I had my 37 week appt today and it went really well. The Dr. did an u/s to make sure baby was good. I was 50% effaced and 1 cm dilated, so not very far along. He said the head is right down there (he could feel it). But he also said that she is "sunny side up." I am really nervous about this b/c I have heard horror stories about how long it takes to deliver a sunny side up baby, and also my friend tore really badly with hers. I'm kind of scared to be honest. The Dr. said that she could turn (which I am really hoping for).

Does anyone have any positive experience with this? I'm so nervous now.

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Ann-Marie

I am sorry you are worried.....I do not have any advise sorry. I hope she turns for you. The only think I have heard is that you tend to have more back labor with a "sunny side up" baby.

GOOD LUCK girly and I am sending you lots ELV!!!!

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Amanda, James & Sweet Mackenzie

7/17 -3rd Laparoscopic Surgery for Endometriosis
8/07 femara & ovidrel First Cy..... 8/24/07
(After trying for 6 years on and off)

Baby can turn up to the last minute -- Danica was sunny side up, and my OB was able to literally watch her turn as she was coming out....

I do hope that baby turns for you though -- it can definitely make things much harder than they need to be. I hope someone has a very positive experience to share w/you!!

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Amanda

Ok, two stories!

My 1st DS was sunny side up. I gave birth without any pain medication. I did have bad back labor and a 3rd degree tear. It didn't kill me or traumatize me too much, cos I just had another baby I also would do it all over again in a heartbeat!!

This baby was also sunny side up. He actually turned while I was pushing. I didn't know they could turn that late in the game, but he's living proof.

So don't fret!! Baby still has plenty of time to turn, and even if she doesn't, it's really not the horrific situation some people say it is.

Good luck and I hope she turns for you!!

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Cohen 4/28/08

Ashley 26
Adam 27

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.

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ds #1 6/02 and ds #2 12/07

Keeping that perineum in tact tips...

Something I often hear on the boards is that mom needed a big episiotomy or tore a bunch because baby was so big. That might be a bit of a leap. More likely it had to do with how the perineum was managed as well as the delivery. My ds2 was 9lbs 9oz and I had a 3 stitch worthy skin tear. I believe that the credit for that goes to my midwife and how she handled the delivery.

Delivering on your back is one of the worst delivery positions. It applies uneven pressure to the perineum and stretches the skin more taut than in many other positions. Simply avoiding this position could save your perineum.
What's wrong with the lithotomy position? Why do we even use this position?
Pushing Positions - Childbirth Resources at StorkNet's Childbirth Cubby.

This link explains the advantages of other positions as well as illustrations:
http://transitiontoparenthood.com/tt.../positions.htm

Good link:
Women and Patients - Book Reviews

Note- I am sure that a lot of moms have success in this position- especially 2nd+ moms. But, it doesn't mean that they couldn't have gone even better in another position. I pushed on my side for 2/3 of the time b/c it felt right. However, against my better judgement and prior discussion with my midwife, I ended up pushing on my back. I had a 2.5 degree tear. Maybe that wouldn't have happened if I was in a dif't position.
Choosing a careprovider that doesn't put time limits on the delivery is another thing mom can do. I can't even count the # of moms who come back with their birth stories and say that they pushed for an hour or less and weren't making progress so the cp did an episiotomy or used an instrument to deliver baby. That just bothers me a lot. Given plenty of time- and opprotunity to try different things- many moms could be spared these invasive proceedures.

If the perineum is respected by your care provider then you should feel good that they will do their best to minimize damage. There are questions you can, and should, ask at your next appointment.
Find out how often your Dr. performs episiotomies.
-The answer should be less than 25% and ideally less than 15%.

-The answer should be "I try to avoid an episiotomy unless the baby has to come out immediately. I prefer to do perineal massage and a controlled pushing phase." The American College of OB/Gyns does not recommend episiotomies as a matter of routine or to prevent tearing (it is widely known that an episiotomy can cause you to tear more than if you just tore. The analogy is that a pair of jeans that already has a hole in them is easier to tear than a pair of jeans that is still intact).

