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Discussion Starter #1
Thought I'd continue this discussion in a new thread since we're getting way off topic in the <a href="http://www.mothering.com/discussions/showthread.php?t=480239" target="_blank">"hands-off/when to arrive" discussion</a>.<br><br>
Pam, yes I consider ROA a "bad" position for baby to start in, reason being that the first rotation of baby into the pelvis usually starts with a clockwise rotation, which means that the ROA baby will end up an OP baby very quickly in labor. As long as an ROA baby is still flip-flopping between ROA and LOA, I don't worry about it, but I tell mom that if baby is *always* on the right, we need to try to get baby to move. As for telling position w/o a vaginal exam, I can almost always tell by palpation whether babe is ROA or OP. Palpation was pretty easy for me to learn quickly and just comes naturally to me. And I've found that usually if I can't tell, mom will have something that tells me ("I have this nagging back pain" or something like that). And if I still can't tell, well, then it's not usually that big of a deal.<br><br>
I would guess that I spend about 75% of prenatal time talking about OFP, and since I'm in their houses at least a couple of times during the pregnancy, we'll talk about where is a good place to sit and posture and such. The first client I took care of switched from a doctor and was really suprised by how much we talked about baby's position from her first appointment (34 weeks) and on. She said no one else (even her Bradly teacher) had really taught her to know where her baby is and how to help her into the best birthing postion (which I joke is "launch" position: OA or LOA).<br><br>
I don't have much of a track record for clients b/c I've only had a few, but I saw this work really well during my apprenticeship and I have done a lot of research on OFP because I have a good friend who had a nightmare transport for a direct OP, acynclitic, military presentation (baby's ear was presenting first). Her midwife told her all the usual stuff: breech tilt, posture, pelvic rocks (which I don't suggest b/c baby can turn breech!), swimming pool relaxing, etc. They did a lot of stuff in labor and pushing to help also, but it just never happened. As a midwife, I know I don't want any of my clients to have to go through what this woman went through unless it's 100% necessary, so I've kinda made OFP my "thing," I guess.<br><br>
And yes, I believe many CPD or FTP c-sections are because of malpresentation and I cringe at doctors who do silly things like break water with a malpresented baby, or induce even tho baby is posterior (which they don't tell mom, of course), because an OP or acynclitic presentation can make the difference in baby fitting and coming vaginally or not and a long labor ending in an unnecessary c-section <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">.
 

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so what do you do to determine positioning during labor? other than a vaginal exam, what would you suggest? prenatally, it's easy, but during labor the abdominal muscles and the uterus contracting makes it really hard. My apprentice and I are considering just going out to primips in early labor and just checking position then leaving until they need us.<br><br>
I just received this information: <a href="http://www.childbirthinternational.com/course16/mod/book/view.php?id=587&chapterid=6609" target="_blank">http://www.childbirthinternational.c...chapterid=6609</a><br><br>
It looks good.<br><br>
I've tried so much during labors - knee chest, homeopathics, rebozo, lunges, duck waddles, stairs - and I'd rather not do it then. In fact, I would rather have women know more about it and be more proactive.<br><br>
I hear from docs (and even tons of midwives!) that OP isn't a big deal at all. In fact, I think there are many newer docs that don't even check for position in labor and don't correlate the position with FTP or CPD.<br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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oh, and I've also tried this: <a href="http://www.gentlebirth.org/archives/postrppr.html" target="_blank">http://www.gentlebirth.org/archives/postrppr.html</a><br><br>
- I must say that the author is completely out of her mind! I'm not going to push my fingers into a baby's fontanelles and rotate the head like that! I've tried it once and it felt sooo wrong that I stopped.<br><br>
Have you ever heard of a midwife simply pushing up on the baby while mom is in knee-chest to disengage the baby? what happened? does she have to hold baby for awhile?<br><br>
I've decided that I will not transfer again for a posterior baby with a primip. I'm working harder to really figure out how to help women and babies BEFORE we get to labor. I don't really want that fear in my life - it's not worth it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lurk.gif" style="border:0px solid;" title="lurk">:
 

