Re: [ozmidwifery] OP babies

[Marilyn Kleidon]

Lois and Robin:   I think you have covered this extremely well. When I was in Seattle, we all greeted the book and exercises offered by Optimal Foetal Positioning with anticipation. However, it seems that there is more to the baby's positioning than exercises and posture of the mum. While I agree one hundred percent that the posture and exercises should be taught and offered antenatally they are no guarantee for avoiding a babe in OP position. I have been midwife with 2 extremely fit young primiparous women who had relatively small babes (6lb 12 and 7lb 4) settle very snuggly into OP positions in labor. They were informed of the exercises and encouraged re posture (which incidently was excellent and neither were couch potatoes) by both their midwives and antenatal class teachers, and one had Penny Simpkin as her doula. One never dilated past 3 cm (over 2-3 days at home then another 24 hrs in hospital) and the other galloped to complete then the baby never descended past 0 station, again after several hours. The babys were never in distress and had excellent apgars upon their cesarean births. However both mums were really disappointed, understandably. During many other births I have been a part of, the baby has often been in an OP position either prior to labor or during labor but obligingly turns at sometime or is born sunnyside up. I even had one bub twist at the waist to come out OA and upon restitution totally unwind herself birthing herself to the waist in one movement (I don't know if that describes it adequately).   On a personal note, my eldest daughter was born sunnyside up after a forceps lift out 26 years ago. I always assumed the forceps were for fetal distress but never really got an adequate explanation. I only know that I had pushed through 2 contractions, the midwife listened for FHT, and I was suddenly up in stirrups, pudendal block, epis, forceps and she was on my belly crying lustily. When her head was out the midwife said to the doctor "it's a face"; since her little face was never puffy or bruised I am assuming face up not a face presentation. In any case, I always felt the OP presentation was due to routine ROM on admission not giving her the cushioning to rotate. Obviously I dilated and the labor was not overly long, however I went on to have another daughter in frank breech position born vaginally, and my third daughter OP on the one VE in labor. That time I refused to have the bag broken at any time and was upright throughout, she was born in the caul, OA in 3 pushes. I think I have a  pelvis which predisposes to these positions. My grandmother only had one baby in five born OA, the other 4 were 2 breeches, one OP, and my mum who was the fifth and a transverse lie (podalic version delivered footling breech, alive) all born at home 1906 to 1913.     I can't think how to end this, so that's all for now. marilyn ----- Original Message ----- From: Lois Wattis To: [EMAIL PROTECTED] Sent: Tuesday, August 13, 2002 7:07 AM Subject: Re: [ozmidwifery] OP babies Robin, you have covered this matter very clearly and accurately, which saves me the trouble of trying to do it.  Optimal Fetal Positioning in pregnancy is a subject I cover with all my clients antenatally.  The case which this discussion arose from unfortunately demonstrates what can still happen.  This woman went to a lot of trouble to optimise her baby's position in the last month of pregnancy -- even forced herself to lie on her left side to sleep rather than back lying which she preferred.  Her baby was in a lateral position (ROL) on palp and VE throughout her labour (about 48 hours latent phase).  She utilised upright positioning and water throughout her labour and reached 8cm dilation with the presenting part at spines before the baby turned to OP and deflexed, and receded back to -1.  The obstetrician/surgeon made the statement that he "didn't believe the baby was ever in the pelvis" based on the little moulding of the head - but she was!  The woman has now been told (by the GP/ob who attended in theatre but never examined her physically) that she most definitely will need a CS for any subsequent births based on her long slow labour, and that the baby (7lb 2oz) did not fit through.  Maybe it's true.  Maybe it's not.  Only another labour will tell the story.  It's disheartening for her and for me, but the outcome is a live, healthy baby, and Mum is recovering extremely well.  She's a gutsy girl who will, I'm sure, research her options well if and when she travels the birthjourney again.  Best wishes, Lois        ----- Original Message ----- From: Robin Moon To: [EMAIL PROTECTED] Sent: Tuesday, August 13, 2002 8:45 PM Subject: Re: [ozmidwifery] OP babies   ----- Original Message ----- From: Jo & Dean Bainbridge To: [EMAIL PROTECTED] Sent: Tuesday, August 13, 2002 9:03 PM Subject: [ozmidwifery] OP babies I have a question that will probably be seen as a silly one to some (but remember I am a consumer so it is my right to ask silly questions!)  If one of the main reasons for cs is failure to progress and fetal malpresentation AND a common factor with both these 'reasons' is a baby that is persistently in OP ... why doesn't anyone do anything to correct this before labour?    Jo, there was a large research study conducted in Sydney recently on OP positions. It concentrated on ante-natal exercises to see if they could 'move' babies into a more optimal position prior to labour. The results were a dismal failure........    I know a large portion of bubs are OP then turn during labour; but it seems like we have found that it is easier to deal with it by cs or forceps rotation...why is it we don't try to avoid the situation altogether?   Usually we need to wait to see if the force of the contractions and the shape of the woman's pelvis will help the baby to rotate. That's what we're looking for prior to c/s or forceps. To give the woman's body every chance.   Very few women I have encountered were even aware of the term OP or what the whole OP presentation involves (longer labours more interventions etc). Why do we pregnant mums not get told during ante-natal check ups what position bubs in?  Why doesn't anyone check when labour commences?    On your antenatal card there is spot for 'presentation'. Usually it has hieroglyphics for the lay person in it in the form of  'OA'. or �T' or 'OP" ( or LOA, LOT,LOP, ROA, ROT,ROP). That is the position of the baby. Most practitioners start documenting it from about 30 weeks.    A competent midwife/doctor will always check the position of the baby when labour commences ( unless you come in very late in the labour and it's all too difficult!). We need it to tell us lots of things. Suggested length of labour, readiness of the baby, potential problems.   I am aware of the optimal presentation booklet and now try to encourage all women I come across to be aware of their posture and to try swimming and sitting in positions as well as vertical positioning during labour that will encourage bub to be OA ....but this is AFTER I had a cs for failure to progress (8cm and stalled for 2 hours no fetal distress- due to having a monitor on and being made to be supine...no wonder bub did not turn himself!)   Good for you, keep trying, it's better than doing nothing, and many midwives are able to offer other practical ways of turning babies that are sometimes helpful.  And I agree wholeheartedly, flat on your back is the worst position to labour effectively in. :-(   Remember this, the shape of a woman's pelvis will influence her labour. a VERY rough triangle shape where the pubic bone is at the apex, will allow the baby to rotate to the anterior nicely. If she is shaped more like a man where the pelvis is more oval shaped the baby will not rotate anteriorly too easily.   I am curious why this seems to be something that is ignored by mainstream but something that plays a major role in how birth results as cs or ivd?? can anyone shed some light??    I hope I've been able to help you a little. I'm getting a little rusty now and others may have other ideas to contribute I'm sure.   Cheers, Robin.   Jo Bainbridge founding member CARES SA email: [EMAIL PROTECTED] phone: 08 8388 6918 birth with trust, faith & love...