What reasons do they perform episiotomies?

What preventative measures do they do to help avoid an episiotomy or tearing?

Will they pressure you to an episiotomy if it looks like you are going to tear? Episiotomy equals guaranteed laceration and many times it results in a worse laceration than the tear would have been. Cuts are almost always deeper than a spontaneous tear. Read the book "Spiritual Midwifery" by Ina May Gaskin and you will find that there are very very few (less than 1%) naturally occurring 4th degree tears (the worst kind)- lots more if you add in that cut. If you are tearing upwards an episiotomy can redirect the pressure downwards which might be a time where it is worth it.

-Discuss this before you are in labor and pushing b/c when you are pushing you will be too preoccupied to make rational, well thought out decisions that can have a profound effective on your future births, your urinary and fecal continence and your sex life.

-You hear of Dr.s and nurses recommending cuts in labor so it is very good to be clear ahead of time what your preferences are. You are the one who will have to recover, not them.

Their attitude towards episiotomies can tell you a lot about their birth attitude.
-Will they rush you throughout your birth? If pushing is "taking too long" but you and baby are well, will they still recommend an episiotomy? How often do they augment labor with pitocin or breaking the water? Are they willing to let nature take its course if you and the baby are well?

-How much do they respect you? Do they want to help you have an easier recovery?

-Are they cool with letting you labor and deliver in positions that are best for you even if they are less than ideal for them? Squatting and all 4s are so much better than being on your back and they know that. It is a lot easier for them though if you are on your back and legs in stirrups.

Are they patient, laid back in a low risk healthy birth, respectful and up to date with current ACOG recommendations?


What else can you to to help keep your perineum in tact?
-Kegels!! At least 5 sets of 10 per day!! These will help you to know how to control those muscles so that you can effectively relax them when you push. They will also help speed up recovery.

-Stay upright during the pushing phase (squatting) b/c that will help the baby descend. You can deliver like that or change to another position for your last pushes. Other positions like sidelying can be beneficial. I have read that actually delivering in a squatting position can put extra strain on the perineum so it could increase tearing. So, while it is great for getting baby to descend it might be good to find a more neutral birth position.

-Try a variety of pushing positions if your progress slows. Hands and knees, side lying, use a birthing bar...More advice:
THE NINTH MONTH

-Start doing perineal massage before your edd. Insist that warm compresses be applied during delivery to help stretch the skin.

-If you have an epidural, ask them to turn it down/ off so that you can feel what you are doing.

-Push only when you have the urge. Sometimes a woman dilates to 10cm and could start pushing but doesn't actually have the urge. Some call this the "rest and be grateful" stage. Don't feel pressured to push.
"The importance of waiting
It is important to wait for the natural urge to bear down before starting active pushing. You are often encouraged to push by "holding your breath and push as hard and as long as you can." Research has suggested that a woman's spontaneous urge to push occurs three-to-five times during a contraction while the woman is exhaling and bearing down." First Time Mothers' Tips


-Along the lines of the last tip...If you do have an epidural (it could work if you don't but it'll be harder) consider the newest trend, "Passive Pushing." Your contractions will naturally work to push the baby out. Some care providers are now encouraging moms to let their bodies do almost all the work and allowing mom to rest. Mom then just gives the final few pushes. This gives the perineum more time to stretch naturally and it conserves strength.
"Pushing with an epidural
If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of "delayed pushing" is currently being studied in women using epidurals as an alternative to routine pushing at 10 centimeters."
First Time Mothers' Tips
And:
Reconsideration of 'purple pushing' urged - Labor and Delivery | OB/GYN News | Find Articles at BNET.com


-Also, when you do push, push when it feels right. There is no scientific reason to hold each push for 10 seconds. 6-7 seconds is actually more beneficial and scientific. Ask that no one count or shout commands at you unless you need them to.

