I have seen two ladies come into the delivery unit this week with babies in the posterior position, both with an OP deflexed presentation, I just wondered how common this was?

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Student Midwife 2007

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Hiya, have found this for you, don't know how common it is in my unit, but we do seem to see quite a lot. I believe that a sedentary lifestyle is thought to be to blame:

http://ancientpathsmidwifery.spaces....D099!453.entry
Posterior baby study

Birth
Volume 33 Issue 2 Page 169 - June 2006
doi:10.1111/j.0730-7659.2006.0098c.x
Volume 33 Issue 2

Occipitoposterior Position in Labor
Elizabeth Shearer, MEd, MPH1
To the Editor,

I read the paper by Stremler et al (1), in the December 2005 issue of Birth
with interest, because a few years ago I served as coordinator for a study
on the association of changes in fetal position during labor and epidural
analgesia (2). The results of our study may shed some light on why Stremler
et al were unable to find a significant effect of position changes on the
incidence of occipitoposterior position, and also on why back pain in labor
is an imprecise indicator of occipitoposterior position.

In our study, lowrisk women were enrolled in early or earlyactive labor, and
given a series of bedside ultrasound examinations to determine fetal
position. We also asked women at enrolment to identify where they were
feeling the most pain (abdomen, back, etc.) and to mark on a visual analog
scale their current level of pain (0–10). We also determined the fetal
position at delivery (before any manual or instrumental rotation attempts).

We found that fetal position changes were common throughout labor, and the
final delivery position was not determined until very late in labor,
apparently in second stage. Overall, 36 percent of fetuses were
occipitoposterior at some point during labor. However, of fetuses who were
occipitoposterior late in first stage labor, only 21 percent were in that
position at delivery. Only 31 percent of those who were occipitoposterior at
delivery had been in that position at enrolment. In fact, 52 percent were
never occipitoposterior on any intrapartum ultrasound examination.
Furthermore, there was no association of back pain reported in early labor
and occipitoposterior position either at enrolment or at delivery. Given the
fluid nature of fetal position, this finding made perfect sense, even though
for many years as a childbirth educator, I firmly believed that back pain in
labor indicated occipitoposterior position.

Women who received epidural analgesia during labor were not more likely than
those who did not receive an epidural to have an occipitoposterior fetus
either at enrolment or right before their epidural. However, at delivery
there was a strong association of occipitoposterior position with epidural
analgesia. After multivariate analysis, women with an epidural were four
times as likely to have an occipitoposterior fetus at delivery.


Elizabeth Shearer, MEd, MPH1 References Go to:

1. Stremler, R, Hodnett, E, Petryshen, P, et al. Randomized controlled
trial of handsandknees positioning for occipitoposterior position in labor.
Birth 2005;32: 243–251.

2. Lieberman, E, Davidson, K, LeeParritz, A, Shearer, E. Changes in
fetal position during labor and their association with epidural analgesia.
Obstet Gynecol 2005;105: 974–982.

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"It's better to be thought a fool - rather than proved a fool!"

That's really interesting KS,

Thanks for posting that.

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Student Midwife 2007

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There seems to be a run of them at the unit where im studying, at the mo.

I have found it really interesting reading up about how in encourage babies to turn. However, i dont see mush of this pratice in actual pratice. Yes women are offered to get into different positions but are not explained, to why this is a good postioion and how labour can be affected by an op baby.

Its as if women and not being given the credit of understanding the mecanisim of laboour.

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I know what you mean Tink, I have found the same thing too.

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Student Midwife 2007

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It should not be this way. Women are being given informed choice.................? well when it suits and when its easy to.

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I know, that is how it seems.

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Student Midwife 2007

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Have the women you seen who deliver an OP baby had quick labours? My one and only witness of this was a woman who had a very quick labour and made sense that her baby was OP due to the fact that the baby had just not had any time to rotate into correct position.
Have only known OP position antenatally a couple of times, but nothing has been advised to women to help change that position.

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Catches: 2 assisted.

http://www.raceforlifesponsorme.org/michelle-susie

No they have all been very slow labours.

One lady suddenly reported that her babie had moved and was coming. She was very right out he popped. I spoke to her after about the feeling she had. The only way she could describe it was as if some one had put a corset on her the wrong way roung and then someone suddenly had twisted it round and fitted perfect. She said the relief of the pain leaving was fantastic.

I will aways remember the way she told it to me.

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Jean Sutton's 'Optimum Foetal Positioning' lectures look very interesting, it looks at ways for women to change the position the fetus is lying in.

OP position seems to be on the increase due to women's sedentary lifestyles, yet evidence suggests changing of maternal positions during labour has no effect.

One of my community mentors would always advise women carrying in OP position to spend lots of time on all fours during pregnancy

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