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Just interested in what different midwives think about posterior/malpositioned babies during pregnancy...are they truly malpositioned (need some sort of intervention to correct), or just a variation of normal (that usually works itself out on its own)? Do you see increased rates of difficulties (prolonged labour, transport, etc)? Do you advice your clients to DO anything prenatally to avoid malpositioning/encourage anterior positioning - (i.e, spend time discussing OFP)? If you have a client who has a babe that is not optimally lined up - is there a point where you suggest a series of positions/interventions to maximize the chances of improving alignment?

Curious in a general way - but personally curious as well. Best as I can figure, babe is LOP and has been since we could figure out positioning. This baby really, really likes that spot
Have not even really discussed it with my MW at this point (keep forgetting to ask her opinion), but have started wondering what other midwives do.

Thanks
Jeanette
 

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For multips, we talk about it, but I find that the body seems to take care of it. Unless there is some issue with the baby needing to be posterior to be born...I have had a couple clients with that.

Those strong end of pregnancy contractions work hard to get babies in better positions, as do the early labor contractions. The shape of the uterus is different with primips, so I think it's much more of an issue with them (not to mention they seem to go over their due dates with malpresentations, which results in "failed" inductions).
 

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Here's what I like to tell mama's: Babies like to come out, like water goes down a drain (circular/clockwise). That's why a baby that's on the left: LOA or LOP will mean a nice straightforward labor. Babies on the right have more work to do. So babies on the right, I encourage more pelvic rocks and OFP stuff - especially pevic rocks at night and sleeping on your left side.

Certianly, it doesn't always "work" but it doesn't always mean that anything is "wrong" either if babe stays on the right. Encouraging optiomal positioning is a good thing in my mind - but a posterior labor doesn't mean anything other than a variation in normal, possilby a longer labor and (most of the time but not always) pretty bad back pain!
Most mama's like to avoid that. And so we do what we can, but not stress too much.

Multips with a pendulous abdomen I worry more about asynclitism and brow or face presentations...so more OFP and even belly bands or rebozo stuff. Still - those mama's know what to do and thier babies come out. So it's all just suggestions with an empahsis on mother and baby's wisdom/intelligence.

In labor - it's the same stuff and more patience. I like the Labor Progress Handbook by Penny SImkin for ideas on malpositioned babies - BUT just knowing that so long as mom and baby are well, all we really need to do is trust the mother and
 

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As a mother with a ROA baby (and shoulder dystosia) a posterior presentation baby and full brow prestentation baby (who was oblique transverse off and on until 40 weeks) having someone adjust my hips and practicing OFP helped immensly. I DO think that I must have a funky pelvis...but having the Webster technique done a bunch also helped me.

As a doula, the rebozo has helped me to turn a couple of babies in labor. CNM's here haven't had much if any experience with it, so it falls to the doula. I also heavily encourage OFP as I was trained by Gail Tully, and she knows what she is talking about!! www.spinningbabies.com

Pam- I am sorry that your families had to go through cesareans. I am certain that they were so happy to have you there with them. Someone needs to get rid of these popular over stuffed couches!
 

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Quote:

Originally Posted by pamamidwife
For multips, we talk about it, but I find that the body seems to take care of it. Unless there is some issue with the baby needing to be posterior to be born...I have had a couple clients with that.
Popping in from another forum (again - I like it here)...what about a multip who's only delivered by c-section for malpresentation? Baby-under-construction is head-down (cheers!), but facing my left side. My previous two were both breech (one frank, one footling) at delivery. Do you think my body would be likely to take care of it, or should I really work at positioning as though this were my first pregnancy? (I have been doing some, but probably not enough...my toddler has decided to run me ragged this last week or so.)
 

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In my experience, multips don't have the kind of excruciating-contractions-two-minutes-apart-for 40 hours-that-don't-produce-any-kind-of-cervical-change kind of labors that primips have. I have also not noticed as many problems with descent in multips with posterior babies as with primips (in some primips, babies won't come down at all until they turn, whereas multips' babies descend just fine and sometimes turn at the last minute or not at all.

