this post interesting: http://midwifethinking.com/2011/04/09/judging-birth/
I have enjoyed reading this article and all the posts. I wanted a 100 percent natural labour /water birth and had done a lot of reading before hand so thought I was pretty well prepared. My mother had three 12 hour labours with big babies so I had this time frame in mind even though my sister had a 32 hour drug free OP birth with bad tearing. My plug came out 6am on the monday, my waters broke 10pm on tues night and 10pm wed night (3 days before due date) contractions started. They were every 15 mins, sometimes every 5 mins and by 7am I called the midwife as they were 3 mins apart. I was coping well but was looking forward to getting in the water bath. My midwife examined me and I wasn’t even 1cm. I felt like there was something wrong with me so when my midwife and the duty obst suggested gel to speed things up I agreed as I thought there was something wrong with my body. Prior to that I had utmost trust in my body’s ability and wasn’t worried about the labour. By 3pm the contractions were continuous. The pain was intense and I felt I must be at transition. But I was only 1cm. So when they suggested an epidural as it might relax my pelvis and help dialation I didn’t need much persuading. Even though I knew an epidural was a downward slippery slope to a c sec. Still no more dialation so next was the oxytocin. Despite the epidural the pain was still intense after the initial 10 – 20 mins of initial relief. I normally find I have quite a high pain threshold. But this was bad. Almost 30 hours since my first contractions and I was almost10cm. This was the first time I was made aware that the baby was OP. The midwife tried moving her but she would just turn back. Her body was still anterior as it had been the whole time it was just her head. I was allowed to push for probably an hour but nothing was happening and she was stuck on my anterior lip. By that stage the epidural had almost worn off and they had to see the obst to prescribe more. The pain was intense. The obst finally arrived, examined me and said c sec. A c sec had been my worst nightmare but I couldn’t sign the forms quickly enough. She was so lodged in my pelvis the midwife thought she would have to be resuscitated with all the yanking. But she was a 9 out of 10 apgar. I bled and had to have a transfusion. I am pregnant with my second and will try for a vbac. I wish I had known early on she was posterior as I would have known there was nothing wrong with me and just to be patient. My aunty on my dad’s side – her first labour was 40 hours. Had I known all this my birth outcome might have been quite different. But I remind myself that I had the perfect pregnancy and a perfectly healthy and happy baby so this shouldn’t worry me. But it has been good to read this info to get a better understanding.
“But I remind myself that I had the perfect pregnancy and a perfectly healthy and happy baby so this shouldn’t worry me.” – this makes me really sad. It is OK to be happy that you have a perfect pregnancy and healthy baby but be not OK with the way your birth experience was taken from you. Allow yourself to feel angry, sad, let down… whatever. Use your experience to grow and prepare for your next birth when you may have a perfect pregnancy, a healthy baby and an empowering birth experience.
I can confirm from experience, this article is very true and although I instinctively knew it during my first labor, I didn’t have the knowledge or confidence to argue with the delivery team, when it was happening to me. I was ~2 weeks overdue (tick), my waters broke spontaneously 7am (tick), contractions followed slow and irregular (tick), baby was brow posterior and he was 9lb3oz, which according to this article, everything was proceeding how it was supposed to in this situation (tick). But THEN 11am, they insisted I must have the drip …. massive contractions/pain that never broke, just one very loooooong contraction (about 3 hours) that had me wanting to die and baby displaying major distress. THEN, a high forceps delivery was considered necessary, so an epidural was arranged. Another hour of torture because the anaethetist on call was mowing his lawns. Finally after a whole lot of brut force, metal, haemorrhaging and an episiotomy from cervix to rectum, my beautiful son was born, right on kick off for the 1988 grand final at 3pm. Hm, I wonder if there was a deadline everyone was working to that day? I strongly believed then as I do now, laboring naturally for 2 days if necessary, would have been much more preferable to what I can only describe as the horrific intervention that took place that day and I only wish I’d had the confidence in my own instincts to have said NO.
It is virtually impossible to say when you are in the middle of labour and those in power are pushing for their agenda. Thanks for sharing your experience.
My first child was born facing sideways. This wasn’t realised until after I managed to birth him after 2 hours of pushing.By which point I was in a haze and really dont remember those 2 hours. Is it common for babies to be unable to rotate and get stuck half way round? (drugfree natural birth).
