Late engaging baby/Pushing on your back?

[Lucysmama]

I am just about 41 weeks pregnant. At my last prenatal, my mw told me my baby is quite high and not engaged. It's almost as if the baby's head is sitting in front of my pubic bone, instead of behind and under it. The baby is kinda hanging out in *front* of my pelvis. Make sense?

She says she has seen other mamas with this issue, and they usually have to deliver on their backs in order for the babies to slip below the pubic bone. I have never heard of this before! Anyone have this happen or hear of it? Did you have to deliver on your back or try many positions to get the baby to engage/ be born? Am I a total freak?

[PapayaVagina]

Do you know what position the baby was in? Anterior/posterior? That can make a huge difference in whether or not baby is engaging.

[CarrieMF]

Have you tried using a slant board? It may help bring the baby closer to your head then when you're vertical again it may drop behind the pubic bone.

[True Blue]

Katie -- I KNOW I read some stories somewhere...on this board maybe???...about women being told to get on their backs to get their babies out and the babies popping right on out! Maybe they were in a similar situation?

[Defenestrator]

Binding your lower abdomen from now until birth can help with this. A firm but not super-tight ace bandage, rebozo, or prenatal belly band will help direct the baby's head into your pelvis and allow for descent.

She is not entirely off-base. I have seen the McRoberts position (flat on your back with your knees up by your ears and your tailbone lifted off of the bed) work well to help angle the baby under the pubic bone when moms have poor abdominal muscle tone or the baby is leaning forward for whatever reason. If you have a posterior babe, though, it would be pretty excruciating. The other technique that could be used would be to get into a forward-leaning position and do belly lifts, either yourself, with a partner's hands or with a partner assisting with a sheet or rebozo. With the sheet or rebozo, someone would stand behind you and wrap a cloth around the front of your lower abdomen and then pull backwards and upwards while you have a contraction. The idea is to try and angle the baby into a more up and down position so that he/she can move down through the pelvis. This can be done while laboring or pushing.

Good luck!

[Lucysmama]

Thanks, guys! I didn't even think I would get any responses!

PapayaVagina - baby is left anterior, was left posterior/transverse for a few days, but went back to anterior yesterday with a lot of swimming and gentle encouraging from me.

Defenestrator - My mw recommended lifting my belly up and pushing it in manually. She recommeded actually binding the TOP of my belly to try to get the baby to move downward. (?) I haven't done that, because it seems like that doesn't make sense. I feel like the baby would then just be smushed even further in front of my pelvis. The lifting up and binding the lower belly does seem to make more sense. I do have poor abdominal muscle tone, maybe that has something to do with it? My muscles in my very low abdomen never really recovered from my cesarean. I actually still have pain/tenderness there almost 3 years later.

ANYWAY - I had a cesarean with my daughter, who also did not engage (she was right posterior and induced, though), so this has me a little freaked out that the baby may not fit down into my pelvis. But from what I am reading here and other places, the baby WILL fit, it just may take some tricky maternal moving and pushing. Is that right?

[Greaseball]

That happened to me! I started to push when I felt the urge but the baby's head didn't engage until 2 hours later. The midwives had me lie on my back and push, and it actually brought the most progress. The baby was LOA, but they said it was getting caught on the bone. I would push on my back in between pushing while standing and squatting. Finally she was born after pushing in a deep squat, but apparently all the back-pushing really helped her move down.

It was horribly painful, though. I could manage the pain while I was standing and walking, but when I had to lie down I just screamed.

[DaryLLL]

Me as well, with ds, #3. I had high riding babies each time. I labored/pushed in various positions, but this one really worked at the end when he was ready to come out. My midwife was also a Bradley instructor and seemed to know her stuff when she recced it. Worked like a charm.

Wit my 2nd I just stood up and delivered her that way. No so good, I tore a little from all the gravity. Basically just a labia skid mark tho.

Lying back I was able to ease him (#3) out, 9 lbs, no tears.

First one was a c-sec.

I think I have a shallow pelvis. There is just nowhere for them to "drop" into. I carried high and measured past dates.

[Lucysmama]

Ok, that is encouraging....

