Left Occiput Transverse @ 40wks

[WindyCityMom]

Does anyone have any information on the Left Occiput Transverse (LOT) position?

Basically, baby's head is in my pelvis, but she won't stay engaged.  Sometimes she's *really* low, other times higher up.  The back of her head is towards my left hip, shoulder/back area is in my lower left abdomen, and her butt is just below the right side of my ribcage.  All kicks are low and on my right side, near my hip, but I do occasionally get kicked higher up when she stretches out.

A quick search on MDC had people saying it was no big deal, that it was a position that some 40% of babies were in before labor.. but searching on google led me to other forums and sites that had people pushing for 2+ hours and needing c/s for deep transverse arrest.

Baby has had an unstable lie.. few weeks ago she was flipping breech every other day.  My DD1 (vaginal birth) was posterior.  She came out just fine.. almost flew out.  My DD2 was a c/s for frank breech (she flipped at 39 weeks, was transverse suddenly just prior) and an ECV failed.  Her butt was very engaged...

Anyways, I'm VBACing.  I'm dilated to a 2 right now.  I had my membranes stripped earlier this week.  Lots of bloody show.  When my midwife did it she said that my cervix was at a 1 but popped open to a 3 as soon as she started.  IMO, my cervix is just not dilating because the baby isn't putting the correct pressure on it.  

What can I do *now*?  I'm on a clock, I have a week left before my VBAC clock runs out.  I plan on firing/being fired by my midwives after that.. I won't RCS because labor hasn't started! 41 weeks isn't even postdates...   I cannot get to a chiro for adjustments/accu/moxi.. was thinking about homeopathic pulsatilla.  Not sure..  what about positions?  Will lots of belly dangling/crawling help?  I know inversions are good.  Anything else?  This is frustrating beyond belief.

Positive stories?

Any midwives or doulas out there see LOT babies born just fine?  I'm expecting a normal sized baby.. past two were 7lbs7oz at 42wks and 7lbs even at 39w6d.

[katelove]

IME most LOT babies rotate during labour. Deep transverse arrest happens but, again IME, is not that common. I don't know of any specific exercises or positions but anything which keeps your belly down and knees lower than hips will encourage an anterior position. And avoid things like deep squats which might encourage descent before rotation.

And, I know it's easy for me to say but try not to stress too much about it. It's likely to resolve itself in labour, especially as this isn't your first baby.

[WindyCityMom]

Thank you so much for your insight!  The fact that I've had so much prodromal labor just worries me.. my cervix needs this baby's head!

So... baby repositioned herself!  I believe she is occiput anterior (OA) now.  Really.  I did an inversion before I posted this thread.  Crawled a little, did a little knee-chest for a minute or two, crawled a little more.  Head was no longer engaged, so I laid back on the couch to see what she'd do (she was awake and active).  Huge lump (butt) surfaced and moved.  I felt her head turn in my pelvis, the tailbone pain was excruciating.  Once she calmed down I checked and sure enough, there's a head VERY low in my pelvis.  Heart tones are about 2.5" above my pubic bone, maybe less.  I'm going to hang out and bounce on my yoga ball and see if she'll engage and stay there.  I can only hope...

By morning it is likely she'll move back or pull some other shenanigan, but I am thankful that it only took a little coaxing on my part.

[katelove]

That's great! And, even if she does move again you'll know what to try to get her back again :-)

All the best, I'm hoping for a VBAC myself in a couple of months so I get the worrying and trying to optimize your chances.

[WindyCityMom]

It is frustrating.. I must have a very roomy uterus.

Best of wishes with your VBAC!

Everyone else, info on LOT is still welcome, baby is likely to be back in that position by morning, unfortunately :(  It will also be helpful for those searching for input in the future.

[womenswisdom]

I would not worry about it at all. I have seen lots of babies LOT prenatally and they have all rotated and come out just fine. No DTA. You know that she can rotate now, so I would just leave her alone. Especially with an unstable lie, I would be very hesitant to do any inversions, however. You don't want her to flip breech or transverse. ETA: Normal descent and rotation start with baby's head in a transverse position which then rotates to OA once it is deeper into the pelvis. So this is really, really not a problem
Edited by womenswisdom - 9/15/12 at 7:32am