In complete contrast by second child was born super fast with one push and the midwifes literally running to catch when I had prepared myself mentally for trouble.
It is not uncommon. And pushing for 2 hours with a first baby and then having quick second birth is also very normal regardless of the baby’s position. Every baby and birth is different 🙂
I quite like this perspective. I’m going to offer this more healthy mindset to my clientele and childbirth preparation students. Admittedly, I love using MFP and see it help labor to progress, but we should have a view more like yours, even while using techniques to assist rotation.
Can you please update this link: research relating to ‘management’ of OP by Simkin (2010)
not working at this time.
Thanks for all of your time and hard work put into this very valuable info. It is very much appreciated.
Sorted! Thanks for letting me know 🙂
Your blog posts are so empowering!
I’m pregnant with my 3rd and trying to understand my last birth (a vbac). That birth was 46 hrs of labor and it wasn’t until the last 12 that the midwives at the hospital (I live in the UK) finally admitted that I was in “established labor,” even though my contractions were very irregular, sometimes 12 mins apart. Baby was partially OB when I was finally assessed, and he spun the long way around to become OA just in time for the birth (cool!).
My question is this: even near the end of labor when my baby was OA, I still had massive stretches of time in between contractions, maybe 5 minutes, so this how my body labors? Will it be that way for my next birth, or were the ‘irregular contractions’ because of the position of the baby? I’m wondering, because if my body’s style is contractions that never get very close together I’m not sure how I’ll be able to communicate to the midwives when I go into labor this next time. Any tips on how to communicate my state of labor when my body doesn’t ‘go by the books’? Thanks!!!!
Your body is unique and this may be the ‘normal’ pattern for you. Or, it could be entirely different next time. I’m not sure what to suggest re. communicating to midwives. Midwives should listen to women and take into account their previous birth patterns too. However, midwives are often working according to policies and hospital timeframes. They will be less likely to fob you off if you have previously had a vaginal birth because there is more potential that you will birth quickly regardless of contraction patterns. If you are having a hospital birth maybe turn up when you ‘know’ you are in labour and insist on staying?
Hi,
thank you for your article – it has helped me understand more and stop blaming myself for having OP birth.
I had reasonable tough labor 17 months ago that took 36 hours. When I first got my contractions I went to hospital soon after as they were very, very strong and regular. The baby was in a perfect position and the midwives said that I would have the baby in a few hours. They couldn’t admit me in and they suggested I could either walk around the hospital or go home and have a bath. I decided to go home and I think that’s why the labor slowed down and took so long. When I arrived second time the baby was in a posterior position already and the midwife said nothing could be done as I was 6 cm dilated and it was too late. I was on gas n air all the time ( not I regret not opting for epidural ). After 2 hours of pushing with my son’s head stuck – doing one step forward and two back I eventually managed to push him out after having an episiotomy. The prolonged labor didn’t leave me with any trauma until I discovered a severe pelvic organ prolapse 12 days later 🙁 I have been blaming myself ever since for going back home and taking 3 baths and lying down as I believed it made my son go back to back and damaging my body in the end. In fact, I was told by my midwife that in order to avoid having a baby in posterior position I should scrub the floors in the last weeks of my pregnancy. No wonder why I have been blaming myself for re-positioning him in the last hours of my labor. Very sad ..
You are not to blame. Perhaps some assistance from your care providers i.e. techniques to help you create space in your pelvis and encourage rotation – may have made a difference… or maybe not. It is never ‘too late’. Unfortunately midwives are not routinely taught these techniques therefore don’t offer them.
Amazing! Thank you so much for this post. I’m a midwife and I’ve always believed that a baby is positioned in a way that best fits that baby and mother and that everyone is different with no right or wrong.
I’m currently pregnant with my first baby and my baby is ROA. I went on the spinning babies website out of curiosity and it refers to an ROA baby as one of the “posterior positions”. Posterior positions being spoken about extremely negatively. I went from feeling great about my pregnancy and up coming planned home birth to having anxiety in relation to my babies position and blaming myself for “incorrect resting positions”.
Reading this has made me feel better, and I’ll try to continue to feel positively about my babies position so I can enjoy my pregnancy and avoid anxiety about this in labour.
