Star gazing, face to pubes, back to back, or more technically Occiput Posterior (OP). What ever you want to call it it never seems to be associated with positive stories. I have delivered only a handful babies in the OP position all of which totally shocked me as I wasn’t expecting a little face to be peering up at me! However I still feel I don’t know enough about why some babies are in this position as opposed to the occiput anterior position (OA).
Throughout your pregnancy, your baby will wriggle into all sorts of positions as your uterus grows. By around 35 weeks your baby will begin to sink into the pelvis ready for birth. Sometimes women say to me that this is around the time they notice a change in their babies movements. It it usually associated with the lack of space the baby has as the head is nicely slotted into the pelvis; those little kicks and punches you use to get change to twists and turns. The ‘occiput anterior’ position is ideal for birth – it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby’s head is easily ‘flexed’, ie his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. The ‘occiput posterior’ (OP) position is not so good. This means the baby is still head down, but facing your tummy. Mothers of babies in the ‘posterior’ position are more likely to have long and painful labours as the baby usually has to turn all the way round to facing the back in order to be born.
So, what can you do to prevent an OP baby? Well, avoiding positions which encourage your baby to face your tummy. The main culprits are lying back in armchairs, sitting in car seats where you are leaning back, or anything where your knees are higher than your pelvis. The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.
- Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.
- Use yoga positions while resting, reading or watching TV – for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides).
- Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.
- Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front.
- Don’t put your feet up! Lying back with your feet up encourages posterior presentation.
- Sleep on your side (preferably your left) and never on your back.
- Swimming with your belly downwards is said to be very good for positioning babies – not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
- A Birth Ball can encourage good positioning, both before and during labour.
I felt it was important to hear some positive birth stories where the baby was in the OP position. Ironically two of my best friends both had OP births (one at home and one in hospital) and agreed to share their story with you. Over to you Lucy.
For my second child I was keen to have a home birth. Having swapped sides of the bed for 8 months or so in order to lie on my left every night, in order to get the baby into the supposed optimal position (head down, back to my left hand side) for the quickest and easiest labour, things did not turn out quite like I had hoped. In the days leading up to labour I had a show, lots of Braxton Hicks and my waters broke on the Monday eve. As I was keen not to go much over my due date, the midwives had given me 3 sweeps on 3 consecutive days and said things would happen soon (was 2-3 cm dilated on last sweep). I went for a massive walk on Tuesday in order to get things moving (as time was running out and would have to go shortly into hospital to have the labour stimulated as it was almost over 24 since my waters broke). I then spoke to my lovely knowledgeable friend, and midwife Clemmie who suggested trashy TV and nipple stimulation to get the contractions started. My older daughter had gone to stay at my friend Emma’s the night before as we thought it would all kick off after the waters breaking and we knew that she would come back probably later that day if I did not go into labour. Anyway with the thought in mind that I did not want my older daughter running round while I was trying to get into the labour mindset, 45 mins into Made in Chelsea and it kicked off! Contractions thick and fast immediately, midwife came within 20 minutes, tens on, hardcore rave tunes on the ipod, lots of gas and air and I got into the pool 2 hours later as I knew the pushing was starting. In my head I only wanted to get into the pool once I was reading to push and things were going according to plan. I expected 5 or 10 minutes of pushing and was really chuffed with myself for being on the home straits. How wrong I was. After 2 hours of pushing the second midwife suggested I get out of the pool. I knew the baby was just struggling to come out and was finding it impossible to get into a comfortable position to push. The water was not helping which I found very surprising. Anyway as I staggered up our 3 steps, heading to our loo upstairs, pushing on the way, aware the contractions were slowing down and much shorter in time length and I was told that they were calling an ambulance to get me to hospital as the pushing was going on for too long. I threw everything into a few last contractions and the ambulance arrived simultaneously with the baby, on the loo!
It turns out the baby was OP, or “head to pubes” as they seem keen on calling it! So despite my 8 months of hating lying on my left, all in the name of having an easier birth, Astrid Audrey was determined to make things difficult and remain in the awkward OP position and therefore came out with a terrible cone head. No-one knew until she arrived that she was back to back and she had broken blood vessels along her cheeks from the endless pushing. In hindsight if I had known I probably would not have been at home but I am chuffed all the same I managed to get my home birth. Why was she in that position? Possibly due to the extensive lying down I did every evening on the sofa and the hours in the car for work during my pregnancy but I will never know!
Emma chose to have a home birth with her first baby, Isis. Here she tells her story of how Isis had other ideas.
I definitely took my first pregnancy much more seriously than my second. I laid off the booze, kept active and consumed a couple of box sets a week . I didn’t go as far as shunning Stilton or letting my roots show but I do remember wanting to get the birth ‘right’. Doing it at home seemed like a no-brainer, as did reading everything Sheila Kitzinger had ever written. I went to weekly yoga sessions, had reflexology and employed the help of my sister’s Doula friend. Hell, I even went to a Janet Balaskas workshop. “Mark my words, you’re going to fire this baby out” my mother beamed as I gyrated on a birthing ball. She couldn’t have been more wrong. To cut a very long birth story short, nothing went as planned. Contractions were all over the place, my waters didn’t break and rather than breathing baby out in a candle-lit living room, I spent most of my time straddling the toilet. When I was finally coaxed into the birth pool, everything ground to an almighty halt. So, 8 cms dilated, I transferred to hospital where I pushed for 4 long hours. Eventually a doctor strode in, gave me an episiotomy and my daughter flew out. “Ah” said my midwife, as if it all made sense, “she’s a star gazer, that’s REALLY lucky.” But having sustained a black eye from throwing myself around in labour so forcefully – not to mention having had my foof unceremoniously sliced – the experience felt far from fortuitous. After the birth I spent a long time researching back to back labours and berating my midwives for not knowing my daughter had turned the wrong way. Turns out it’s pretty hard to diagnose. Five years on and the emotional and physical scars have faded nicely, I even went on to have another baby. Back to back labours are no fun but I know it could’ve been a hell of a lot worse.