What do you usually do with a laboring mom with an OP baby?

[Gilby]

I have seen so many OP labors lately and birthed an OP baby myself. I'm wondering what you as a midwife or your midwifery practice usually does with an OP baby.

Do you let nature take it's course? Do you try to speed labor as OP labors can be quite lengthy? Do you attempt to turn the baby in some way during labor? Do you have a standard sequence of actions? Herbs, positions, drugs, maneuvers?

I'm wondering because the mothers and midwives I've worked with seem to spend the whole labor focusing on this aspect of the labor/birth and wondered how 'big of a deal' (for lack of a better word) this is for most midwives.

Thanks!

[birthdancedoula]

Most OP labors I see the midwives use a belly binding technique to encourgae baby to turn. That and positioning. Most times it works.

My first was OP and my mw didn't do anything. Didn't make any suggestions at all. It was hellacious. Gosh, knowing then what I know now:.

[ldsapmom]

My second baby came out op. Funny thing, I never had ANY back labor -- none. Now he felt like he was grinding into my pubic bone, but I didn't have any back pain. His labor was 8 hours from start to finish, too, so not long.

His brother, my third, was in OP position, and I did have some *mild* back pain. He rotated during a lunge and was born 2 contractions later, but was smaller (8 pounds, 2 ounces, compared to OP-born baby's 9 pounds, 9 ounces). 6 hours of labor from start to finish.

As a doula, I just try to get mom to change positions to help open the pelvis or get gravity to back-off for a while and hope for a realignement.

[sweeetpea]

If the position is not causing a problem, I recommend just to let it be.

If the labor is slow to progress, and mama is getting very tired, or being threatened with pit or other interventions and/or if the back labor pain is unbearable, I help mama use positioning to try to spin baby. Side lunges, stair climbing (or step aerobics if stairs aren't available ), belly lifts, pelvic rocks have all worked for various clients to shift baby and jumpstart a slow labor.

[Carolinamidwife]

ETA: This is a midwife POV... sorry if you meant this for doulas!

I strongly encourage moms to start working on optimal fetal positioning before labor begins and then strive to maintain an OA position. Not only can the labor take longer but the pushing can take longer (a negative if you are in a hospital and likely to result in a vacuum happy OB).

50% of transports I have been on have been due to suboptimal fetal positioning, I do consider it fairly important. Not a deal breaker, obviously, I caught an OP military presentation baby not long ago so anything is possible.

[sevenkids]

I don't think OP is a malpresentation.....often it's the best way for a baby to fit into the pelvic inlet, and most spontaneously rotate to OA once they navigate their way into the mid-pelvis. Sometimes a low-lying, anterior placenta will keep the baby OP until baby works it's way down, or it's the shape of moms pelvis and/or baby's head. IF it's causing a lot of back pain, then we focus of relieving the pain with counter-pressure, positioning, heat or cold packs, sterile water papules....

Prenatally, I encourage good posture, a nice, wide support belt, and regular chiropractic visits, to minimize mamas discomfort but I'm not fanatical about actually getting baby to rotate until everything lines up.

But I don't find OP that babies give that much trouble in labor, it's those little thumbsuckers with their heads tilted to the side, OP or OA, that have a hard time moving down and cause all sorts of pain; back, hip, and pubic.

[Carolinamidwife]

I never said it was a malpresentation, just suboptimal. It's so interesting how we all have such different experiences.

[durafemina]

student midwife here, and just had an OP labour 7 weeks ago. We used lots of positioning, hip squeezing, water and TENS for the discomfort, patience, and homeopathic pulsatilla 200c. Dd turned from ROA all the way around to LOA and it took all night, but after that the 2nd stage was super fast (and she was my first).

I also don't see it as a malpresentation - just the route that particular baby needs to take and with patience and support can!

[BirthFree]

I try to get baby to turn. The majority (over 90%) of our ICAN Moms here had OP babies for their cesarean births. I know it can be done but it takes a lot longer and a lot more work generally. I figure if a baby won't turn, that's totally fine, but I give it a good shot to see if we can get baby into an easier birth position. I don't freak out about it, but definitely show Mom of some good positions to be in (usually tweak something she's already doing) to encourage baby to turn.

I have Penny's Labor book and it has good pictures, thoughts on how to turn an OP baby. I keep it in my doula bag. It's a LOT of info, but if I need refreshers or to show the family what I mean, I take it out.

It's worth the effort and focus very often. Sometimes it's not, but I've seen it be a serious issue esp. with first time Moms so I think it's worth the energy to get baby to turn if at all possible.

[mwherbs]

some babies fit best OP

we recommend mom walk- walk daily and in labor- there are studies that show that a good number of babies at some point in labor will be in OP position and that only a % of babies who start labor OP will persist in that position.

many use hands and knees but with the spin that a baby makes lying on one side or another may also benefit.

