Posterior birth -- insights, birth stories, pushing positions, etc.?

[lunita1]

I'm pregnant with #4, and I've been thinking a lot about my second daughter's birth lately. She was posterior, and it was by far the most dramatic of my labors. It went relatively well, but it was different than I would have chosen and I still second-guess my own decisions and the actions of the midwives who attended my birth (CNMs at a low intervention, baby-friendly hospital). I think it's worth revisiting because my brother and I were also born sunny-side up (2/3 of my mom's births) so I suspect there's some kind of anatomical/inherited tendency to carry our babies that way and it's something that might crop up again with this baby.

First, no one told me she was posterior until it was time to push. I'm not sure why? It frustrated me, because I had worried a lot about posterior births, researched a lot, and learned a lot about birth positions, labor positions to turn a baby. I would have worked harder during labor (spent more time on all fours, etc.) to turn her if I had known she was posterior again. A few days before at my prenatal, she had turned anterior.

She was still at -2 when I was fully dilated. My bag was also intact, and I asked the midwife to break my water, thinking maybe that would help her descend. Bad call, especially since she wasn't engaged (cord prolapse risk??)

The birth tub made my body temp rise (is that common? is it a sign that the water temp was too high?) so they asked me to get out. I was in transition and I have a very hard time getting from one place to another in transition, so I ended up staying out of the tub from that point on.

My midwife decided to try a flat on back, hyperextended (or something like that? I think my hips were elevated or something??) position for pushing, because she thought that would help dd get past my pelvic arch. I started pushing before fully dilated and before baby was engaged. My midwife held my cervix back and it was basically directed pushing. It was really an awful, painful pushing stage. I don't think I had a true urge to push but the back pain was so intense at that point that I just wanted everything to end (as I pushed, I was quite vocally telling my daughter to get the heck out of me. LOL). She came in about 45 minutes or an hour, which I know is relatively fast but in contrast my first was only a 20minute pushing stage and my third came out in a couple of quick pushes..

I can't recall reading other women's birth stories involving pushing when baby wasn't engaged. Was that just a really weird thing to do or is it more common than I realize? Is the pushing position the midwife recommended for a posterior birth something others do commonly? In contrast, I pushed my #3 out from a fully standing position and my first was sitting up, legs held back.

Anyone else have posterior birth stories? Input? (I'd love midwife/doula insight, but I know I'm not supposed to post this in the birth professionals forum.)

[AutumnAir]

I don't really have a lot of insight for you, as I ended up being forced to transfer and DD was yanked out with forceps.

But I can share some of my experience. DD was my first (and only so far) and she went pretty late (43+1 weeks). Looking back on it I should have realised something was off, because my waters leaked quite a bit, with a few hours of mild-ish contx, but then resealed 5 days before she was actually born. (I also think my midwife should have given me a heads-up that likelihood was she was malpositioned from that clue, combined with the longer gestation.)

When contx started for real they were 'normal' for the first few hours. I'd been in the hospital all day being bullied for going so late and had sort of noticed some then but was too busy trying to get them to leave me alone to really pay attention. By the time I got home and sat down and really started to notice them they were already about 5 minutes apart and 45 sec.-1 min long and I was starting to have to concentrate to get through them. Textbook thus far. That went on for about 6 hours with contx. gently ramping up in intensity, but about midnight all of a sudden something changed - I think DD turned or wiggled herself into a particularly bad position - but from then on the pain was incredibly intense, and even worse I had absolutely *no* break from it for the rest of the labour.

That actually made it really difficult for me to cope with, because I didn't have any time to regroup, breathe, eat, drink, try to move or anything. I couldn't talk really at all and was a bit worried because nothing I had read prepared me for the possibility that there wouldn't be any breaks between contx. I never felt worried about DD, but started to worry that maybe I was just a total wuss and not coping properly.

