Posterior Position

A posterior fetal position and presentation (also called as the sunny side up) is when the unborn baby faces upwards, with his head pointing down and is burrowed deep in the mother’s pelvis.

Types of posterior positions

Direct occiput posterior

Direct occiput posterior is the classic posterior position where the unborn baby is facing straight forward.

Right occiput transverse

Right occiput transverse (ROT) is the starting point of the improper fetal position. This is where the unborn baby will slightly rotate to posterior during the process of labor.

Occiput posterior

Pregnancy week by week

Occiput posterior (OP) is when the unborn baby lies with his back against his mother’s back. OP makes the labor process longer because he cannot tuck his chin easily. This then results to an awkward position in getting through the pelvis and the birth passage.

The word occiput refers to the back part of the baby’s skull (occipital bone) is in the back of the mother’s pelvis.

Right occiput posterior

Right occiput posterior is when the unborn baby is positioned in a straight back with his chin up. This position commonly happens on 1st time mothers.

Left occiput posterior

Left occiput posterior is when the unborn baby opposes his mother’s liver. This in turn gives him the space to curl his back and tuck his chin.

Causes of a posterior baby

  • Low thyroid function
  • Fetal malposition
  • A laboring mother who has an early epidural before the unborn baby even has the chance to reposition himself

Signs and symptoms of carrying a posterior fetal position

Baby bump feels soft

A soft baby bump indicates that the unborn baby is in an occiput posterior position.

Fetal kicks in the middle of the belly

A mother – to – be carries an unborn baby in occiput posterior kicks in the middle of the belly.

A concavity around the belly button

A concavity around the belly button refers to a lumpy and bumpy belly which emphasizes the unborn baby’s body.

Amniotic sac breakage

Did you know that about 1 out of 5 occiput posterior labors experience amniotic sac breakage before labor? This is when the water breaks as the membranes dilate and rupture.

Back labor

Back labor refers to the intense back ache that majority of women feel during labor. On the bright side, some women do not feel any back labor despite of the posterior fetal position.

Irregular stages of labor

Irregular stages of labor is when the process has a stop and start pattern.

Irregular labor patterns

Irregular pattern is when all or some (one or two or three stages of labor) stages of labor are prolonged due to the occiput posterior.

No sign of fetal engagement

No sign of fetal engagement is when the unborn baby does not engage even during the course of labor.

Pros and cons of the posterior fetal position

Not all expectant mothers who carry a posterior baby experience difficulty during delivery. Carrying a posterior baby has corresponding factors that can make their laboring process difficult or smooth sailing.

Factors of a smooth – sailing delivery with a posterior positioned baby

  • A second – time mother whose given birth easily before
  • A posterior baby whose chin is placed on the left side of his mother
  • An unborn baby positioned in a left occiput posterior, especially whose chin is tucked or flex
  • A small and/or averaged – sized baby
  • A woman who does not have an android pelvis
  • A woman who has a wide pelvis [wide enough to accommodate the baby’s extra head size]
  • An expectant mother who use various birthing techniques
  • An expectant mother with a calm mind
  • A posterior baby who has shifted from right to left after doing reversals

Factors of a difficult deliver with a posterior positioned baby

  • First – time mother
  • A first – time mother whose baby has not dropped into the pelvic region by the 38th week of gestation
  • A mother – to – be with an android pelvis (also called as dude – shaped or runs like a boy). An android pelvis is described as a deep – seated pubis with a slender pubic arch where her sitz bones are close together (closer or equivalent to the width of a fist)
  • A mother – to – be whose baby in her 3rd trimester does not shift position or presentation at all. He may kick or stretch inside the womb however, his trunk is motionless all throughout pregnancy. In line with this, studies show that mothers in this type of situation have a broad and tight ligament
  • A laboring woman who is lying flat on her back
  • A laboring woman who refuses support and assistance when the process exceeds her ability to sustain herself [that is the spilling ketones, lack of fluids, unable to eat and bed rest over 24 – 48 hours)
  • A mother – to – be with low energy levels
  • A mother – to – be suffering from various pituitary disorders
  • A mother – to – be who lacks emotional reassurance and support that is from a doula
  • A laboring woman whose hospital staff cannot match or find the suitable method to the baby’s needs for flexion, rotation, and his descent level in the pelvis

The aftermath of the posterior fetal position

Carrying a posterior baby can cause a variety of effects once the laboring process begins.

Effects of carrying a posterior baby

Prolonged labor

A prolonged labor is when the pushing process last for at least 18 – 24 hours.

