Is LOA better than ROA? - Mothering Forums

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#1 of 23 Old 01-16-2007, 02:27 AM - Thread Starter
 
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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?

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#2 of 23 Old 01-16-2007, 03:16 AM - Thread Starter
 
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I just found this on plus-size-pregnancy.com

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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.

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#3 of 23 Old 01-16-2007, 11:17 AM
 
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I don't disagree with LOA being better than ROA and more likely to be anterior, but I know plenty of ROA babes that were born anterior (mine included).

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#4 of 23 Old 01-16-2007, 02:35 PM
 
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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.
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#5 of 23 Old 01-16-2007, 06:35 PM
 
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Hey Pam I promise to make sure and emphasize Optimal Fetal Positioning like from spinningbabies.com in my future classes. And possible "early bird" classes to help imform moms how to avoid some of those stupid tests and Toxemia.

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#6 of 23 Old 01-17-2007, 08:06 PM
 
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LOA is considered optimal because of the way the baby rotates when it descends. the majority of babies rotate clockwise. an LOA baby is more likely to remain anterior. an ROA baby is more likely to spend some time in the OP position (see Human Labor and Birth). however, i really think it depends on the mom's pelvis in the end. I've given birth to 2 LOA babies and one ROP baby. the ROP was my third, and i did have a period of a couple of hours when i stalled out. i am pretty sure she was making the long arc rotation during that time. or maybe she just wanted to be born in August instead of July


oops i just read that someone else already said basically the same thing..
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#7 of 23 Old 08-08-2008, 08:41 AM
 
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Originally Posted by pamamidwife View Post
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.
It's interesting to hear your opinion pamamidwife, especially in regards to first timers.
Do you believe that is because the uterus of a primi is more likely to be tighter and less likely to allow the baby to rotate straight from ROA to LOA, or rotate much at all?

How would you help a first timer whose baby was always ROA / ROT during pregnancy?

I am really concerned about this, mine is like that, I can not get it to move to LOA. I think my placenta is also on the left anterior side and that might make it even less likely that the baby will go there with it's back ..
But in general, it's never getting it's back away from my right side, no matter if I lie down on my left side, sleep on my left side, do pelvic tilts and stuff.
It's not moving much at all except streching it's legs into my left side sometimes from what I can feel.
I know as a first timer my biggest worry should statistically be a dystocia and malpositioning issues and I would appreacite any tips you would give me if you were my midwife what I can do to make this baby try and move more, try to get it OA or LOA. I tried swimming, pelvic tilts, inversion, massaging it trying to push it over, visualization .. the back seems like stuck on my right hand side ...
I tried to drink a lot of water, keep well hydrated, and I usually drink a lot of water as it is .. trying to make sure I have a lot of amniotic fluid so the baby has more space to swim in, but in general I measure small and didn't show much, my belly is still quite small now at 35 weeks. I can imagine how it doesn't have much space to shift around ..

I would be very interested what you would tell me to try,
thank you so much!
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#8 of 23 Old 08-08-2008, 09:40 AM
 
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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).
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#9 of 23 Old 08-08-2008, 10:23 AM
 
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I'm agreeing with Ms Black, I believe that babies naturally tend to lie in the position they need to be in in order to work their way through the bones and get born. There's so many variations in the female pelvis that believing there is only one optimal position for babies to be born is scary to those who's babies present in anything but. ROA and ROP and whatever not LOA are not bad, evil positions, they're just positions. I've seen many babies come down ROA and do a full arc rotation at crowning. very cool. I've seen babies that needed to rotate to OP in order to fit through the pelvis. Yes, sometimes babies in another position may bring about a longer, more painful labour, but it's usually for a very good reason and is just what is needed for the baby to come out.
It's funny that we keep saying "breech is a variation of normal" but panic when baby is anything but LOA. I'd much rather see an LOA baby than a breech!

Asynclitism, with thumb-suckers and compound presentations all wrapped up in one, seem to be all I get these days. Can't tell when last I've seen a nicely flexed, OA baby.
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#10 of 23 Old 08-08-2008, 12:10 PM
 
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Sevenkids said--

"Asynclitism, with thumb-suckers and compound presentations all wrapped up in one, seem to be all I get these days. Can't tell when last I've seen a nicely flexed, OA baby. "

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*!