I hope we are not pathologising ROA babies too now! I am going to add this video to the blog post but thought you might like to see it now. This is what an OP birth of a big baby can look like:
Enjoy the rest of your pregnancy x
Sadly for me and many other women a OP baby can destroy your life. In my opinion this is a complicated dangerous position . Most doctors and midwives don’t even measure the size of your pelvis much more they will not tell you the RISKS of such a birth. Honestly don’t even think in giving birth naturally via vagina with OP baby. On this post I don’t see you are telling women about the HIGH risks of such birth.
I give birth vaginaly after 2 days and a half in labour …VERY PAINFUL LABOUR….and in the end I had forceps delivery and end up with a FOURTH DEGREE TEAR
FORTH Degree TEAR will destroy your life . Since 2010 I had to have every year surgery to fix lots lots of damage this birth did.
Honestly DON’T DO IT if your baby is OP . It seems to me nobody talks about the real risks. Come on…is not about positive thinking only. I wish the doctors offered me a C Section . I am not having a pleasurable sex life because of this. I suffer with fecal and urinary incontinence…… horrendous. Luckily I had a second and last pregnancy and had to have a C Section . Yeh is a bit har hard for a month or 2 but after that is okay compare with the stickers I had all over my vagina and anus.
DON’T DO IT
GET A C SECTION
YOUR HEALTH IS MORE IMPORTANT
LOVE xx
I am so sorry that you had such a traumatic birth. A 4th degree tear is awful. Forceps delivery is a major risk factor for such a large tear. Especially if the practitioner does not use them correctly ie. pull upwards as the baby comes through the curve of the pelvis (a common mistake and pulling down causes injury).
OP is a very common and normal position for the baby to be in – up to 30% of babies labour in this position and less than 1% of women have a 4th degree tear (most with a baby in an OA position not OP). It is not a cause and effect. OP is not a ‘high risk’ birth. If you can provide me with research evidence otherwise I am happy to amend the post. (Did you read the post and watch the movies? it was not based on unsubstantiated positive thinking)
A c-section is significantly more risky for a woman’s health than a vaginal birth. I am sorry that you are one of the less than 1% of women with a significant tear (most likely caused by medical intervention). I hope your care provider did not tell you it was because your baby was OP. And… this post was written because ‘everybody’ talks about the alleged risks of OP and no one talks about the reality / evidence.
I wish you well in your healing.
I would like to find out how significantly more risky C-sections are as opposed to vaginal birth.
I hear that over 50% women will have some degree of prolapse and this is the outcome of vaginal delivery. Also up to 36% women end up with a levator ani muscle avulsion. Both issues don’t have magic cures and leave YOUNG women with a restrictive life, unable to enjoy motherhood. How does that compare to C-section as I have not heard of such life impacting problems after a C-section.
C-sections are not offered to women unless there is a risk factor because they are more risky for the woman. This is agreed by OBs internationally.
Yes – women suffer damage to their pelvic floor after pregnancy… even women who have c-sections (due to the weight of baby). The practices that women are subjected to during birth increase the chance of damage eg. directed pushing (see this post https://midwifethinking.com/2016/01/13/perineal-protectors/). And most the most significant perineal trauma occurs with forceps (often incorrectly used).
However, morbidity and mortality is higher with a c-section. Here is content cut and pasted from my previous work/writing (refs below): Complications that can occur with a caesearean include:
MOTHER – bleeding resulting in hysterectomy (0.7%); bladder or bowel injury (0.1%); infection (6%); readmission to hospital (5%); and persistent pain in the first few months (9%). Maternal death 2.2 in 10,000 (compared to 0.2 for vaginal birth)
BABY Around 1-2% of babies born by caesearean are accidentally cut during the procedure. Babies who do not experience labour are more likely to have breathing problems at birth requiring admission to special care nursery. They also miss out on being exposed to vaginal bacteria resulting in a different gut microbiome. This may explain why babies born by caesarean section are more likely to have health problems, such as asthma and diabetes, later in life.
FUTURE PREGNANCY – increased rates of miscarriage, stillbirth and uterine rupture and maternal death.
“If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years.”
http://www.tandfonline.com/doi/abs/10.3109/14767058.2011.553695
However – I realise that this is an emotionally driven debate and you have had a traumatic personal experience. My point is that this is not about OP position. I was responding to the comment suggesting that all women with OP babies have a c-section.