I work as a midwife and as a doula. As a doula OFP and doing lots of maneuvers to turn a posterior baby are really, really important because of the nature of the hospital experience with its time limits, negative comments of the hospital staff and threatened interventions.

One thing that my preceptors did that seemed to work a lot of the time is to try and stop a labor which has started and has the hallmarks of a posterior labor (with the exception of PROM, which they would not try to hold off labor with) These would include back pain, baby who could be palpated in posterior position, flat or indented belly around umbilicus, contrax close together but weak or not producing cervical change, etc. They would suggest mild herbs/drugs/baths/relaxation, etc. to try and get labor to slow down or stop so that moms could get a break and start over again in a few hours or days. We found, for whatever reason, that oftentimes after that break, labor would begin again in a much more productive pattern. One theory that I have about this related to the belief that some people have that one cause of posterior babies is abdominal muscle tension -- the diaphragmatic release and some of the rebozo techniques are designed to get abs to relax. Maybe the herbs or baths are getting a state of deep relaxation that our clients have found difficult to achieve in pregnancy. Maybe the little break allows a deflexed head to reposition itself. I don't know. Seems to work a lot better than the hospital way of strengthening ctx via pitocin, though.

One thing I have decided not to do, though, is to try and get moms out of certain positions just because I am worried that they might cause a posterior baby. (like lying on her right side or on her back). I find that moms often do a lot better listening to their own bodies' signs when trying to labor. If a mom asks for help in trying to relieve back pain or in trying to turn baby, I will often suggest knee/chest, because I have seen it work. It is almost always uncomfortable, but it is a relatively quick solution, usually working in less than half an hour.

Good luck!
 

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im an apprentice, and my son was born OP. i thought he might be OP prenatally, but i never really gave it much thought, and then when my labor was absolute hell (pelvis and thigh pain, oh my friggin goodness!) it just made sense. still wbe expected he would turn eventually, but he didnt! he came out sunny side up. i had an 8 hour labor, too.

anyway- ill be honest. i was very lazy during the latter part of my pg. i am positive that is what caused ds to be positioned that way. i encourage all the women in my cbe classes to stay active up until they have the baby. by active i mean walking, swimming, and sitting up straight or leaning over a birth ball, etc- not slouching in a sofa. i think most babies wills ettle into a good position if mom stays active.

i do think it makes a difference in pain perception. my labor was relativiely short, primip-speaking, but i think his position put a lot of strain on my pelvis which is what caused the leg and pelvis pain, which occured during and between ctx. miserable!
 

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Quote:

Originally Posted by homemademomma
anyway- ill be honest. i was very lazy during the latter part of my pg. i am positive that is what caused ds to be positioned that way. i encourage all the women in my cbe classes to stay active up until they have the baby. by active i mean walking, swimming, and sitting up straight or leaning over a birth ball, etc- not slouching in a sofa. i think most babies wills ettle into a good position if mom stays active.
I've had a bug the last few days - maybe a week. I'm feeling really run down, and haven't been walking as much as earlier in the pregnancy (partly because dh just started a job and it's a lot of work to get out with dd). I'm about 35/36 weeks. Until my energy level picks up a bit, do you think that sitting up straight, doing yoga (cat & cow, tailor sitting, etc.) and generally trying not to sit in the same position too long will make a difference?
 

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I hope this thread is appropriate for my question. I am 34 weeks and 6 days. At my appointment yesterday, the midwife had a very difficult finding the heartbeat - we could hear it on the left through the umbilical cord with the Doppler, but the baby is extremely active. She finally found the heartbeat slightly above my navel towards the left. On previous appointments, the heartbeat has been consistently on my lower right side. Because of this, she insists that I get another ultrasound at the end of next week (when I will be 36 weeks), to determine the baby's position. (For insurance reasons, they will not do breech deliveries and have to screen them out.) She did attempt to be positive, as in saying that it is still early and there is still time to get the baby to turn, etc. However, before attempting to find the heartbeat, she had felt for the baby and was quite certain that the head was down. Afterward, she wondered whetheer what she thought was the head could actually have been a hipbone.