And thanks, sevenkids, for your affirmation of my thoughts on this. Didn't think everyone would agree, but I did hope *someone* would!
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#11 of 23 Old 08-08-2008, 12:53 PM
 
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Originally Posted by MsBlack View Post
Sevenkids said--


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*!
As I spit between my fingers "phtooy phtooey!!" and throw salt over my shoulder! Last 2 births had a nuchal cord, one was twice around the neck, once around the shoulder, looped under the arm and once around the ankle. Yikes! It was like unwrapping a present.

The other was three times around the neck and nicely wrapped around the belly. Loong cords!
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#12 of 23 Old 08-08-2008, 12:58 PM
 
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Could there be a connection between women being told to lay on their left sides and ROA being more likely to switch to posterior?

Heh. Or not... babies turn because of the uterus. That's kind of cool. I though they turned because of the funneling of the pelvis which should be the same on both sides.
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#13 of 23 Old 08-08-2008, 01:41 PM
 
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MsBlack and Sevenkids, are your births primarily homebirths?

I ask because as a doula who is fairly well educated on OFP and I will disclose up front it is a passionate topic for me, I see far more problems with ROA babies in the hospital/medicated/epidural restricted movement population.

I don't worry so much about fetal position with my birth center or homebirth clients as we have planned for freedom of movement and we move and navigate the labor as nature dictates.

However, in the population stuck in bed on fetal monitors, with pain meds, AROM and epidurals I see far more problems with ROA babies, especially in first time moms, turning OP and often see quite the stall as baby tries to complete the turn from posterior back to OA on the left side during the later stages of labor or even during pushing.

As MsBlack discusses her asynclitic babies and babies wrapped in long cords and sucking thumbs and holding ears I have to say in the typical hospital population I don't often see that. Of course we know the asynclitics usually wind up born by surgery, and my guess is the others are sedated by the meidcations their mothers have taken which would explain a lack of active participation from baby in the birthing process that we often see in their unmedicated counterparts.

Just my .02

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#14 of 23 Old 08-08-2008, 02:37 PM
 
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April--

all homebirths for me, apart from occasional transport which I will accompany/support--but these are few.

Yes, restricted movement and reduced (or eliminated) sensation, due to EFM and epidurals/other meds would surely make a huge difference in these 'alternate presentation' births. Not to mention that as long as I have a mom who is fed, hydrated and such, and whose state of mind is therefore not being compromised by physical exhaustion/deprivation, we have as much time as we need. Not that I often see births that go beyond 18-24hrs (rarely), but if one does go into a 2nd or 3rd day then there is no need for worry. And except for really unusual situations, in my experience when mom is doing ok then baby is generally doing ok too.

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.
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#15 of 23 Old 08-08-2008, 02:51 PM
 
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Sapphire Chan said:

"Could there be a connection between women being told to lay on their left sides and ROA being more likely to switch to posterior?"

I think this is possibly a very good point. I often hear mws recommending this when baby is ROA in late pregnancy and early labor--in a pre-emptive attack on OP labor, as it were. But that seems to be based on a belief that ROA babies *need* to shift to LOA to birth right, or that they *will* shift to LOA eventually--so we will just 'help' that along. And it's also based on a fear of what some think of as an evil presentation, one prone to problems for all concerned.

Yet the woman who is asked which positions feel best to her, who is encouraged to trust that she can instinctively serve the birth dance without being told how to do so, is the woman who might not choose left side-lying at all.

I even suggest recliners for sleeping, to women with severe SPD pain that prevents good rest! I know this is practically heresy in the face of the theory that reclining may contribute to malpositioning...but getting good sleep and later having the energy to deal with a possible OP labor is in my mind FAR preferable to growing exhaustion as labor approaches. Funny thing--none of the handful of women who have spent their last 4-6wks sleeping (well!) in a recliner, had any position problems. And approached labor well-rested and in good cheer.
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#16 of 23 Old 08-08-2008, 06:24 PM
 
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I totally agree with MsBlack

I really don't like the term 'malposition' for OP babies. It implies that they are in a 'bad' position, which I have a hard time coming to terms with. As Gloria Lemay says, I think the whole positioning thing has become a 'thought virus' that has taken over parts of the country. I've seen pregnant moms terrified of having a posterior baby, or convinced that their baby is on the 'wrong' side if their baby is ROA.

I'm not trying to imply that posterior babies do sometimes lead to painful, longer labors. I had one myself. But, I also know women who have had babies born posterior (they didn't rotate anterior during labor), that have fast, straightforward labors.

I just really don't like telling women that they need to 'do' something (OFP) to get their baby into the 'correct' position.