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<div>Originally Posted by <strong>pamamidwife</strong></div>
<div style="font-style:italic;">I've decided that I will not transfer again for a posterior baby with a primip. I'm working harder to really figure out how to help women and babies BEFORE we get to labor. I don't really want that fear in my life - it's not worth it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"></div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"><br><br>
There. The trend will change....NOW. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> I think that we will see a huge difference by really working with primips prenatally (even more than we are) with being aware of their baby's position and all they can do to affect it, etc.<br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/love.gif" style="border:0px solid;" title="love">
 

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Okay, as a doula who basically works with ONLY hospital clients (<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> please give me some info on OFP... I know LOA is the best, but are there books about palpation/how to tell what position the baby is in that I can read? I've tried palpation a little but I'm pretty clueless, and I always encourage clients to ASK at their appts (but those who see docs, the docs in town won't palpate) and I'd like to know more so I can help clients. With the c-s rate as high as it is, I think the best shot for a primip to have a vaginal birth at the hospital is if baby is in OFP. Thanks. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/bow.gif" style="border:0px solid;" title="bow">
 

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There's a really good article in DONA's doula magazine on fetal postitioning and how to tell which position the baby is in.<br><br>
Let me see if I can find it in all this mess and I'll mail it to you.
 

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<div>Originally Posted by <strong>doula and mom</strong></div>
<div style="font-style:italic;">Okay, as a doula who basically works with ONLY hospital clients (<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> please give me some info on OFP... I know LOA is the best, but are there books about palpation/how to tell what position the baby is in that I can read? I've tried palpation a little but I'm pretty clueless, and I always encourage clients to ASK at their appts (but those who see docs, the docs in town won't palpate) and I'd like to know more so I can help clients. With the c-s rate as high as it is, I think the best shot for a primip to have a vaginal birth at the hospital is if baby is in OFP. Thanks. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/bow.gif" style="border:0px solid;" title="bow"></div>
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One easy way is asking mom where she is feeling baby kicks. Kicks near the fundus on the right side is generally indicative of an LOA baby, and kicks up high on the left usually means an ROA baby. If she feels kicks all over the front, esp near her umbilicus, that can mean a posterior baby.<br><br>
As far as palpating, any midwifery text explains how it is done/what you are feeling for. Basically to figure out the general position of the baby, you feel the 2 sides of the uterus and are feeling for which side you feel a back (it will feel long and solid) as opposed to which side you feel little bumbs and spaces. Again, though, a really good way to start is to ask which side mom is feeling kicks. Usually the baby's back is on the opposite side of those kicks.
 

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Discussion Starter #9
Pam, in labor I can usually tell by palpation and visualization, but I also do a vaginal exam when I get there (or shortly after), which will confirm or deny baby's position. I know you lean toward not doing that, though <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">.<br><br>
ITA that it's not something to be handled during labor. I've never seen that work. Okay, maybe it turned the baby but if mom is hurting like H*ll and can barely tolerate one contraction through that position, then I don't really consider that effective or productive. I personally don't like being that mean to my clients!! They're hurting enough without me making them do something that hurts more and causes them to have to fight every instinct in their body!<br><br>
And yeah, sometimes OP isn't a big deal (witness the moms in the Philippines), but sometimes it REALLY IS! And I can't tell which time it'll be a big deal before labor starts (or doesn't progress!), so I'd rather err on the side of caution. The one thing I've found is that my clients are REALLY in touch with their babies and their movements, just through the conversations we've had about OFP. I think that's a really good thing and I love to see it happen <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">.<br><br>
Doula and Mom, I cannot say enough about the book <b>Sit Up and Take Notice: How to Position Yourself for a Better Birth</b>. A direct OP baby is really easy to find because there's a saucer like indention near mom's navel, which would normally be filled by the back but in this case is left vacant by the arms and legs. Asking where kicks are is a great way to know, and also looking for baby's back. It'll usually be on the right or the left (and mom will feel kicks on the opposite side). Spinningbabies.com talks about "belly mapping" and is designed for mothers, but can be applied by everyone.<br><br>
Incidentally, everyone (client-wise) that I've sent to spinning babies hasn't been able to make heads or tails of their babies from the information there. Has anyone else experienced that with their clients?? I've looked over the info and it makes great sense to me, but I don't know if it would have worked for me when I was pregnant with Samuel and clueless. Just wondering....
 