‘Risk’ needs to be determined by the woman taking the risk – and to do so she needs adequate evidence-based information. This site attempts to share this type of information rather than fear mongering based on cultural beliefs or individual experiences.
There is help out there for women who have traumatic births. This organisation do great work: http://birthtalk.org. I hope you can access some help and support to heal from your trauma.
REFS
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/consent-advice-7/
Hansen, A.K., Wisborg, K., Uldbjerg, N., Brink, T., ‘risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study’, British Medical Journal (2007), doi:10.1136/bmj.39405.539282.BE.
Dahlen, H.G., Downe, S., Wright, M.L., Kennedy, H.P., Taylor, J.Y., ‘Childbirth and consequent atopic disease: emerging evidence on epigenetic effects based on the hygiene and EPIIC hypotheses’, BMC Pregnancy and Childbirth (2016), 16:4, DOI 10.1186/s12884-015-0768-9
http://www.cmaj.ca/content/176/4/455.short
http://www.ajog.org/article/S0002-9378(08)00268-8/abstract
I know quite few people who had a fourth degree tear- all happened in hospital, all after having normally positioned babies, and epidurals!
I have had 5 babies at home.
The last four babies were ALL OP babies, not interested in turning at all during pregnancy, even though II used optimal fetal positioning principles, but ALL turned in labour at the last minute, using suggestions from Spinning babies and were born with no problems at all.
It is awful what you went through, but is not the norm.
well, congratulations for delivering OA babies in the end. I’m glad it all went well for you.
That was rather snarky!
It’s not about asking for congratulations- I was sharing factual information about OP pregnancy and delivery, none of which was taking away from the experience that above lady had with her delivery, seeing as most people that post online about issues do so because their situation went wrong, not well.People need to hear the flip side too, that it is perfectly possible to birth most OP babies with no damage.
This makes me really depressed how some women suffer and yet there is little sympathy from others. It’s sad how the world works and those who have had no issues dismiss other’s misery. For me it really doesn’t matter if something happens to 1% women or less, it happened to me ( I ended up with a prolapse after having an OP birth and I am changed and left disabled forever..) and from my experience I know that women who have not had issues don’t care about it. A lot of them just fob you off saying that they managed to deliver with no problems – great! I congratulate you all! I kind of understand that’s just the way it is that people can’t put the themselves in the same situation and understand what one is going through.
I’m sorry aidoo2013 you have been going through this and thank you for sharing about your bad experience. We have to start talking about this as women have suffered in silence for too long. I wish you all the best and I hope you recover from this soon.
Also, I hope you realise you can go legal route because of the damage you’ve suffer and I think we should start doing something to make doctors and midwives start looking after us better.
Dear Rachel,
first of all I want to thank you for this wonderful encouraging blog which I enjoy reading so much and which provides so much valuable education!
I had a c-section two years ago due to a mento-posterior (ie. OA) face presentation which has been explained to me is really rare and in contrast to OP face presentation not possible to birth vaginally.
As I read a lot to prepare for a subsequent pregnancy and vbac I’m still puzzled about what caused this malposition. The “classical” suspects myoma or a malformed pelvis could not be confirmed (I had a midwife looking at my pelvis). None of the obs I met could provide any further explanation than “it happens sometimes”.
As I am really curious and always want to know why I got my own little theory which I would love you to comment on if it sounds realistic. I read in a very interesting childbirth book of the famous Austrian ob Alfred Rockenschaub that OP position was often associated with face presentations. I remember my midwife often having trouble finding the baby’s heartbeat in the last weeks of my pregnancy and she occasionally suspected that the baby was OP but couldn’t confirm that because I had so much amniotic fluid. In fear of the baby lying “the wrong way” I did some hands and knees, swinging my enormous belly. One time I did so it felt like my baby’s head had locked in place, it somehow clicked.
I did not go into labour spontaneously and due to suspected GD (which I now know was a misdiagnosis and nonsense) I agreed to my midwife’s suggestion to try an induction with Castor oil so I could have the homebirth I wanted. Eventually contractions started, I was really excited but comfortable, the contractions were completely manageable and not painful at all. I went to the tub and maybe two hours after contractions had started my waters broke. Although I expected them to, the contractions did not feel differently after the waters were gone.