By the time the MW arrived at 8 am I had been in labour that I noticed for about 14 hours, 8 of which were this whole-body, non-stop pain. She checked me and I was 8cm. 2 hours later I was 10 but with a lip. She never did or suggested *anything* that might help resolve that lip, despite me labouring for another 4 hours without a pushing urge. That's when she finally got totally fed up with me and bullied me into transferring to the hospital where they immediately delivered DD by forceps without so much as telling me what they were planning to do, let alone asking for my consent or giving me any pain meds. I highly doubt there was any good reason to do this, as DD's apgars were 8 and 9, but I did discover from deciphering the hospital notes that DD was posterior and asynclitic.

I know each birth is different but I am also very worried about having a similar problem next time.

Like you, part of my problem was that I didn't *know* that DD was posterior until after she was born when there was nothing I could do about it. If I or the midwife had realised it earlier there were plenty of things that we could have done to try to sort things out - like rebozo sifting, belly lifting, position changes, going up and down stairs and, as a last resort manual dilation of the cervix, which is what your MW did, and what was done to me in the hospital just before they used the forceps.

So, I think my first concern is being able to recognise it myself - it was always described to me as 'back labour' but honestly what I felt wasn't localised to any particular area of my body - it really felt 'all-over'.

Oh, another thing I remembered - DD was having small variable HR decels during labour which the MW used as a tool to bully me into the hospital, but on researching it afterwards I discovered that posterior babies very often do have variable decels and they are not correlated with any negative effects (in other words it seems to just be normal for posterior babies and doesn't do them any harm).

I also think having a premature pushing urge is common with posterior babies, which sounds like what you're describing, sort of... I never got a real pushing urge, though I did 'think' about pushing a few times and tried it sort of half-heartedly, but it never seemed to go anywhere, and I was afraid of swelling up my cervix and was waiting for the fetal ejection reflex - though maybe you don't get that with posterior babies?

I don't know the specifics of your situation, but having you push flat on your back sounds counter-intuitive especially since posterior babies are presenting the wider portion of their head so you need even more space and I would assume that you'd need all the flexibility you could get for your pelvis to expand.

Anyway, not a lot of advice, but just to let you know there's someone else out here who's thinking about the possibility of another posterior baby and what could be done better next time round.

[Astraia]

DD was posterior and asynclitic for at least a chunk of labour. The midwife tried to turn her at one point and it didn't work.

My labour was pretty normal- mild contractions for 4 hrs, active labour for a total of 8 hrs (which included the 2 hrs pushing).

For labour she had me changing positions regularly. She also never told me she was posterior. I knew that hands-and-knees was most comfortable for me, but I didn't have backlabour and other positions were bearable so it didn't really click for me.

I started bearing down a tiny bit at the peak of a contraction when I was 10 cm with an anterior (I think anterior?) lip. MW had me start full-out pushing then which was... well, sucky.

I pushed in a variety of positions- side-lying, toilet, birthing stool, hands and knees, and lying flat on my back. I hated the squatting positions, it sent shooting pains up my thighs and hips. I really didn't like being on my back because it took so much effort to lift my head and shoulders off the bed. I liked hands and knees but was only "allowed" a couple of contractions like that because I didn't push as effectively that way. I delivered on my back.

I assume she was worried that due to DD's position I'd have to push long and hard to get her to move past my pubic bone. Not sure how true that is... But labour was moving along at a good rate, I was dilating normally, I wasn't in a lot of pain, I wasn't tired or coping poorly or anything so there really wasn't a big rush.

I really would have appreciated knowing she was posterior. There are a lot of things you can do to help change positioning- rocking on hands and knees, climbing stairs, etc. It might have changed the pressure to push, I might have been given more freedom to assume positions I wanted instead of being moved at the MW's discretion. Or maybe not. Who knows?