(Just as a disclaimer, my experience is based on homebirths, as well)

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#17 of 23 Old 08-08-2008, 06:31 PM
 
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Yes, home births. Of course, if a mom isn't moving it's going to make a huge difference in how easily her baby comes out.

Quote:
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.
Could have written this myself. Sometimes, as sucky as it sounds, it's the position that's the least comfortable that works the best. I also find that rocking mom gently, while she is left-side lying, often helps the baby rotate, and many moms find the rocking motion very comforting, even during a strong, hard contraction. Even suckier, sometimes semi-fowlers, with legs resting wide on pillows, helps the baby descend and rotate and be born quickly after. Sometimes, there's a point in labor when mom has to stop worrying about being comfortable and submit to the strength and power of the labor. As my good friend and three time client says, "Let go, and let God!"
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#18 of 23 Old 08-09-2008, 02:22 AM
 
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Originally Posted by MsBlack View Post
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).

Yes, Yes, Yes. It's interesting to read my thoughts from a year ago...I've definitely shifted my expectations and beliefs around positioning since then!
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#19 of 23 Old 08-09-2008, 02:37 AM
 
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I'm loving this thread about "malposition". As a former labour and delivery nurse, I allowed myself to be terrified of my baby that hung out LOP from about 28 weeks until the day before she was born. I was so convinced at first that a malpositioned baby was a sentence to hospital transfer and endless intervention in labour and birth. My midwife had a significant influence on freaking me out about it, too.

Weeks of crawling around scrubbing floors on all fours, swimming, exercising and doing OFP stuff only helped give me a killer lower backache (I think it was the crawling that did it), and baby stayed LOP.

I meditated on it, and spoke with my baby and told her that I was ready to birth her in whatever position she needed to be in. The evening before she was born, I looked down at my newly changed belly with an LOA baby. My water broke late that night and I had a lovely homebirth the next evening.

I think I could have saved significant stress if the "malposition" hadn't been so pathologized. I've heard recently that there has been a study showing that encouraging OFP/exercises doesn't actually result in any more LOA babies? Does anyone have links or info on this?

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#20 of 23 Old 08-10-2008, 03:23 AM
 
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I haven't seen OFP turn babies much prior to labor, or even in labor.

I just got back from a birth where a first time mom had a baby that was ROA/ROP throughout the last trimester. He was born this evening after about two hours of active labor ROA.

I really regret all the negative energy I put into freaking out over positioning of baby. It really stressed me out as a midwife.
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#21 of 23 Old 08-10-2008, 12:12 PM
 
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Quote:
Originally Posted by MsBlack View Post
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).
MsBlack, Your reply is so succinct, so well put, would you mind if I copied it and put it in my notes? This is one of the best explanations I have ever seen for this issue. I love it...wish I lived closer to you!
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#22 of 23 Old 08-10-2008, 02:01 PM
 
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I'm just back from a hosptial birth. Baby was ROA through all of late pregnancy. In early labor I visited with her at her house and tried to calm the demons in my head thanks to the wise voices in this thread.

When mom was at the hospital in traige she went from 1-4 during the innitial exam. Everyone threw a party, admitted her. The nurses prepared for a quick labor. That nagging voice was in my ear and I fought to keep the mom moving.

She sat at 5 cm for (let me count, I'm tired!) 10 hours. Her FP gently suggested some pitocin at that point and they agreed, then had an epidural about 2 hours later. My internal doubts shrieked some more.

Mom got some sleep and inched her way to complete over about 12 more hours. Her epidural was pretty heavy at that point so she started pushing on her back and side, after 2 hours there was no progress at all. I talked with the amazing labor nurse a bit, she went out and talked to the doctor, and he came in and suggested turning off her epidural. After about half an hour we were able to get her onto hands and knees..........and that darn baby moved! She was born after 4 hours of pushing, with marks on her head and face that showd just how asynclitic she had been and a nuchal hand.

I know that with 99% of the care providers and 80% of the nurses at this facility this birth would have been a very different story, and I'm so, so proud of the strength and faith of my client. Even with some of the midwives in this area, I think she would have been a transport and the outcome wouldn't have been as good.

All this rambling is a big old thank you to the voices in this thread that calmed my doubts. Had I not read it this week, had I not had this topic in the front of my mind, I think my doubts could have been passed off to my clients. Instead, I kept thinking "she's in this position for a reason, let's help her find her way".

You guys rock.:

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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#23 of 23 Old 08-10-2008, 02:46 PM
 
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Cathi--

Sure...just credit me! Not that I 'invented' the concepts but I guess it is my personal way of saying it....
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