Long Posterior Labors

Archived User

Long Posterior Labors

Mother of 1. Wondering if I did something wrong in my posterior labor.

My water broke, but only slightly. Contractions starting out at 5 min apart. Labored at home for 9 hours, went to midwife birthing center, 4cm dilated. Midwife determined baby was posterior. Did everything we could do to turn him. Midwives were having problems with their tub, got into a cold tub about 4 times. Had 9 hours of transition 8cm -10cm. Midwife determined I needed an epidural to help relax. I refused epidural at first, but after while we transported to the hospital. Dr. broke my water, I got epidural and baby was born within 6 hours. Total of 31 hours of labor. I had such natural plans for my birth. I've read about how to relax in childbirth and just let my body do what it was made to do. I went into labor not wanting my water broken, but now I am wondering it thats what was holding me up. Having back breaking pain for 24+ wasn't the greatest help. Nor was getting into a cold bath tub. Is there anything that could have been done differently. My midwife said my water may have broken up high just to let a little out then closed back up. Is that possible? Also are posterior labors more common when you've already had posterior. Also wondering if I should just stay at home and give birth next time. Also I was given a handout prior to labor on how to avoid bad postitioning, mainly posterior. I stuck to all the "correct positions".


Henci Goer

RE: Long Posterior Labors
(in response to Archived User)

I hear your frustration. First of all, an ingenious study showed that positioning in pregnancy doesn't prevent OP babies. Investigators periodically did sonograms on laboring women, starting at hospital admission. They found that occiput anterior (OA) babies, the favorable position, swiveled to OP as well as vice versa. (They also found that back pain is not a reliable predictor of OP.) Second, yes, you are more likely to have a repeat OP baby, but "more likely" doesn't mean it's a sure thing. Maybe you won't, and while this is a bottom-line kind of comfort, if it does, you are that much ahead in that you know that you can get through a tough labor.

As for advice, as you did last time, I would hold off on an epidural. It is a good thing to do when you've tried everything else and are exhausted, but the study also showed that babies are more likely to persist in the OP position when the woman has an epidural. I would also hold off on rupturing membranes early on. There is some evidence that supports the theory that intact membranes are beneficial. The cushion of fluid ahead of the baby's head helps the baby turn because it keeps the baby higher in the pelvis where it has more room to maneuver. Rupture membranes, and you risk the baby dropping into the pelvis and getting stuck in the OP position. Stay active during the dilation phase. I'm sure a search of the internet would provide info on positions and activities to help rotate an OP baby. Use measures for back pain as needed--soaking in warm water, a warm shower, ice pack, etc. The great thing about these strategies for rotation and comfort measures is that even if the baby isn't OP, they won't do any harm. During the pushing phase, try positions other than on your back. Lying on your back prevents the sacrum from flexing open, and you may need that extra room. Your care provider can also manually rotate an OP baby that is still OP when you are fully dilated. This study and this one have evidence for manual rotation. Finally, Penny Simkin has a review of relevant studies on strategies to prevent, diagnose, and manage labors complicated by OP.

~ Henci

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