Every woman’s nightmare-back labor. A woman may experience back labor if her baby is in the OP (occiput posterior) position.
This is also called sunny side up. Normally, a baby faces the mother’s back, which makes for a nice normal labor since a smaller diameter of the head is coming through the pelvis. However, if your baby is posterior or facing your stomach during labor, it ain’t fun. This is the number one reason why midwives have to transport a woman during labor to the hospital.
We have many tricks up our sleeve for prevention of posterior babies and also tricks in labor to turn an OP baby, however sometimes nothing works. In this situation mom gets stuck at 6 centimeters, is having a really long labor, and needs some help. This is an appropriate time for an epidural and pitocin or possibly even a cesarean section. OK, that said, none of us (midwives or clients) want to have this happen, so here are some of my tips for not having a posterior baby, or fixing one if you do.
At 36 weeks, I usually recommend doing a hands and knees position for a few minutes every night before bed and again when you get up in the morning.
This helps encourage an anterior position of the baby. Do this every day until you go into labor and do it again on and off throughout labor. Also, a birth ball or exercise ball is great to sit on throughout pregnancy and labor.
Check out this website: Spinning Babies
I am always on the lookout for a posterior baby. Okay I should say usually since I may not notice right away if my brain is fried from being up all night at another birth.
Signs of a posterior baby:
1. overwhelming back pain prior to 9 cms.
2. unusal contraction pattern: 1 strong contraction followed by one weak contraction (ongoing pattern) instead of all contractions are strong
3. Dip in uterus below belly button-belly should be very round and not concave
4. Long labor-once mom is 5 cms and having contractions of 3×60+ she should be dilating 1 cm every hour or two, if not, something’s up and it’s probably that sweet little face!
Things I do to fix a posterior baby in labor:
1. Hands and knees for 30 minutes
2. Vaginal exam to check sutures of baby’s head (feel position of baby)
3. Knee Chest position 30 minutes
4. Rebozo technique- a sheet wrapped around the lower half of your belly while midwife stands with her legs on either side of your legs and rocks the sheet from side to side to jiggle the baby. This sounds horrible but usually feels great. I alternate rocking with just using the sheet to provide support for the belly-helps take the weight off of your back.
Side Lying Position
5. Exaggerated side-lying positions-right side 20 minutes then left side 15-20 minutes repeated for an hour.
6. Manual vaginal rotation of baby’s head-this should only be done by a skilled midwife or doctor.
7. Catheter-yes, even though I am a midwife, I confess I do sometimes use a catheter! The bladder may be full and taking up precious room preventing the baby from turning. I just use a quick in and out catheter.
8. Sterile water back papules-these are 4 tiny injections of sterile water. The injections are done just barely beneath the surface of the skin along 4 acupressure points. After I give them, they look like bee stings. These work great for about an hour. They provide relief for back pain while the baby is still posterior.
Of course, usually just hands and knees works, however if it doesn’t, then I proceed down the list and not necessarily in order.
It is usually obvious when the baby turns. The mother begins to make different sounds. She has relief of back pain and baby descends rapidly. She suddenly has a normal contraction pattern and usually dilates quickly, then has the overwhelming urge to push. It’s almost as if her uterus has already done all the work of labor, even though her cervix is only 6 cms., and then once the head rotates, the cervix “catches up” with the uterus!
These techniques can also help if baby is asynclitic.
