So, you’ve been doing everything you can to help this baby turn over and get into their optimal position: you’ve been on all fours and in the knee-to-chest position for so long you’ve picked all the lint off the carpet. You’ve been sitting on a birthing ball at the dinner table, computer, and while watching late-night TV. And STILL your baby is stubbornly posterior. How are you going to face this labor?
OP labor is what is commonly called ‘back labor’. The baby’s spine is lined up with your spine and in this position it is harder for him to tuck his chin into his chest and come out at the smallest circumference: the crown of the head. Instead, his chin stays up and the larger circumference, the forehead enters the pelvis first – an awkward fit. The back of his head presses against your tailbone, causing that exquisite back pain. Sometimes, when an OP positioning is diagnosed, the mother is advised at the outsed have an epidural, and if the decent is prolonged she may have an assisted birth.
There is a potential problem with accepting this epidural: your pelvic circumference. When lying on your back, your pelvis compacts into it’s narrowest shape. OP means that a larger shape of the baby’s head is presenting, so if the pelvis shape is also at it’s smallest, you may have more difficulty getting the head to pass through. This could lead to assisted delivery or Cesarean on the pretext that your pelvis is ‘too small’ to have your baby (also known as cephalo-pelvic disproportion, or CPD).
You actually want the exact opposite to happen! Rather than constricting your pelvis, you should aim to help yoru pelvis have its most open shape. More space is created in the pelvis by leaning forward, or being on your hands and knees. This also has the benefit of lessening the pressure of the head on your tailbone (lying down means gravity adds more pressure in that area). If you go into labor and the baby is still posterior, I would advise you to ask for a natural birthing room if there is one in your hospital, or let the staff know your goal is to labor in a way that comes natural to you. Then they are more likely to be generous with allowing you to adopt the position you desire. You could even request for your initial 20 minutes of monitor time to be done while you are still on your hands and knees. A mother I assisted whose baby was OP did just that instinctively, and simply refused to lie down or even sit. The midwife managed to apply the monitor and get the required inital 20 minute printout while the mother was in this position just fine.
Another way to help the pelvis to widen is to have someone do hip presses – that means they stand behind you, placing one hand on either hip just below your hipbone where you can feel the outer edge of your pelvis sticking out and press together very firmly during contractions. You may find this feels soooo good. Then, at the end of the contraction it may feel better for as much pressure as possible to be applied against your tailbone, providing counter-pressure to the baby’s head on the other side and relieving the strain you feel there. Bring a sock filled with rice, or containing two tennis balls, or even a rolling pin to help apply this pressure. Remember, the kind of pressure you will find helpful does change during the course of labor – what felt good at first may irritate you later. Make sure your birth partner is aware of this and that you agree to feel free to direct them to do something else instead. These presses and lower back massage can be done while you’re leaning against a counter, on all fours, or holding onto your partner’s neck, swaying to music. Gyrating your pelvis in circular movements and figure 8s can help your baby turn into the easier anterior position during labor, so move plenty to help him find freedom to flex and turn.
During contractions, try lunging forward when on hands and knees, bring one foot up beside your chest. Rock during the contraction. This lunge provides a twisting sensation in the pelvis that may help the baby turn. You may also do this while standing, with one foot up on a chair and someone behind you to help you keep your balance. Go to spinningbabies website for more illustrations of positions to adopt during labor to help your baby turn.
For pain relief I would recommend looking into using a TENS machine. It is much better to try to use a small machine over which you have control, before giving yourself over to others to make decisions for you! Some women don’t like the sensation of a TENS, while others have called it their ‘friendly little buzzing bee’ and swear by it. A TENS machine can be rented from Yad Sarah in Israel for a small fee. The electrodes are applied to your back, exactly where your pain is in a back-to-back labor. I recently spoke to a midwife who swore by her TENS machine for her OP labor with her first baby. There are no side effects, either for you or the baby, no drugs to be flushed out of your system.
How about a mobile epidural? This may depend on the anesthesiologist and hospital policy; I would call ahead and ask. If you do feel the need for an epidural don’t, whatever you do, feel guilty – you alone know what you are going through; you don’t need anyone’s permission. If your mobile epidural is successful (not always do they have the same effect on everyone) then you will be able to still move onto your hands and knees, as long as there is someone next to you at all times holding on and making sure you’re stable and supported. Epidurals have quite a few side effects, so read up on epidurals so you can make an informed choice. Most doctors and midwives do not fully explain them at births.
Monitoring is the same as in any other birth. To facillitate the desired mobility in OP deliveryies you can refuse the straps (except in the case of dips in heart rate or an epidural) and the heart rate will be checked every 1-4 hours. If the pushing stage of an OP labor is extended, the baby’s heartbeat will be monitored every five minutes to be sure the baby is coping well; but even so you can ask that they the hand held monitor be used instead.
Finally, as the baby’s head is being born imagine your vagina relaxing and becoming HUGE, and repeat this to yourself over and over again as the baby crowns. Believing positive words with your head that you can open wide, relax, accept will cause more relaxation in the muscles. As is true during sex, engorgement of blood causes the tissues to expand and become more stretchy, and this is all connected to your frame of mind, the hormones your brain releases. Fear and tension make for painful intercourse. Fear and tension, then, must make for more lacerations in childbirth too. I really wish every mother could read a copy of Ina May Gaskin’s Guide to Childbirth before going into labor! The entire first half of the book is positive birthing story after positive birthing story – women giving birth OP or to big babies (10 lb) with no tearing, even for first babies. The goal of immersing yourself in other women’s positive experiences is to immerse yourself in the idea of the normality of birth, that things can go well. I believe it – I’ve seen it and experienced it myself. You can too!