We called the midwife. When she came in she asked if the contractions had been like this all the time. She claimed this were no real contractions and had me go out of the tub to check on me. She was surprised to find me 7 to 8cm dilated but felt something on the head that was not supposed to be there (the nose as we learned later). So we went to hospital. When we got there I was completely dilated with my still painfree contractions, an experienced ob confirmed the mento-posterior face presentation (he was also really surprised and said it was fascinating how my cervix opened without any pressure), and I got the c-section.
Of course I’m sad about the missed experience, it feels as if I had prepared for a marathon just for being dragged into a car after 10km and brought to the finish line without anything that I could do. On the other hand I would have never learned so much about birth without it, feeling that I now am really prepared to make my own decisions and take my responsibility for a future pregnancy.
Now my questions: Have you ever heard of or experienced that relationship between OP position and face presentation? Was there a chance, my baby would rotate again to be born in an OP face presentation position? Do you know if there is a big chance for this happening again? Is there a “risk” in being OP and my uterine scar whithout any risky intervention like induction or augmentation?
Thank you so much for your work and your time, this place is a treasure. I hope what I wrote is readable to you as English is not my native language.
I am unable to comment on individual situations for a number of reasons. However, in general. No, I don’t know of any association of OP with face presentation – this is not the outcome of most OP babies. Face presentation is rare and OP is very common.
Induction of labour increases the chance of mal-presentation. Induced contractions can ‘push’ the baby down before he/she has a chance to get into a favourable position.
Not sure why your OB was surprised your cervix dilated without pressure from baby… although few care providers understand how the uterus/cervix function in labour (clue – it is not all about pressure on the cervix 😉 )
I have no idea if your baby would have rotated if left… it is unlikely unless techniques were used to move him/her out of your pelvis eg. positions + rebozo.
There is no additional risk during a VBAC if the baby is in an OP position (almost half of babies are OP in my experience). It is extremely unlikely that a face presentation will re-occur. So rare there is no research available re. the incidence or reoccurrence.
The most likely outcome for a VBAC after a previous face presentation is an uncomplicated vaginal birth – statistically that is 🙂
I can’t thank you enough for this article! It has helped my midwifery practice and helped me reassure my clients and family members. Great piece!!!👍👍👍💕 I am the author of For Generations by Mary Earhart on Amazon.
Thank you Mary x
Dear Rachel,
I am a BIG fan of yours, when I was student midwife I kept comming back to your site. Love everything you publish. I love this post too, and mostly agree with you!!! But I do bet you have read/herad of/ been at a Spinning Babies workshop. We can’t make the baby rotate, but we can get our bodies into a more physiological state, as modern life has taken that away in some ways. Many woman have long prodromal labor that starts and stops, for 4, 5 days. They can not sleep and begin labor exhausted. And we tell them tha is normal. Then someone realizes the baby is in an OP position, and there are ways to help baby either rotate or flex and have labor begin and help the mother with that exhausted start. MANY OP babies have no problem at all rotating like you say, once they reach the pelvic floor, and many are born in OP positions easily!! but some Op babies are deflexed and have a hard time. The uterus is curved in the left side and oblique in the right side. Some OP babies can’t navigate the sacrum and deflex… and we can help them and their mother. I’ve seen some natural births transfer from home to hospital for long challenging labor that ended up needing forceps or a c-section with op or transverse babies. I was a student midwife and we didn’t do anything about ir because we assumed OP babies were normal. Now, I do use spinning babies when labor gets long and tired, when labour comes and goes for days, and in many many ocasssions, it works and it helps. Those deflexed babies in labour many time have “colics” and a physyotherapist is needed because the deflexed position os long posterior labor has really swollen their spine.
Spinning babies techniques are a valuable intervention and I use them myself on occasion (particularly with epidurals). However, most OP babies and mothers do just fine without intervention… so the default is reinforce the expertise of the mother and wait to see if intervention is needed 🙂
FTM here, 37 weeks pregnant with a baby girl who has been hanging out OP or some posterior variation for at least the last month. My doula suggested checking out the Spinning Babies site at a check-in last week, and it has been TERRIBLE for my mental health. What had been a happy, healthy feeling pregnancy has turned into a lot of self-recrimination and panic for having not been able to turn her yet, despite following the recommended exercises.
