Preventing Occiput Posterior Baby Positioning

Left occiput transverse - our baby's current position

Yesterday my husband & I had another appointment with Charlene, our midwife. She determined that the baby was in left occiput transverse position. The good news is that he is head down, but we really don't want him to rotate any more posterior. Like into occiput posterior position - the reason I had my C-section when birthing Gerritt 4 years ago. I still remember the excruciatingly painful back labor (it was worse than the uterine contractions). Plus the occiput posterior baby most likely will lead to a long & exhausting pushing stage & even a possible hospital transfer (yikes!). So... we have another plan in place to prevent another posterior occiput baby.


Occiput posterior position

A posterior occiput baby has its back facing the mother' back & such baby needs to rotate all the way around in order to be born. Posterior occiput babies can't fully flex their heads to help them descend into the birth canal & the diameter of the head is larger than that of an occiput anterior baby (the most desirable birth position). In an anterior position the baby can easily tuck its chin onto its chest to fit through the pelvis.

How can you tell if your baby is in a posterior position?

- You may feel a lot of the baby's movements (punches & kicks) in the front
- Your abdomen may appear flat below your belly button when you are laying down on your back
- Your midwife can tell when she palpates your abdomen in clinic

What makes babies turn posterior?

- Sitting in cars
- Leaning back in comfortable sofas or recliner chairs
- Limited physical activity
- Poor posture
- Crossing one's legs

How can I prevent my baby from being posterior?

- Avoid all reclining positions. You should always sit with your pelvis tilted forward. This can be accomplished by always having your knees below your pelvis & your back straight. Sitting on a birth ball or sitting backwards on a kitchen chair is great.
- Get into the hands-and-knees-position as often as you can. Do it while you watch TV or read a book. Crawling is helpful too (go ahead & scrub the floors on all fours!).
- Do pelvic rocks 10 times in a row 2-5 times a day. Get on your hands & knees & rock your pelvis up & down (alternatively arch your back by tucking your pelvis under & then straightening, like the mad cat pose in yoga).
- Sleep on your left side with your left leg straight & your right leg at a 90-degree angle supported by a pillow or two. This creates a "hammock" for your baby & will encourage the baby to have their back cradled into your tummy.
- Pregnant in the winter? Babies like to have their backs warm. If you are pregnant in the winter & are not wearing a parka that closes in the front, your baby may decide to correct this by turning his back towards yours to stay warm & cozy.

I truly believe if I had followed the above instructions or at least was aware of the concept of optimal fetal positioning, I would have avoided my C-section. In my first pregnancy I had just graduated from the UW Nurse Practitioner program & spent months preceeding Gerritt's birth hunched over in front of the computer studying for my board exam. I hope this information will help someone else.

Additional Resources:

1) The Midwifery Group (the midwifery practice in Vancouver, Canada)

2) The Spinning Babies (a website dedicated to optimal fetal positioning):

a) Occiput posterior (OP)
b) How can I help my baby stay anterior?
c) Myths of occiput posterior