Filed under: birth, breech (posterior baby), labour | Tags: posterior, turning baby in utero, painless childbirth, posterior baby, relaxation, painfree birht, odent, pelvic rock, occiput posterior
Two facts regarding posterior position have been authoritatively confirmed by published prospective studies.
The first fact is that worrying pregnant women about the position of their baby in the womb is useless. A large Australian randomized controlled trial involving 2547 pregnant women has eloquently demonstrated that hands and knees exercise with pelvic rocking from 37 weeks’ gestation until the onset of labor does not reduce the incidence of persistent occiput posterior position at birth.
The second fact is that fetal position changes are common during labor, with the final position established close to birth. This is the conclusion of a prospective study of 1562 women to evaluate changes in fetal position during labor by using serial ultrasound examination. Among babies who were posterior late in labor, only 20.7% appeared to be posterior at birth.
Finally, when the mother had no epidural, the overall rate of posterior position at birth was only 3.3%, although this study was conducted in conventional departments of obstetrics, where the basic needs of birthing women could not easily be met. The rate was 12.9% in the epidural group.
When taking into account these two well-documented facts, focusing on the right question becomes easy: what factors can influence the rotation process during labor?
The answer is simple: The factors that can facilitate the rotation process are those that make a typical fetus ejection reflex possible.The passage toward the fetus ejection reflex is inhibited by any interference with the state of privacy. The ejection reflex does not occur in the presence of a birth attendant who behaves like a “coach,” an observer, a helper, a guide or a “support person.”
The fetus ejection reflex can be inhibited by a vaginal exam, by an eye-to-eye contact or by the imposition of a change of environment. It does not occur if the intellect of the laboring woman is stimulated by rational language (e.g., “Now you are at complete dilation; you must push”). It does not occur if the room is not warm enough or if the lights are bright. The best situation I know for a typical fetus ejection reflex is when no one is around but an experienced, low profile, silent, motherly midwife sitting in a corner and knitting.
The image of the “knitting midwife” should not be understood in a literal sense. Instead, it symbolizes the authentic midwife as a protective mother figure whose own level of adrenaline is maintained as low as possible.
Noticeably, when the conditions for an ejection reflex are met, most birthing women find spontaneously complex and asymmetrical bending-forward postures that probably play an important part in facilitating the rotation of the baby’s head.
Persistent posterior position at birth will become exceptionally rare on the day when the meaning of privacy is understood and authentic midwifery has been rediscovered.
- Michel Odent, MD, excerpted from “Occiput Posterior Position Should Be Exceptionally Rare at Birth”
Filed under: birth, breech (posterior baby) | Tags: back labor, breech, breech birth, breech delivery, communicating with the baby, kicking baby, posterior baby, transverse baby, trust in birth, yurning posterior baby
from the women whose children are “rescued” from her womb by a surgeon? OK, there are two things…
P.S. If you feel your baby is crying for help, get help. Being empowered isn’t about doing it yourself, it’s about making the best choices we can with the information we have.
Filed under: breech (posterior baby), traditional midwifery | Tags: natural childbirth, midwifery, traditional midwifery, breech, breech birth, posterior, turning baby in utero, comrado
A Zapotec partera will massage the woman’s legs to diagnose tension. By becoming aware of tension in her legs she discovers where the baby is pressing against the woman’s spine and causing backache, and this shows how the baby should be repositioned. She starts doing this at thirty-two weeks and massage sessions are arranged every fifteen days. As well as massage of the legs, she palpates the abdomen, kneads it, lightly massages it with the sides of her hands, and ‘lifts’ the baby if the mother has uncomfortable pressure against her bladder and pelvic floor…If the baby does need repositioning she asks the woman to lie on her back on the ground, with her knees drawn up and heels flat. Then she places a long shawl, the rebozo, under her back and pulls it up at either side so that it cradles her hips. She pulls alternately with her hands to rock the woman’s pelvis from side to side in the sling formed by the rebozo. She may also do this in the second stage of labour with the woman in a standing position, leaning back against her, to help her to push the baby out. These complex techniques of massage and rocking are now being reassessed and incorporated into modern midwifery skills in Mexico.
An aboriginal tribe in Japan, the Ainu, also used massage to turn the baby from posterior to anterior. Indeed, evidence from many cultures suggest that this is a midwifery practice that has been largely forgotten today.
In the past in Europe and North America, obstetricians often used to turn a baby from breech to vertex in order to avoid Caesarean sections and difficult vaginal deliveries. But over the last twenty years or so, few have learned how to do it and many now consider it not worth the bother. Yet randomized controlled trials have revealed that two out of three birth can be turned, and will stay head down for birth, if rotation is performed after thirty-seven weeks or early in labour. This halves the Caesarean rate for breech births.
Modern midwives are not taught how to do this. Nor do they know how to rock and massage babies from posterior to anterior so that the head is in a more favorable position to pass through the cervix and birth canal. Only in countries where professional and traditional midwives have an opportunity to share their skills is this still possible.
Sheila Kitzinger “Rediscovering birth”
