I stumbled across this in the New Posts' page, hope you don't mind me posting. I had a posterior ds with my first birth and set off to make sure that didn't happen with ds2 (it didn't!). I researched a ton and I am convinced that posterior babies cause a heap of troubles and are responsible for the ever increasing c-section rate. The good news is that you can do things to try and change baby's position *now and in labor!* And I highly recommend doing them.
Malpositioned are often the source of FTP (failure to progress) and CPD (cephalopelvic disproportion- aka "too big baby for mom") diagnosis. They can mimic CPD by making a long, slow, labor and a harder delivery. A malpositioned baby is a correctable situation though. If FTP starts to cross your Dr.'s lips in labor, ask if there are positioning things you can try before a c-section. If there is no distress then there should be no reason to at least try, right? It's the only way you'll know.
A malpositioned baby can make birth more complicated so it is to your advantage to get the baby in the proper anterior position.
A malpositioned baby can make for a slower labor. Your body might be contracting at full steam but the contractions have to work overtime because ideally your body wants the baby to turn. So your contractions are working on changing the cervix, lowering the baby and helping baby to rotate.
In a posterior labor you will probably have a lot more back pressure and pain during the contractions. Sometimes that is all you feel- your back- and you only feel a tightening in the front.
A traditional hosptal birth can increase the chances of a longer, more complicated labor so definetly know your options and know what affect things can have on you and a vaginal birth.
1. Laboring in bed makes it really hard for the baby to turn. Ideally with a posterior baby you would try positions like hands and knees or leaning over things. These will shift the weight of the baby around and help them to be able to move.
2. Having your water broken can force the baby into the pelvis at that angle or an even worse angle. The baby can almost get wedged there. A lot of babies that are dubbed "too big" were just malpositioned. Avoiding having your water broken can really up your chances or success.
3. Those 2 above things can also factor into the pain part. Laboring in bed with a posterior baby hurts. All that pressure is in your back and the added pressure just intensifies the contractions. Your body knows better than to lay in bed that is why it is screaming at you to get up. The amniotic sac forms a cushion from the intensity from the contractions for both you and baby. Staying out of bed and keeping the amniotic sac in tact can make things easier, less painful and increase your odds of a vaginal birth.
4. Patience is a virtue that is often lacking in a lot of births today. Labor hurts so even if we know that pitocin or having your water broken might make the birth more complicated, it is appealing none the less because it means that maybe you can get the birth done with sooner. Unfortunately, your body might know better and you might not get the result you were hoping for. Like I said before, a posterior birth is slow for a reason. Rather than intervening with pitocin or AROM, try 15 minutes of getting out of bed and getting on your hands and knees or something. It might make all the difference in the world.
5. Just as a warning, epidurals are not always effective as they normally would be with a posterior baby involved. You will still have a lot of pressure on your back. When the epidural is in place you might lose some of your valuable assets- mainly the ability to get out of bed and change positions.
Prevent malposition with different stretches and exercises:
Back Labor and Optimal Fetal Positioning:
MotherSpirit Article:* How to Prevent a Posterior Labor
These are some of the key things to do now, from that link while still pg:
" *Avoid all reclining positions. If you have a soft reclining seat or couch, best to put a pillow under your bum and tilt your pelvis forward.
*Keep knees below your pelvis at all times, back straight. A large birth ball is the perfect ‘chair’ for this position. Those nifty office chairs with knee rests are also great. The goal is to keep the pelvis tilted forward at all times.
* Keep active, walk as much as possible.
* Practice pelvic rocks on your hands and knees every day for minimum 3 times a day for 20 minutes and/or;
* Take up the knee-to-chest position (sometimes called the playful puppy pose…chest to the floor, bum up in the air) for an hour or so everyday. Some people prefer this because it will prevent a posterior baby from engaging until it is in a good position. (Once baby engages posterior, it’s much less likely s/he will turn.)
* While this doesn’t sound like much fun, scrub your floors on your hands and knees regularly. Crawling around in this fashion is great for getting baby anterior.
* Talk to your baby; ask him/her to turn to anterior (or better yet, ask him/her to turn to a position that will help labor…sometimes there is a good reason for baby to be posterior).
* Visualize an anterior baby, preferably LOA (left occiput anterior) with baby’s bum in your front, but slightly to the left of your belly button.
* Sleep on your left side, with your left leg straight and your right leg at a 90-degree angle supported by a pillow or two. This creates a ‘hammock’ for your belly and will encourage the baby to rotate.
* Avoid squatting unless you are sure baby is now anterior…squatting can force a posterior baby into the pelvis before s/he rotates, making it much less likely s/he will turn anterior without being disengaged first.
* Relaxing in a warm bath and telling your baby you are happy s/he is about to arrive can also make a world of difference! Doesn’t hurt to try it. "
I made an effort to avoid the couch at the end of pregnancy and sat on my birth ball instead. My CNM suggested leaning forward with elbows on my knees too. Lots of pelvic tilts.
Optimal Fetal Positioning
Optimum Foetal Positioning
Plus sized mom or not this link lays out the challenges a malpositioned baby can add to labor, how to prevent it, and other great information. A must read, imo.
New One
My 1st labor started with my water breaking at 42 weeks (I always wonder if the membrane stripping was responsible). I labored at home for 9 hours (I was GBS-, low risk, in contact w/ my CNM...) and had made exactly 1cm from my exam 3 days prior. I started contracting regularly w/in minutes of the water breaking and went in when the contx were 3 min apart. Labor was slow! I stalled for a few hours at 5cm. Transition lasted 3 hours. Total labor was 20 hours. But, ds finally turned right at the end of labor and I pushed him out in 35 minutes w/o really trying. Had I had a dif't care provider I probably would have been given pitocin at 5cm but instead I kept walking and changing positions. I did it unmedicated and felt so amazing afterwards. I didn't really know that a posterior baby was harder to birth till I started telling my story. The back labor was killer and the only thing that helped- aside from staying out of bed!- was my dh applying major counterpressure. My doula couldn't push hard enough. Poor guy's arm really hurt the next day and I think I had a bruise from him pushing so hard. Even though I did it I was still happy when ds2 wasn't malpositioned.
Oh, I did tear but that was because I didn't listen to them when they told me to stop pushing during crowning. It was just a 2.5 degree tear so not the worst and it healed well. I have not read a correlation in posterior babies causing worse tearing so don't stress about that. I'm on a roll now so I think I will post some tips on keeping that perineum in tact next. Feel free and read or just skip it. I'll put it out there though!
I hope that info helps some.