I just wanted to say how much I appreciate this post, and all of the comments from women who have had successful OP births labours or births. It’s incredibly helpful to receive affirmation that my body and baby know what they’re doing – so thank you! I’ll try to remember to report back with how things go.
If you’re aware of any new articles, I would appreciate any more research that supports the perspective in this post?
There hasn’t been any further research… but lots of evidence in the way of women birthing their OP babies without problems 🙂
Let us know how you go. And at 37 weeks there is still plenty of time for your baby to move before labour 😉
I wonder if you can fix the link to ‘things to try during OP labour to create available space for baby. I am getting drop box files deleted. Id love to share with my classes.thanks a million
fixed 🙂
2 OP deliveries for me.
My first was a LONG, horrible labor.
2 days of laboring at home, I couldn’t wait for an epidural. They broke my water to try to speed things up, but after 24 hours I was still barely progressing (but now had infection and fever). 40 hours of laboring in the hospital, 3 hours of pushing (I was so exhausted, I would black out between pushes). Meconium, dropped heart rate, stitches from tearing and a hemorrhage.
I couldn’t stand up straight for weeks from the strain of back labor, and was stitched too far apart and suffered severe discomfort during healing. Not to mention the baseball sized blood clot that came out of me once I went home.
It was scary.
11 years later, OP birth # 2.
I told my doctor that I refuse to go through that again, I begged him to cut me open if it were the case.
Due to Gestational diabetes, I was induced 1 week early. Induction started with just the “pill” on my cervix, which got things going, but not enough. Added Pitocin and labored on my own until my waters burst and the back labor set in. WOWEE… epidural was my best friend.
I got great advise to keep the pain level around a 3 with the epidural so I can still feel my legs enough when it’s time to push.
I was comfortable enough for visitors, which was a good distraction. Once the shakes started, I was turned on my side with one leg in the air until I couldn’t resist the urge to push (about 1.5-2 hours). They dropped my hips down low and a big old OP baby head literally popped out in 3 pushes. More stitches and hemorrhage.
I started to faint on my way to the bathroom, in my reflection, my lips were blue. I had to be wheeled back to bed with a cool toilet/chair contraption.
Hemorrhoids and super swollen bits had me sitting on a donut for a few weeks, but the recovery was WAY easier.
No more for me.
Wow a baby staying OP during the entire birth is uncommon. They must fit better that way in your pelvis! 🙂
I had a very difficult and painful back labour with my 9lb8 baby who was ROT (Turing to ROP with each contraction) my waters broke at the beginning and I laboured for only 12 hours (other than the off and on for the day before) before my daughter started to seem like she was tiring. I got to 8cm where I ‘failed to progress’ and her heart rate seemed less happy. She never made it past -1 – At that point she went slightly transverse then back into ROT. I shrunk a cm. I had made it this far without any epidural or pitocin (as it was a vbac) and I was sooo exhausted and was screaming through every contraction that I wasn’t in the tub (which they made me get out once I stopped progressing) I wasn’t breathing through them well (could that have made my daughter tire and heart rate show that?) Any way my midwife, the doctors and my husband all have up on me at this stage and told me to get a c section. I wanted to keep going because I just kept thinking ‘she might turn on the next one!’ But they had their way and I didn’t want her heart rate to get to emergency status… so ended in c-section number two (my first was breech). I hate c sections so much and find them very traumatising… I felt such a failure. I’m glad we’re all healthy and well. But I hate what it does to my head and how it makes all future pregnancy’s more complicated. So many stories on here woman seem to labour for twice as long as me with back labour etc without their babies going into distress. So it can’t just be intensity and back labour that causes this? Was it Cos I wasn’t breathing enough? Or something else? I have had xrays and checks since and my pelvis and everything seem perfectly normal. I had been doing exercises to balance pelvis etc and I’d been going to a chiropractor- so I really don’t know what to do differently this time round (20 weeks pregnant with baby number 3 – planning vba2c. So don’t trust my body anymore though and so full of fear. (Yes I’m going to go to therapy etc before the birth) but I just feel like I need answers to move on!
My son was born OP and I wish the midwifes and doctors had explained me what is explained in this post. I had an epidural because I was in a lot of pain and stuck at 5 cm and after about 13 hours he was born and I was left with a fourth degree tear that wasn’t stitched well so after one week I was back in the hospital for sphincter surgery and now I will have issues from that for the rest of my life (luckely very small issues for now but still).
