[ozmidwifery] Foetal positioning

[Sally Westbury]

Foetal malposition lengthens labour and poses maternal risks Source: Obstetrics & Gynaecology 2005; 105: 763-72 Assessing the impact of foetal position at full dilatation on labour duration and indicators of maternal morbidity. Pregnant women with occiput posterior or transverse position at full dilatation are at increased risk of a prolonged second stage of labour and of maternal morbidity, research shows. "Since Mauriceau's classical work was published in 1681, the occiput posterior and transverse malpositions have remained an obstetric challenge," write Julie Senecal (Laval University, Canada) and colleagues. For the current study, the team assessed the effect of such foetal positions on the duration of the second stage of labour and on indicators of maternal morbidity, using retrospective data for 210 women whose foetus was in the posterior position, 200 with it in a transverse position, and 1198 with an anteriorly positioned foetus. This revealed that foetal malposition at full dilatation was associated with significant maternal morbidity, including increased risks of instrumental delivery, caesarean delivery, oxytocin administration, episiotomy, and blood loss exceeding 500 ml. In addition, the duration of the second stage of labour with early or delayed pushing was higher for transverse (3.6 hours and 2.5 hours, respectively) and posterior (3.8 hours and 3.0 hours, respectively) positions than for the anteriorly positioned group (3.1 hours and 2.2 hours, respectively). "Guidelines that propose norms for expected labour duration should take into consideration position of the foetal head at full dilatation and the strategy of pushing," conclude the researchers. Posted: 12 April 2005     Sally Westbury Homebirth Midwife   "It takes courage to remain a true advocate for women, challenging authority and sacrificing social and professional acceptance. It takes courage for a woman to choose a caregiver who will truly advocate for and empower her."    -Judy Slome Cohain