-Don't pull your legs back into your chest. Some nurses ad Dr.s are really fond of this position b/c it is convenient for them. Not so kind to your though and that is what matters! The askdrsears.com website has some additional tips on pushing that might be worth a read.
THE NINTH MONTH

Perineal Massage
Here is an article that explains the technique:
How can I avoid an episiotomy? - BabyCenter

Remember to do those Kegels!!
Kegel exercises - BabyCenter )

With my 9lb 9oz ds I pushed in the hands/ knees position for a bit but it really didn't feel right at all so I went to sidelying. It felt much better and I was really productive. My midwife knew how afraid I was to tear so she really walked me through what I needed to do to avoid it. When the baby was crowning I wasn't allowed to push for about 3 contractions. It was so, so hard to hold back. He was right there and I could have gotten him out but by keeping him there and getting him out little by little I allowed the skin to really stretch slowly. It took a ton of control but it was so worth it. I just kept repeating to myself that there were no do overs. I had to listen to them and get this right. It was a great recovery from a tiny tear. I am so glad that I didn't have someone rushing me. The warm compresses were awesome too. Total pushing time was 22 minutes with him.

Hope some of those tips help!

Beth

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ds #1 6/02 and ds #2 12/07

Both of my boys came sunny side up- and both turned during the pushing stage. With my 1st it took me 65 minutes of pushing to get him turned around and out- and yeah, I did tear pretty badly with him. Not horrible but it took a bit of stitching up afterwards. However, start to finish (pushing included) my labor/delivery was about 4 1/2 hrs. Not bad for a FTM and a sunny side up baby!

With my 2nd as soon as I heard he was coming out that way as well I kinda got nervous- but concentrated that much more on the strength of my pushes and he turned so quickly. He was born in 10 minutes! I had less tearing that time also. His labor was longer but the delivery part was way smoother.

Maybe you can try some of the above techniques (like positioning) even before you go into labor and see if that helps to turn her ahead of time. Heck- given my history maybe I should too! GL to you! I know it can be done (without pain meds no less if thats the route you were hoping to go!) and I know that you and her can get through this L&D just fine!

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Derek (DH), Derek II (DS), Sammy (DS)
Expecting #3 May 21st 2008

Allison Rene
May 13th 2008
7 lbs 6 oz & 20 in long

My two VBAC's were sunny side up. If it happens, I found the best place is bent over a shower seat, hot water down the back, and rocking. Alot of back labor, more than front, so tennis balls, massagers, anything to bring relief is great! Try to stay out of the bed as long as possible, and if there is a birthing ball, USE IT! My kids did not change positions (my hips are screwed, so I think it is the only way they can actually come out) but it made things so much easier. Avoid the episiotomy, if sunny side up, you rip more with it than without. Also, warm cloth down there applied as you are stretching helps you tear less, and perenial massage. That being said, yes I ripped pretty good, but it healed up quick, and barely bothered me. The squirt bottles with hot water are awesome for that! Best of luck getting baby to change positions. I am doing it again, knowing how baby is going to come out, so it is do-able adn once you hold your baby, it really won't matter so much about anything else!

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Ian was sunny side up. It was a lot of work and I did get an episiotomy, but it was fine. I think if they know, they can give you the episiotomy at the right time so that you don't tear. They're not that bad and heal just fine. I personally see no reason to make it a c-section b/c of that. JMHO

Good luck!

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Sounds like you are making some good progress and you had a good appt. Sorry to hear baby is sunny side up. So far, I've never experienced that so no advice here. However, it looks like others have given you some good advice and my fingers are crossed that this little one turns for you!! Good luck and KUP!!

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I have not had any experiance with this, but i wanted to tell you good luck, and hopefully one of those suggestions will work for you!

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No experience here, either bu tI will send some 'turning vibes' for you! ~~~~~~~~~~~

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Thanks so much for all the advice and encouragement ladies. It really helps a lot to know so many of you have been through it...and survived!! I am trying the different positions to encourage her to turn. Hopefully they will work. Thanks again, so much!!!

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Ann-Marie