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Discussion Starter #10
I've also tried "dialing" the baby's head to an anterior position and had to stop because of my stomach turning. It was done to Samuel, 1.5 hours into second stage. He had terrible swelling and overlapped sutures and was TERRIBLY colicky. I 100% believe that's why. And after trying it (as a last resort), I can say that I'll never do it again and it makes me sick that it was done to my baby (and done effectively, which means a lot more pressure was exerted on him!).
 

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Charlotte, is that book available on like Amazon.com or something? Or where would I find it?<br><br>
For you homebirth midwives, do you find that your clients are generally interested in positioning and amenable to trying things to help it? In general, find that most of my clients don't give a rat's ass, and generally blow me off if I talk about it.<br>
Then, when I know I have an OP, I'm never sure how long to wait it out, especially with a client who isn't into birthing normally. I had one client recently, a primip, who told me the whole pregnancy she was going to give it a try, but all the women in her family need cesareans. She spent the whole pregnancy sitting semi-reclined, was not interested in learning about fetal positioning, spent early labor lying in bed and crying until an epidural was placed at 3 cms, and of course her straight OP baby ended up pretty wedged in the pelvis by then. When she started pushing, baby's heart rate plummeted with each push, and she was not willing to try any position changes or wait and descend. At cesarean, baby was straight OP of course. She now says she knew she'd need a cesarean just like her mother (who had a primary cesarean without labor at age 15 because the doc told her she was too small to even try) and her auntie (who had a primary cesarean for "fetal distress" because "the cord was around the neck" at 8 cms - 2 hours into labor!) So, in such a situation, how much trying do you do? When do you bow to mother's "intuition" about a situation and just throw in the towel? Or do you all not really see this with a homebirth practice?<br><br>
I have another client wanting to VBAC due in 3 weeks, whose first cesarean was for failure to descend, after and induced labor, with a very early epidural. She wants an epidural this time, too, and is also uninterested in trying to get/keep her baby OA now. How likely is this to happen?
 

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Discussion Starter #12
DoctorJen, I bought mine at Midwifery Today. It's written by one of the authors of <b>Optimal Foetal Positioning</b>, but is much more in depth about why OP can become such a problem and how to prevent it.<br><br>
I think that since our clients are 100% committed to an unmedicated birth, a simple comment about back labor and posterior babies tends to get them motivated very well. Generally, homebirth clients are more receptive to the non-invasive things. I was thrown for a loop when a friend (planning a hospital birth) asked me to palpate her baby b/c he had been breech for quite some time. I palpated and found a direct OP baby, and told her what I knew then about how to help him turn. She said "oh, I'm planning on getting an epidural, so I don't care." I was quick to point out that because of the biggest diameter of the head presenting, a direct OP baby MIGHT NOT FIT and she might very well get a c-section out of the deal. She seemed to care a little more after that, but I never really talked to her again. He was born OA after a very short labor (but long enough for that beloved epidural), so I'm guessing he turned.<br><br>
I feel for you, trying to be a more contientous provider and meeting with brick walls like that. It would be so easy to cave, but it's so great that you haven't!!
 

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you know, I've had some clients (not primips, though usually) totally blow me off about OFP. One was an RN, planning a VBAC at home with me. Her baby stayed persistently posterior and off we went for a repeat cesarean after 27 hours of hard labor. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"><br><br>
I'm totally going to make this work. I have a client planning a VBAC with me. She's distressed because she has carried this belief that her body didn't start labor on its own with her first (was an induction due to a "huge" baby, induction failed, cesarean to 9.11 baby, was posterior we think). So, here she is at 41 weeks and not a hair of anything showing that she's getting ready for labor. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Went and saw her tonight and sure enough baby was ROP. (Has been ROA for awhile). She's doing some OFP stuff tonite and making an appt with the chiro for a Webster tech treatment ASAP.<br><br>
We might do a diaphragmatic release later this week.<br><br>
I think that it's so good to talk about it. The more women that know, they're better able to pass on this info to friends/family members that want to know, too.<br><br>
God, all the docs in this area are pretty blase about OP. I love you, Jen. Move to Oregon. We need you here.
 

