Labor Challenge

Occiput Posterior

The most common position for a baby during labor is head down with the back of the head (occiput) facing the front of the mother (anterior). When the back of the head is facing the back of the mother (posterior) the baby's position is called Occiput Posterior. This occurs in 15-30% of labors. A baby who does not rotate into an anterior position during labor is considered a "persistent posterior."

Why is this a labor challenge?

When the baby is in a posterior position, the bony part of the head is pressed against the bony part of the pelvis. The pressure of the contractions pushes the head into the pelvis and can cause tremendous back pain. Some women feel the pressure even between contractions. Few women expect to feel their contractions as mostly a back ache.

Because the posterior position puts bone near bone, it is more difficult for the baby to fit into the pelvis. Posterior babies generally require longer labors, and if the baby persists in a posterior position, second stage may be longer than average as well. This can be fatiguing for a woman.

When the baby remains in a posterior position (5.5% of labors), the mother is more likely to experience a longer than average labor (both first and second stages); the use of synthetic oxytocin to augment (speed up) labor; epidural for pain relief and a cesarean surgery.

Some women experiencing back pain in labor find relief from regional blocks, however anesthesiologists will not guarantee they can remove the back pain. There are various labor positions and techniques that can be used to encourage the baby to rotate, however they may not be effective.

Potential Solutions

Change positions regularly, focusing on positions that will encourage the baby to rotate.

Use counter pressure on her back

Try the Hip Squeeze

Stay in the moment. Don't focus on how many more contractions she may have, but how she is handling the contraction she is having right now.

A long labor can bring fear of problems with mother or baby. Be sure to ask the midwife about any concerns to help the mother understand that a long labor does not necessarily mean something is "wrong".

Things to discuss with your caregiver:

Having the ability to move and change positions during labor, especially upright positions, can increase the chances of your baby moving into an anterior position. It may be wise to discuss with your caregiver how much freedom of movement you will have.

You may want to discuss techniques and tips your caregiver has for dealing with a posterior labor before labor begins. This will give you an understanding of the type of care you can expect - will your care giver help you into positions or recommend an epidural?

Discuss with your caregiver any concerns he or she has with letting a slow labor progress without intervention. Valerie El Halta explains that the most common procedure to speed labor, pitocin and artificial rupture of the membranes, cause a baby to move deeper into the pelvis reducing the chances for the baby to make a full rotation and move into proper position.

It may be helpful to engage in pelvic rocking or other activity to gently move the pelvis during pregnancy to help encourage the baby into a proper position. Your caregiver can alert you to any reasons this may be unsafe for you.

Some women find a chiropractor can realign their pelvis to improve the position of a baby. Your caregiver can help you determine if this is an appropriate treatment for you.

References:
El halta, V. Posterior labor: A pain in the back. Midwifery Today, 36 (1995), 19-21.
Diaz AG, Schwarcz R, Fescina R, Caldeyro-Barcia R. Vertical position during the first stage of the course of labor, and neonatal outcome. Eur J Obstet Gynecol Reprod Biol. 1980 Sep;11(1):1-7.
King, J (1993). Back Labor No More! Dallas: Plenary Systems.