<<<Go Back

AVOIDING BACK LABOR
by Ann Abbott, CNM

Back labor ensues when the baby’s head enters the pelvis facing up, toward Mom’s pubic bone, rather than down towards the sacrum or tailbone. The technical term is occiput posterior (OP), and it is responsible for longer, more painful labors, and not a few cesarean sections. How can we encourage babies to engage in the more favorable, occiput anterior (OA) position?

Your midwife will be checking baby’s position weekly in the last month of pregnancy. Women with posterior babes often say, “the baby seems to be all hands and feet!” and they may notice more frequent urination, or even leaking urine, as baby’s forehead presses against Mom’s bladder. OP position may contribute to several days of ȁprodromal,” or non-progressive, labor as the baby’s head attempts to enter the pelvis.

Some experts fault our less active lives, and more low-slung furniture, for the apparent increase in OP labors. Pelvic shape is thought to play a role as well. But semi-reclining on a comfortable chair or couch in front of the TV may encourage the heavier parts of the baby, the spine and back of the head, to gravitate toward Mom’s spine, resulting in a posterior position. Here are some suggestions to try to prevent it.

1. Avoid relaxing in semi-reclining positions. When sitting with knees higher than hips, the angle of the pelvic brim (the “inlet” to the pelvis) to the spine is reduced by 25%. This discourages baby’s descent into the pelvis and can favor OP position.

2. Avoid long trips in cars – same effect.

3. Avoid sitting with legs crossed.

4. Deep squatting is not recommended in late pregnancy unless the baby has already entered the pelvis in OA position. Squatting reduces the angle of pelvis to spine (see #1) and makes it difficult for baby’s head to enter the pelvis in any position. In the last 6 weeks of pregnancy, you can do a modified squat, sitting on a stool about 12 inches off the ground. Keep your back vertical, supported by the wall, with knees wide apart.


Postures that encourage OA position:

1. Upright and forward-leaning postures, with knees lower than hips, give the baby the best opportunity to enter the pelvis in OA. Watch TV while sitting upright on a dining room chair, or a computer chair that tilts slightly forward. Or kneel on the floor, leaning over a footstool, beanbag chair or exercise ball.

2. Sleep in a side-lying position with top leg resting forward so knee touches mattress. An extra pillow can be placed between thighs. If baby persists in OP, sleeping on the stomach, supported by pillows and cushions, may achieve rotation. Gravity will pull the heavier spine down towards Mom’s abdomen, away from her spine, into OA position.

3. Do pelvic rocks for 10 minutes at a time, 6-8 times per day. On hands and knees, slowly arch the back up like an angry cat, tucking the tailbone under; then slowly flatten, and repeat. A variation is to rock several times, then crawl forward, exaggerating leg movements, then rock again.

4. Regular exercise (walking, yoga) helps keep the joints in the pelvis moving, and encourages OA position. Swimming, especially front crawl or breaststroke, can be beneficial as well.

5. Take warm baths in a side-lying position (no semi-reclining!), massaging your belly, and visualizing the baby in a side or anterior position.

6. Chiropractic adjustments such as the Webster technique, acupuncture, or homeopathic Pulsatilla (30C or 200C) may be useful.


If we suspect the baby is OP during labor, we will encourage forward bending positions, walking up stairs, or raising one hip by resting a foot on a low stool. Lunges sometimes provide that extra space a baby’s head needs to find the optimal path. Relaxing on your side or hands and knees in a warm tub can be a magical remedy, or perhaps bouncing gently on the birthing ball will be your best place. The good news is that most babies do find their way into OA position. We hope it will be sooner, rather than later. And we’ll be there with you as you make this momentous journey.


For more information:
http://www.homebirth.org.uk/ofp.htm
http://babiesbynature.com/resources/optimalfetalpositioning.html

Disclaimer: The above represents the author’s opinion and is intended for the use of clients of the Midwives at Mount Auburn. It should not substitute for the advice of your own care provider.