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  • Writer's picture Suzanne Fowler Evans

Posterior Baby - Why oh Why ....?

Posterior Presentation - what's it all about and what can we do about it?

Many years ago a very lovely and wise midwife called Jean Sutton presented us with anecdotal evidence that by using the right positions to labour and give birth in we would avoid the growing number of posterior presentation babies, commonly known as back to back.

She was one of the original movers and shakers of modern maternity care and took the birthing world by storm with her very sensible and frankly, obvious theories and suggestions which she umbrella termed Optimal Fetal Positioning or OFP for those of us in the know.

We all laughed at the time at the ridiculous prospect of women still giving birth on their backs when what we needed to do was lean forwards, wiggle our hips and provide a ‘shoot’ for our babies to come through. So armed with bits of tumble dryer plumbing and a tennis ball off we went to tell the world how we should, and would, be giving birth in the future.

The thing is, in the main, her theory worked!!

Roll on 25 years and low and behold we are still giving birth on our backs - why oh why when we know how beneficial upright, forward leaning and open positions are, do so many women end up on their back. Once we have worked this out it might lead us to why so many babies seem to suddenly be posterior just at the time of ‘pushing’.

I am going to blame what is commonly referred to as The Cascade of Intervention, once labour has been meddled with, either by a form of induction, trace monitoring, some kind of pharmaceutical pain relief, having a vaginal examination, having concerning chat with a midwife or consultant ….. The list could go on, but once you have had to switch from instinctive brain to articulate brain you can start to lose the motivation to get into positions that are right for you and our baby.

Information is key and you can sometimes tell if your baby is posterior in labour as it tends to lead to a longer labour, with slower dilation and a lot of low back discomfort. Unfortunately these labours often result in women opting to have an epidural, which is totally understandable as it is exhausting labouring for so long. If your birth partner is aware of this they can ask your midwife some questions around what is the best plan of action so you can become part of the decision making around what happens next. Unfortunately, so often when we have this type of labour it can lead to having an epidural, catheter and continuous monitoring, the cascade of intervention takes over and you are so much more likely to have an assisted birth.

So how to avoid a back to back baby in labour could be quite simple and here are my tips on how to do it;

1.Head to the midwife led unit and be as active as possible, or request that any balls, mats etc are brought into the room you are labouring in so the assumption is not that you are going to be labouring on a bed.

2.Remember gravity is your best friend (together with oxytocin) in labour so focus on getting the second heaviest part of your baby, their back, to your front by using all fours positions.

3.Get your birth supporters on massage dutty and focus on the low sacral part of your back and encourage you to move your hips.

4. If you agree to have a vaginal examination, ask your midwife to work round you, you don't need to ‘hop up onto the bed’.

5.If you need continuous monitoring in labour ask for telemetry monitoring so your movements are not restricted.

6.If you decide to have an epidural, establish that it will be low dose as you want to be at least able to be supported in more upright, forward positions than being propped up on a bed.

7.Ensure that everyone knows you want to allow the epidural to wear off enough to be able to direct your pushing and feel the baby as you give birth.

And don't forget to use your BRAIN - Benefits, Risks, Alternative, Instinct and Nothing. It might just be that your baby needs to take their time to rotate round, and assuming all is still good with you and your baby, take your time. A baby can also be born in a back to back position, known as face to pubes or star gazing so that is also worth bearing in mind and worth discussing with your midwife if needs be!

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