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OK, I am not a mw or doula but reading this thread and very interested. I am due in Dec and hoping for a vbac. I want to do anything I can to increase my chances. I was induced at 38 weeks with my twins and did not progress "fast enough" but I always wonder if baby A was not in a good position. After 18 hours of pitocin he never came down past -1 or -2.<br>
So when do I need to start worrying about position of the baby?<br>
Is the sit up and take notice book more geared towards mw's or will I be able to understand it and get something out of it/<br>
Any other helpful tips would be appreciated!
 

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<div>Originally Posted by <strong>logan&jordansmommy</strong></div>
<div style="font-style:italic;">Is the sit up and take notice book more geared towards mw's or will I be able to understand it and get something out of it/</div>
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Karen,<br>
I think that that book is great for parents, too! It is very straight-forward, has some lovely illustrations, and is a quick read.
 

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Discussion Starter #16
Yes, I think the book is probably geared more toward parents than providers. It is definitely a very good and quick read. It's in my lending library and I've loaned it to most of my clients at one point or another in their pregnancies.
 

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About three years ago I downloaded and printed Jean Sutton's original article on Optimum Foetal Positioning - do you think I can find it now? Of course not because I had a pre-nesting clearout!<br><br>
Anyhow, OFP really interests me - as does the new rotational positioning which Pamela just posted - I wish I could have tried that. My first two children slid out without trouble but my third never engaged, was ROT and became wedged in the inner curve of my hip/pelvis and stayed there even with my waters broken (SROM). Despite all kinds of position changes my contractions went odd - sporadic painful and irregular which led to a transfer and Pitocin to get everything moving again. Which it did after 4 hours of awfulness. Afterwards the hospital mws said I had been lucky that I hadn't had a C/S straightaway.<br><br>
Between 2 and 3 I had had a collision with a bicycle: it moved a vertebrae in my back and put a twist on my neck and in my pelvis. I did see an osteopath and was much straighter before I became pregnant again but now I think that I had a structural problem which didn't help dd engage.<br><br>
Now 33 weeks pregnant with number 4 I am seeing an osteopath again regularly and getting noticeably rounder in my pelvis and being really careful about my positioning. Babe is LOA not engaged but definitely much lower than dd at this stage - although that may just be my loose accomodating uterus and ligaments!<br><br>
I wish I had thought about getting adjusted more regularly with dd but I couldn't really afford it at that time. Perhaps a combination of better alignment and OFP would have saved me some distress. I blab on about OFP almost as much as breastfeeding now!
 

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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/clap.gif" style="border:0px solid;" title="clap"><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/notes.gif" style="border:0px solid;" title="notes">:
 

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Found that book at Cutting Edge Press. Could not find it at Midwifery Today but that doesn't mean it isn't there. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br><a href="http://cuttingedgepress.net/cep/proddetail.asp?prod=bksitupandtakenotice" target="_blank">http://cuttingedgepress.net/cep/prod...pandtakenotice</a>
 

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<div>Originally Posted by <strong>Charmie981</strong></div>
<div style="font-style:italic;">Incidentally, everyone (client-wise) that I've sent to spinning babies hasn't been able to make heads or tails of their babies from the information there. Has anyone else experienced that with their clients?? I've looked over the info and it makes great sense to me, but I don't know if it would have worked for me when I was pregnant with Samuel and clueless. Just wondering....</div>
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I would be considered a client. I was clueless with ds - had no idea if he was breech or vertex much less which direction he was facing. The info on spinning babies was very helpful to me - when I went to my ultrasound, I told the tech what position the baby was in and she confirmed what I said with the ultrasound. I had terrible back labor with ds so I'm obsessed with the position of this baby. It was nice to know I'd "figured out" how to tell what position the child was in. So <i>I</i> think the directions are adequate...
 
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