There are 2 short films that look the same to me. Are they different?
Thanks for pointing that out! I’ve fixed it 🙂
Thank you for this post and the many others on your website, they are so thought provoking and helpful. Do you have any thoughts on whether in some cases an epidural can actually be helpful in allowing the mother to relax enough to allow a posterior baby turn if she is very tense (either generally or specifically holding tension in the pelvic floor)? Thank you
An epidural relaxes the pelvic floor. The tension in the pelvic floor helps the baby to rotate = why epidural increase the chance of a persistent OP.
However, yes epidurals can help some women relax in general… but they don’t assist the physiology of rotation and descent for baby 🙂
Hi Rachel, I’m still really struggling to find an answer to my burning question. If in an OP labour you have the early urge to push because the position of the head is different and engaging with nerves at a different point, will you get an urge to push again when they have actually moved down and are ready to be born? I had the early urge to push with my first baby (OP) long before he was born and then I had directed pushing from the midwives (even though it was at home) to birth him. If my upcoming birth turns out to be another OP baby with a similar labour I have no idea whether I should allow directed pushing (which in general I know to be an absolute no no but without knowing whether another urge to push would have come if they’d have left me to it I don’t really know how to plan for it!). I’m talking from a physiological standpoint rather than an individual one, ie is there another point at which the OP baby’s head can engage with the nerves to promote pushing? Thank you
The uterus pushes the baby – regardless of whether you have an urge or not (women in comas have given birth). Your body doesn’t need direction.
Thank you. I had no idea about women in comas.
I really do want to share my story, but this finding to night, has only brought tears to my eyes, I had an op but ended up with C/S. if only I had this information earlier, I would have gone through a natural birth. I opted for C/S because I was scared my son would be distressed, as I’ve been on induction & argumentation for days with no progress in cervical dilation. To make it worst, I was never told my baby was presenting occipito posterior, I only understood this after birth, & I had complications following surgery. It was not a pleasant experience, am only grateful for life & my newborn is healthy.
I was Multip with hx of uncomplicated 3.5h water birth. My second was an OP baby with a deflexed head. It was the most excruciating pain I’ve ever felt in my life. Far exceeding the pain I felt in labour of my first. for the majority of the labour the contractions were q5-7 mins lasting 30-45 seconds. Most of them were less than 30 seconds right to fully dilated. From onset of contractions to fully dilated was 10 hours. I got in the tub for the pain and the contractions ceased. I got out instinctually believing something was wrong and was put on efm – I was having tachysystole and ended up having a ruptured uterus. No one noticed because the contractions were so short. We went for cs and I bled nearly 4 litres and narrowly died. OP will forever be something I’m vigilant about in my practice as a midwife. The 4 P’s and the contraction pattern is critical. The work it has to do to move that baby was too much in my case. I know a primary rupture in a Multip is insanely rare, and yet I’ll not be able to let go of the fact that those contractions were so so so intense and only lasted 30seconds… going on like that for hours is not good for it. Love your work. Thanks for reading my story ❤️
I’m so sorry that you experienced that. I’m sure it has made you vigilant! It sounds like a truly obstructed labour with a deflexed head. This can happen with OA babies too. Yours was a complicated birth rather than a physiological OP birth.
This blog was really eye opening to me thank you Rachel. I now think I had an OP Labour with my second and wow was it hard. Worst part was an overwhelming urge to push from SO early on and being told to ‘blow it away’ it’s too early to push for hours and hours fighting against my body’s natural urge to do so. It was devastatingly hard/impossible. A VE to confirm ‘only 3cm’ totally demoralising. Eventually following another VE after many more hours and told though not fully dilated, the cervix is now very thin and stretchy ‘ok time to push’ I then relatively easily birthed my big 10lb 1oz baby boy in an upright position. Your points make so much sense to what I experienced and what my body was trying to do. I feel sad about the advice I was given to avoid creating ‘an anterior lip’ and ‘pushing before I was ready’ that I think disrupted what could have been a much better, less traumatic and empowering birth experience. I’ve since questioned – should I have just pushed and gone with that overwhelming urge from my body? Maybe I should have and my baby would have rotated with greater ease. Now pregnant with my 3rd and going to try and tap into my own inner wisdom and think twice about a VE during labour this time. Thank you 💚