When Baby is in a Posterior Position

The ideal position for a birthing baby to be in is head-down in an Occiput Anterior position (OA), which means the baby's head is down and the baby is facing the mother's spine, with its own spine out toward the mother's front. Most babies will naturally move into this position during labor, some earlier than others.

When the baby has not moved into the OA position (about one in four begins labor in this position) is it referred to as Occiput Posterior (OP) or a posterior baby. Most babies will turn into an anterior position at some point during labor, but some will actually be born in a posterior position with their face upward or "sunny side up" as they emerge from the birth canal. When a baby is posterior it can lead to longer labors because it takes time for the baby to move into a favorable anterior position.

Another problem with posterior babies is that it tends to cause back labor, or back pain during contractions. I had back labor with all of my babies, and I don't know whether or not it was linked to the position of the baby, because I never asked for my doctor to check the position. I know from personal experience how hard back labor is, and I would recommend if you experience it in labor, ask someone to check the position of the baby to see if the baby is possibly in a posterior position.

There are many things you can do to correct the baby's position if your baby is posterior. First, try to determine the position of the baby. You can sometimes feel where the feet and hands are by where you feel kicks and punches, and from there locate the baby's back on the opposite side from the movement. If you feel the movements in the front of your abdomen this can be an indication that the baby is in a posterior position. If you feel movement on the right side it could mean your baby is in a Left Occiput Posterior (LOP) position, and if the movements are on the left, it could indicate a Right Occiput Posterior (ROP) position. Your doctor or midwife can also help determine the baby's position by palpating your abdomen to locate the baby's back, or by feeling the baby's head by doing a vaginal exam. If the baby is found to be posterior, you can try the following positions to help turn the baby*:

1. Open knee-chest. From a hands and knees position, move your knees backward and outward and lower your head and chest to the floor or bed. Make sure your buttocks are high in the air and your thighs are angled away from your belly so that your knees are slightly behind your buttocks. Try to stay in that position for 30 - 45 minutes. Your partner can help you maintain the position by kneeling next to you, facing your head, placing his or her hands on your shoulders, and pulling up and back slightly. This position can help reposition a baby in very early labor.
2. Leaning forward. These positions include hands and knees or kneeling; standing; or sitting while leaning over something such as a birthing ball, bed, or a counter, and may help reposition the baby. They also help take pressure off of the sacrum to help relieve back labor.
3. Pelvic rocking. In a forward leaning position, rock your pelvis forward and back or in a circle. This movement helps dislodge the baby within the pelvis, and encourages repositioning from a posterior position. I remember this movement was particularly comforting for me while in labor.
   
4. Abdominal lifting. During contractions, while standing, use your interlocked fingers to lift your abdomen up slightly in while bending your knees. Doing this can help relieve back pain and encourage the baby to move into a more favorable position.
5. Abdominal stroking. In hands and knees position, you partner can reach under your abdomen and firmly and repeatedly stroke in the direction the baby should rotate (if you know your baby is in ROP or LOP, this is especially helpful to stroke from the side your baby's back is on to the other side). It's best to do this between contractions and should feel very good. If it's uncomfortable, then stop the movement, and do not try the movement if you don't know the baby's position.
6. Standing, walking, and stair climbing. These positions use gravity to encourage the descent and movement of the baby into a favorable position because of the movement of the pelvis.
7. Slow dancing. Stand and sway side to side while allowing your partner to support your weight. This is a great alternative to walking.
8. The lunge. Place a chair securely (so it cannot slip) to one side of your body. Place your foot closest to the chair on it and slowly lean toward the chair, allowing your knee to bend as you lunge. You will feel your leg muscles stretching. Hold the position for a count to five, and then ease yourself back upright. Do this during contractions for 5 - 6 contractions. If you know the baby's position, lunge toward the side where the baby's back is. If you don't know the position of the baby, then alternate sides and continue lunging on the side that is most comfortable to you.
9. Side-lying. This is a common recommendation during pregnancy and labor. Place a pillow between your legs with your knees bent. If the baby is LOP, lie on your left side. If the baby is ROP, lie on your right side. If the baby is direct OP (baby's spine lined up with mother's spine) choose a side and watch for repositioning of the baby.
10. Semi-prone. Lie on your side with your lower arm behind you and your lower leg stretched out. Place your upper leg on a doubled-up pillow with your knee bent and roll toward your front. If your baby is ROP, lie on your left side. If your baby is LOP, lie on your right side.
    

*Positions and suggestions were taken from the book Pregnancy Childbirth and the Newborn, by Simkin, Whalley & Keppler.