Mother – to – be’s who carry a posterior baby are expected to experience a prolonged labor.

This increases the chances of being injected with Pitocin [which can be done as intravenous infusion or intramuscular infusion]. Pitocin is an aqueous nona peptide solution of synthetic oxytocin, which can also be found in pituitary extracts of mammals.

In addition to that, a good sleep followed by oatmeal also restores the contraction patterns as well.

Medical practitioners use this type of drug because of the following benefits enlisted below:

  • Controls bleeding after childbirth
  • Triggers uterine contractions to induce labor
  • Strengthens labor contractions during the process of labor
  • It can also induce abortion

Arrested labor

An arrested labor is when the delivery process completely discontinues.

Vacuum – assisted vaginal delivery

A vacuum – assisted vaginal delivery is where a medical practitioner uses specially designed instruments called ventouse (a vacuum device) and forceps. This type of delivery aims to assist and guide the baby during the last stage of labor.

Despite the aforementioned risk (prolonged and arrested labor), some mothers – to – be opt to be assisted with a vacuum device than to undergo the cesarean cut.

Cesarean section delivery

A cesarean section is when the baby is delivered by surgically incising the mother’s lower abdomen and uterus.

If the posterior fetal positioning is severe (unborn baby cannot reposition himself and the vaginal delivery is impassible), the mother – to – be must undergo the cesarean delivery section.

Postpartum hemorrhage

Did you know that about 18% of all child deliveries experience postpartum hemorrhage? Postpartum hemorrhage (commonly known as postpartum bleeding) refers to the loss of about 500 – 1000 millimeter of blood within the 1st 24 hours after childbirth.

Perineal tears

Perineal tears refer to the spontaneous tearing of the perineum – the muscular area that separates the anus to the vulva.

Severe perineal tears occur to mothers – to – be who opt to push through the vaginal delivery despite of their baby’s improper positioning.

Episiotomy

An episiotomy (also called as perineotomy) refers to the surgical incision of the perineum to assist in natural birth by enlarging the vaginal opening. This surgery is made right before child delivery.

Episiotomy is performed if the mother – to – be with a baby in the face – down position after an unsuccessful attempt of the vacuum – assisted vaginal delivery.

Lower 5 minute APGAR scores

APGAR test serves as the 1st examination to a newborn baby which is given right after delivery. It aims to evaluate a newborn’s physical health condition to check if he needs an extra medical care (neonatal intensive care unit) or immediate medical attention.

This type of fetal test is given to the newborn in multiple times:

  • 1 minute right after birth
  • Repeated after 5 minutes
  • Repeated after 1o minutes if the results are low

The APGAR score was developed by anesthesiologist Virginia Apgar. Even though the APGAR serves as the developer’s middle name, this test usually stands for:

  • Appearance (skin pigmentation)
  • Pulse (heartbeat rate)
  • Grimace response (reflex irritability)
  • Activity (muscle tone)
  • Respiration (breathing rate and effort)

Medical practitioners combine the five factors which will be scored from 10 – 0 where 10. These scores indicate the following below:

10 – Highest score.

8 – Good health condition.

2 – Best score.

1 – Poor muscle tone and difficulty in breathing due to immature lungs.

That said, enlisted below are the signs of APGAR scoring:

Appearance

2 – Normal skin pigmentation from head to toe (excluding the palm of the hands and soles of the feet which are naturally pink).

1 – Normal skin pigmentation however, the palm and soles are bluish.

0 – Pale or bluish – gray complexion from head to toe.

Pulse

2 – Normal, about 100 heartbeats per minute

1 – Below 100 heartbeats per minute

0 – No pulse rate

Grimace response

2 – Tugs away, sneezes, coughs, or even cries with stimulation

1 – Facial expressions only during stimulation

0 – No response or expression to stimulation

Activity

2 – Active and spontaneous movement

1 – Arms and legs activate a slight movement

0 – No movement only a limp tone

Respiration

2 – Normal rate, effort, and crying

1 – Slow and/or irregular patterns of breathing with weak cries

0 – Not breathing

Preventive measures to posterior positioning

All fours

All fours or being on the hands – and – knees during the latter months of pregnancy or labor triggers the baby to reposition correctly. Researches even show that doing the all fours alleviates back pain.

Pelvic rocking exercises

Do some pelvic rocking exercises for 2 times a day in 10 minutes for 37 weeks.

Manual rotation in occipitoposterior position

Some mothers- to – be who attempt doing the manual rotation in occipitoposterior position successfully repositions the baby.