Oct 31, 2011 11:27 AM
Lauren Kuppers Hickman
Hi Henci! I am a new mom and birth doula and have a several questions about babies who are in a posterior position during labor and delivery. It seems like there are a lot of c sections happening due to posterior positioning of baby (myself included). What can we do to help these babies deliver vaginally, even if they don't turn to an optimal position before birth? Does having an epidural increase your chances of having a c section due to posterior positioning? I have seen an epidural used to relax mom so that baby can turn, but I have also seen it hinder pushing efforts when baby decides not to turn. I know there is a lot out there about getting baby into an optimal position before labor, but isn't it just the way some babies need to come out? Thanks for sharing your wisdom!
Oct 31, 2011 11:28 AM
You are right that OP babies greatly increase the likelihood of cesarean delivery and instrumental vaginal delivery as well, which has its own potential harms. OP is undoubtedly the cause of many more cesareans for slow or no progress than the baby's size. Prelabor efforts to get the baby into the favorable OA position don't work. A study in which women had periodic sonograms during labor showed that babies who started labor OA rotated to OP as well as the other way around, but that most babies went to OA by late labor. That same study also showed that epidural analgesia increased the likelihood of persistent OP, meaning that the baby was still OP at time of delivery. As to what can be done, based on what I just wrote, women should delay or avoid an epidural. We also have some anecdotal evidence that positioning in labor such as hands-and-knees may help, and we have no evidence that it does any harm, so it is worth trying. We have a study showing an association between artificial rupture of membranes and persistent OP. Early AROM not only doesn't decrease likelihood of cesarean, it may increase it, so women lose nothing by refusing it. Finally, we have consistent evidence that manual rotation of a baby who is still OP at full dilation increases spontaneous births with no evidence of harm from the procedure. This word definitely needs to be gotten out to doctors and midwives, because it could spare a lot of women a surgical or instrumental delivery.
In the interest of time, I'm not going to put links to the abstracts for the studies I mentioned, but if you need them, paste my response here into a post to my Forum on the Lamaze website at http://www.lamaze.org/Default.aspx?tabid=363. Post under the "normal pregnancy & birth" subhead.
All Times America/New_York
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