The issue for me is that I am quite certain that my baby is head-down, probably in the OP position. I've used the belly mapping techinques from the Spinning Babies website (the description for OP corresponds exactly to my current situation), but even just from watching and touching my belly, I can tell that the feet and legs are at the top right/center and that the head is below my navel. I have also been very active, doing a lot of walking and spend the weekends squatting in my garden. I did explain all this to her, but she is very insistent on the ultrasound anyway. This is making me feel much less confident about working with this birth center. I am worried that an ultrasound this late will bring up all sorts of false issues - I highly doubt the ultrasound tech wil say, "the baby's head is down/up; good-bye" and leave it at that. I strongly feel that the ultrasound is unnecessary and I am having a real problem with the idea that the midwife has greater faith in this technology than in her own abilities to determine the baby's position and in my knowledge of my body.

Should I find someone else to consult with? Or should I get another ultrasound? Other ideas? Thanks.
 

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Quote:

Originally Posted by yamilee21
(For insurance reasons, they will not do breech deliveries and have to screen them out.) She did attempt to be positive, as in saying that it is still early and there is still time to get the baby to turn, etc.
How can they screen you out? My babies have turned breech at 39 weeks (dd) and 38.5 weeks - during labour (ds). Anything can happen.
 

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Yamilee21 - you do not have to consent to an ultrasound. Dopplers are notroious for finding the heartbeat in all kinds of weird places and do not definitively indicate baby's position. Palpation and fetoscope are much better indicators as well as your own feelings and intuition. I'd listen to you


I'm sorry she isn't trusting you more than her trust in technology.

Makes me sad for midwifery when I hear stuff like this!

Storm Bride - i just want to say - please try not to stress. Your baby is smart and knows just how to be.

Homemademama - it could've been becasue of "lack of OFP" - BUT it very well coulda' been how your baby needed to be born. I've known many women who's baby's and labors were always posterior...sometimes it's just how they need to come out! If your baby was born OP - it'd be my inclination that this is how your pelvis is shaped. Other woman labor forever with an OP baby and then baby finally turns and the birth...this, to me is more of a "malpositioning" issue. Still - whose to say there was anything 'wrong'?!? Some labors need to take longer for whatever reason.
 

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Quote:

Originally Posted by loved
Storm Bride - i just want to say - please try not to stress. Your baby is smart and knows just how to be.
My babies are smart, no doubt about that. But, they also seem to be a bit contrary. Why on earth would babies turn breech virtually at birth? I think everyone agrees that breech babies are harder to deliver vaginally (even though OBs and midwives have very different ideas on how to handle them). So...why would they turn at the end of a pregnancy, when they're almost ready to be born?
 

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Yes - both c-sections...the first an emergency as I was fully dilated when I got to the hospital, and the second a "planned" section instead of VBAC when she was found to be footling a week before my due date.

This baby's head down at 36-37 weeks, and I'm planning a VBA2C. The pregnancy's gone really well (so did my other two), so I'm optimistic.
 

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I was a doula for a Momma with a VBA2C and it went perfectly, The baby came out and she was so mellow the OB thought she had had a epidural until I told him otherwise at the end! She had several OB's call her at home and threaten her with being irresponsible and putting her baby in jeopardy! CYBelieve it! Good luck to you!
 

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That's just appalling, but considering some of the posts on obgyn.net, it's not terribly surprising. I'm feeling very lucky in having the OB that I have...I didn't really pick him out - he's the one that my family physician refers to when moms are considered "high risk". But, he doesn't like doing c-sections (I don't know his rate, but people like to have him do them, instead of other surgeons, so it may be higher than he'd like) - I've seen him attending other births, and he's definitely not a "cut first, find out if it was necessary later" type. And, he's supporting my VBA2C...I know he's concerned about the rupture risk, but he's not being obstructive. (And, in fairness, he's probably seen ruptures...I haven't, so obviously he's going to find that risk more "real" than I do.)
 
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