I am just afraid I will need another cesarean. I am not afraid of a long or difficult 2nd stage, but am petrified of the idea of another surgical birth. But hearing these stories from vaginal birthing mamas helps.

DaryLLL- I am also carrying high and measuring about 41-42 now. Baby's butt is only a couple inches below my bra!

[ckhagen]

I just wanted to say that I hope this works out for you!
DS was turned sideways (facing my left hip) and never engaged and I ended up with a c-section. So, I know how freaked out you must be. My situation was caused by an overabundance of amniotic fluid, so he was just floating around in there, never even dropped until they broke my water.

Gosh I'm hoping this goes good for you!

[wasabi]

All three of mine did not engage prior to me beginning pushing. I know the first and third were posterior and think the second may have been as well. I pushed in a sitting position with the first two (9lb and just over 10lb respectively). With my third she was supposed to be 11.5lbs. They were convinced she would be a shoulder distocia and they insisted that I push flat on my back. Then even ended up doing McRoberts which was incredibly painful and also involved someone pushing on the baby from outside my stomach while the OB pulled the baby out by the head as well as my knees being pushed all the way back to my ears. The midwife later said she had been stuck but she was born entirely on one contraction/four pushes. That does not meet even the conservative definition of shoulder distocia which is at least 90 seconds between the delivery of the head and the shoulders. Oh yes and she was under 10lbs! I will never push on my back again. My current midwife is horrified that they handled it that way and reiterated what I already knew which is that all research indicates that hands and knees is the best position for resolving SD and that sometimes just getting into the position is all that is necessary. Your issue is a little different but I would expect if the issue is getting the baby to drop into the pelvis you would want similar techniques. Good luck with it. I can really understand your frustration.

[DaryLLL]

I pushed for 45 minutes in various positions. I only got onto my back after all that and baby just zipped around my pubic bone and crowned in one push. It was so fast. I then had to breathe through a few to let my perineum and labia stretch.

I was not flat on my back, just semi-reclined with lots of pillows behind me, homebirth.

[Defenestrator]

Originally Posted by Lucysmama

I had a cesarean with my daughter, who also did not engage (she was right posterior and induced, though), so this has me a little freaked out that the baby may not fit down into my pelvis. But from what I am reading here and other places, the baby WILL fit, it just may take some tricky maternal moving and pushing. Is that right?

I have seen a couple of times where moms who had a history of being induced for post-dates (don't know if that was your reason) later had c-sections for cpd, then came to the homebirth practice I apprentice in and had babies who didn't descend until week 41, 42 or more. I wonder if these particular moms' pelvises don't relax sufficiently to allow the baby to descend until then. What would have happened if they were allowed to go into labor on their own the first time?

The binding recs I gave are to try and mimic the action of well-toned abs, so yes, the support would come from down low. I also don't think that binding the top of the abdomen would be helpful.

As far as pushing positions go -- you should still choose the one that works best for you and is comfortable. Midwives often will encourage moms to be upright and forward-leaning during labor, though, and with a baby whose head is forward of the pelvis or with a pendulous abdomen those positions can make things worse instead of better. I attended a labor last week in the hospital where the mom was pushing in a squat, on a toilet, on h+k and leaning over the back of the bed and had 0 progress. Only lying down helped her. The midwife on call wouldn't let me use a rebozo with her (I was her doula). I think that we could have done well with something forward leaning if we could have lifted her belly at the same time.

As far as McRoberts and the final part of pushing goes, you can always switch to another position as soon as the baby gets under the pubic bone and begins to stay down.


Good luck!

[Lucysmama]

Thanks everyone!!!

[Nelybel]

Oh I am soooo glad to see this thread. I've never heard anyone talk about this (or read about it) but I think this was the case with me last pg. I also ended up with a c/s (much unwanted). Ds was high, not engaged at all, no effacement, no lengthening etc at 40 weeks. My ob didn't mention any of these possibilities. I'm seeing my midwives tomorrow and will be asking lots of questions now based on this thread.

I've been so afraid this baby (due sometime middle-late Jan) will do the same thing and I'd never go into labor and end up with another c/s. I'm feeling encouraged but need to get more educated about this aspect of birthing (and hopefully my midwives do have some experience and knowledge of this.

Thanks again!!
J