[Plummeting]

I guess I was very, very lucky. DD was posterior (and born sunny side up, so never turned) but I really had a short, uncomplicated labor. I also didn't know DD was posterior until probably 90 minutes before she was born. My water broke at 2:30 am, but I didn't have any contrax. I went to the hospital around 5:30 or 5 and had an enema to start labor around 8:30. (I had said I'd like to try nipple stimulation instead, which my m/w was fine with, but the nurse misheard and brought the enema and I was really scared of being induced, so I just let her go ahead and give it. Wouldn't do that again. lol)

Contrax started at 9 and were manageable until maybe 11:50, at which point there was no break in between at all and I felt like I was going to be the first woman ever to birth a baby through my anus, because the pressure there was soooo intense. I didn't have back labor. I had butthole labor. That was when the m/w told me DD was posterior. I went from 4-10 cm in about 30 minutes, when I started feeling what I guess probably is fetal ejection reflex, if that's a real phenomenon. I just felt DD being pushed out, but it wasn't by me. I didn't know what was happening. I had to convince them to check me again, because they'd just checked me 30 minutes ago. When they did, I was 10 and they told me to push. Once I started pushing I never felt any pain with pushing other than at crowning. No contrax pain or anything, though. DD was born after 30 minutes of pushing. I will say I never felt any urge to push. I just did it because it felt better than that feeling that my insides were pushing her out without my assistance. That was unpleasant to me. Oh, and I pushed sidelying. There was no way I could've done it any other way - it hurt too much.

Anyway, so I'm not sure if you were looking for positive posterior stories, but I did have a good experience, if that helps you feel any better.

[LavenderMae]

My youngest was posterior. My labor with him was very intense but also very short (just under 30 min) but I had weeks of prodromal labor though. I did try to to turn him when I realized he was posterior but he was already tightly engaged at that point. He was born in one push so I guess not the norm for posterior babies, I pushed kneeling on the floor. I didn't purposively push my body just did it (that's the only way it's ever happened in all 3 of my births), I actually wish I could have slowed it down. I did have back labor and it was quite painful and sharp, my after pains were the same.

[earthyamber]

My youngest was posterior and it was tough. My midwife tried to turn her the day before labor but she wasn't moving. That night I took a castor oil mix to start labor and wen't into labor in the morning. Total labor was 4 hours. I stood and rocked a lot, walked outside, squatted. For pushing she had me on the bed (she said it would help). I tried pushing but I quit because the pain was sooooo terrible and she was nearly out and it burned so bad (I panicked and it was not a good time to panick). My midwife then told me sternly that I had 5 minutes to get her out or she is calling an ambulance and I was going to the hospital. That scared me and I got her out in 2 minutes (total pushing time was 40 minutes)! She was a huge baby at 22 inches and 9 lb 15 oz and she was born posterior. It was a painful birth but I was happy she came out okay and I didn't have to transfer. Overall it was a good birth experience given her position and size.

[nikirj]

DS was posterior. We didn't know for sure until he came out that way. But my labor pattern was super funky (it seemed like I was in good labor, and then it just backed off...a HELLISH ctx every hour or so for about 10 hours, and then out of nowhere I hit transition). It took just two pushes to get him out. For some reason I arched my back pretty significantly on the first push even though I was on my back, which might in some way have helped him get through (I can't visualize how that would have helped, but it did work). I probably pushed past at least a little cervix, because about 10 minutes before I started pushing I'd had an exam and was supposed to be 7cm. Nobody had hands in there while I was pushing, though (they didn't have a chance I suppose), so I don't really know.

It was an easy but confusing birth after the textbook labor and birth I'd had with my first baby.

There was no good reason for him to be posterior. He was bigger than the girls, who were both born anterior and after much shorter labors. Actually, maybe living in a computer chair that tilted backwards for most of that pregnancy was the culprit, since I had posture-enhancing seats while I was pregnant with the other two...who knows. I just know that labor was more painful and longer than the other two, but that at this point it's more a curiosity than something I'm upset about.

I was trained as a student to notice posterior positions and nuchal arms towards the end of pregnancies and give parents resources to help get babies in better positions. But if a baby was positioned well at the last check and nothing in labor suggested otherwise, I'm not sure I would have specifically checked in labor (palpation isn't so comfortable then) until I did a VE (and even then I wouldn't be too pushy about it unless I already had suspicions).

[beckyand3littlemonsters]

all my babies have been posterior position and all my labours back labours actually when caden was lieing the "right" way at one point in my pregnancy i started worrying that i wouldn't know when i was in labour if i didn't have a back labour, i know probebly sounds daft doesn't it.
staying off your back whille in labour is a must imo as being on your back makes the pain worse, also being upright when pushing helps.