I also like belly banding - sometimes a baby turns inward so that it is not in an uncomfortable position that is hard to maintain (lax abdomal muscles can allow an OA baby to be doing basically a back bend)

persistent OP is more common in births where mom is given something that will change the baby's ability to think and move and the other way drugs effect a baby turing is that mom's muscles are loosened and change maternal landmarks babies turn in response to resistance - so once they come to certain areas and meet resistance they change direction-- babies even do this after they are born that is why crib bars have to be very close together because a baby will push against the bars and then actually twist and turn to fit through but if the muscles are loose or baby's thoughts are impared harder to navagate through

[sevenkids]

so once they come to certain areas and meet resistance they change direction-- babies even do this after they are born that is why crib bars have to be very close together because a baby will push against the bars and then actually twist and turn to fit through

Good observation! It's true, I never thought about that. I'm filing that away to tell moms in labor!

[Meche]

As a doula, I encourage proper posture and cat/cow exercises prior to labor. In an OP labor, I would suggest hands and knees position, sitting on birth ball and I use peppermint essential oil on the lower back to encourage baby to turn, if it would. If not, then maybe baby wasn't meant to come out OA.

I've had a back labor myself and attended a client with an OP/face presentation. Both were hard but do-able without drugs.

[ldsapmom]

I remember reading a statistic that only maybe 5% of babies are born OP -- that a large number turn.

Being an OP mom who birthed a 9 and a half pound baby with a 90 minute second stage, but an overall about 8 hour labor, I knew it wouldn't be the wprst thing if my next baby were OP, but I also felt in my gut, if he were in the right position, he would come right out. He did maintain an OP position for most of the 6 hour labor, but then I did a lunge and he literally "fell" into an anterior position. And like my gut feeling, he was born in 2 contractions, which, having a 3-hour+vacuum-assisted second stage with baby #!, and the 90 minute, hellacious second stage with #2 (hellacious because it hurt every.single.time I pushed), it was such a pleasant experience.

I knew I had birthed one baby that way, and my body might just settle them in OP (despite my attempts at OFP). I wasn't scared of having another OP baby, I just felt I could do it even better/faster if he were presented in a more optimal position.

I would encourage that positive energy, to not be afraid, especially during an active birth, but to have the faith that the baby will come out in the right way for him and mom, and that their bodies aren't doing anything wrong.

[mwherbs]

ldsapmom wrote>>>>>"I did a lunge and he literally "fell" into an anterior position."

ah yes, I forgot lunges they can make a difference.

[Gilby]

:
This is all fabulous information!

[ldsapmom]

Originally Posted by mwherbs

ldsapmom wrote>>>>>"I did a lunge and he literally "fell" into an anterior position."

ah yes, I forgot lunges they can make a difference.

On his brth video, you can hear my midwife say to my doula, "Have you ever seen a baby turn that fast?" to which my doula replied no. Lol. She told the midwives in her practice, and from every birth after that until she retired, she would have mom lunge at some point (if mom did not have an epidural).

[kltroy]

Originally Posted by ldsapmom

On his brth video, you can hear my midwife say to my doula, "Have you ever seen a baby turn that fast?" to which my doula replied no. Lol. She told the midwives in her practice, and from every birth after that until she retired, she would have mom lunge at some point (if mom did not have an epidural).

Ok help me here - what sort of lunges? To the side like you're just stretching your inner thigh muscles? To the front? This is a good tip that I want to file away - my first baby was breech so I've been thinking happy vertex good-positioning thoughts this pregnancy

[ldsapmom]

I was out of bed, holding a handle at the end, trying to squat. One thing I have noticed with my OP babies is not really back labor, but frontal pain, in my low belly -- that's where my pain centers. So when I squatted, I quickly realized that was NOT going to work for me. I immediately stood up. I was still in a contraction, so I was pushing in a standing position. My midwife quickly popped a foot pedal our of the bed, and I raised my left leg about a foot and a half off the floor to the pedal position, and that's when my pelvis opened wide enough to let him turn and drop.

Kind of like the picture here (b), where her foot is up, except my foot was on a pedal-rest-thing. Also, picture her turning her upper leg to our left, so her legs are essentially apart. Does that help? I can't really find anything else to help show it. http://www.prevention.com/images/cma...view_lunge.jpg

Here is another picture. Under "Positions for Being Active During Labor" you see the lunge in the second frame. Just like that . http://www.transitiontoparenthood.co...rs/arthome.htm

[kltroy]

Very helpful. Thanks! Definitely filing that tip away for my labor

[attachedmamaof3]

Just want to throw out there (as a mom who apparenly ONLY births OP babies ) This may be the way some mothers birth!

All 3 of mine were born OP. I had no real issues except persistant back labor (manageable). All my labors were fast (last 2 precipitous) but with no real "pattern" to my contractions. (in fact, 2nd was a UC because labor went so fast MW didn't get there in time) 15 min 7 min 3 min 6 min 2 min 5 min then WHAM pushing urge!

My MW stated that she believes this must be the way I'm built or the way my babes feel most comfortable.

1st labor- OP (internal version turned from transverse)- 7 hr labor
2nd child- OP two nuchal hands-2.5 hrs (almost born in caul)
3rd- OP-2.75 hrs

I also tend to birth standing/leaning or squatting and spend most of my labor on all 4's rocking or squatting. My DP pounds the crap out of my back and we make it work!