For some reason I remember reading this somewhere but I don't know if it's true or why. Is one better than the other? and why?
post #1 of 23
1/16/07 at 2:27am
|The ideal/easiest position for birth is generally LOA (Left Occiput Anterior), with baby facing the mother’s back, chin tucked under, head looking slightly towards the mother's right side and the baby's spine along the left side of the mother's belly. A baby that is ROA (Right Occiput Anterior, or back along the right side of the mother's belly) can also be delivered fairly easily, but has a distinct tendency to flip into a posterior position before or during labor.|
I think that for first-time moms, it matters more. I've seen plenty of ROA babies born, but usually to moms who have had babies before. The typical rotation of the lower uterine segment turns the baby clockwise - therefore a baby on the right has a higher chance of being posterior and being forced down and engaged posterior rather than turning to LOA.
But I've seen ROA babies born to women with babies before - and I'm sure to some first-time moms, too. I just like to get those babies of first-time moms turned to LOA prior to labor...but then again, I have a huge issue with malpresentation. It is something the universe is helping me with.
I would add--a nicely flexed, OA baby *who is not wrapped up in the cord and/or sucking thumb/holding onto their ears at birth*!
|For some moms, it seems that movement and/or fairly frequent position change is what is needed to aid baby's descent (such as hula or stairwalking, or the series' of repositions every few ctx, as suggested by Simpkin in Labor Mgmt Handbk). For others, seems to be more about mom finding one or 2 positions that she sticks with as long as possible (usually where ctx are strongest, but mom can also relax fully while baby continues to sound good--often, sidelying). This is discovered in process by trying different things and seeing what works.|
I tend not to look at the ROA baby during late pregnancy as a problem or potential problem. It is true that some ROA babies shift into OP, on their way to LOA prior to delivery (possibly during labor), and that some 'get stuck' there, contribute to more pain and so forth. But I have only seen this be a problem once myself, and that was for a mama who not only was under monumental stress during her pregnancy--which I repeatedly warned her was likely to make labor relaxation/efficiency much harder to come by-- but she also had a prior back injury and recurrent pain issues w/that (something she failed to tell me until many hours of excruciating back labor, btw. We transported for epi, she had her baby vaginally many more hrs later). Most often, these ROA babies rotate before or during labor without major issue--or are born straight ROA.
I think positioning has a lot to do with baby's size and shape as that relates to mom's individual pelvic size and shape (possibly placental position enters in as well). Especially for moms who are at least moderately active (not total couch potatoes!), I tend to trust that there is a good reason for baby's chosen position (even if I can't know that reason for sure myself), and I also tend to trust that mom and baby can do their birth dance perfectly well for birth to be accomplished safely and within mom's limits of stamina and so forth.
During late pregnancy when we see that baby tends to be ROA, OT or OP, moms often wonder if this means she'll have an awful labor, wants to know if I'm worried or if she should do anything to 'correct things'. Certainly I'll mention spinningbabies, and speak of the importance of movement/exercise, maybe chiropractic and maybe stress reduction if either of those seem to apply--but I also speak of trusting the process, trusting herself and baby to do this dance just right. I talk about the fact that it IS a dance and an ongoing process, that she and her baby CAN work together toward the baby finding it's way out--that neither she nor baby are passive recipients of fate, but active players all the time. That they are active players even if she doesn't 'know what to do' intellectually...that she and baby are always doing this dance. And I ask her to pay attention to the small things like what moves or positions she seems to really like--to listen to those cues and trust that she can be guided at a body level if not an intellectual one. I remind her that every labor is different, that its possible this labor will be longer or 'harder' somehow--but that we (her dp, myself, others invited) will be there doing what we can to support her work with food, drink, massage, encouragement--whatever support she may want/need at that time. I also suggest she talk to her baby about all this, and send the baby verbal and/or visualized requests to get itself positioned 'best for motherbaby' (and/or to pray, as may apply more for some women).
I'm not saying that there is, or never should be, any birthing difficulties brought about by malpositioning. I am saying that I think HCPs worry way too much about this, and that that worry is not helpful to mom or process. I am saying that while it is observably 'true' that LOA is the most common and seemingly 'optimal' fetal position, the range of normal is wide indeed--and nothing is 'optimal' for everyone in the world. Finally, I am saying that when we trust women, babies and birth--and when we focus more on the basics of birthing support (food, drink, rest, peeing, comfort measures) than we do on position worries--we are most likely to see births go just fine even when 'malpositioning' is in play.
And I don't like that word! "malpositioning", which means bad or even evil positioning. That word--just like 'physiologic ANEMIA of pregnancy' or physiologic JAUNDICE of neonate'--implies wrongness and something to worry about. Maybe we need a new word, to help remove the negative charge around it that really does nobody any good. I'm not talking about playing pretend here--but about influencing our own realities as moms and mws, by choosing another way to grasp, understand and support 'non-LOA fetal position alternatives' ( hmm, no cute acronym there, I'll have to think about it more).