As a midwife in private practice, the far majority of my clients are seeking further support, education, advice and debriefing for a previous difficult labour and birth…many of the difficulties due to malpresentation of their babies…due to their baby being in a posterior position (OP). This means the baby is presenting head first, but instead of facing backwards towards the mothers back (OA), the baby faces forward, towards the mothers front (OP)(see below)
As part of my education for my clients I discuss ‘optimal fetal positioning’ in pregnancy. This means adopting certain positions from time to time, avoiding sitting for too long, staying active, in order to encourage baby to present in an ‘anterior’ or ‘more favourable position. The reason why I do this is because sometimes when babies present in a posterior position labour can be very difficult and exhausting for women, and due to many factors, a client may be more likely to have a caesarean section or an assisted vaginal birth than a woman who’s baby presents in an ‘anterior’ position.
Recently I read one of Rachel Reed’s blogs on posterior presenting babies…
Rachel states in her blog that posterior presenting babies should be ‘celebrated’…and as midwives we shouldn’t be concerned about this position as most babies will rotate to an anterior position during labour. Also she states that teaching optimal fetal positioning is not evidence based practice and that there is in fact no evidence to support that teaching this and adopting these position changes in pregnancy will encourage a baby to rotate to the anterior position.
I read each and every one of the research trials that she referred to and indeed, there appears to be no evidence to support educating women to use ‘optimal fetal positioning techniques’ in pregnancy.
HOWEVER…a baby in a persistent OP position during labour results in lower rates of vaginal births, higher rates of caesarean and more prolonged and difficult labours. http://www.scienceandsensibility.org/can-we-prevent-persistent-occiput-posterior-babies/ . Of all women in one particular study who had babies presenting OP in labour, 22-24% of babies did not spontaneously rotate to the anterior position. Of all babies that did rotate to the OA position, 94% had spontaneous vaginal births. Of the 22-24% of babies that didn’t rotate to the OA position, only 3-6% had spontaneous vaginal births (http://www.scienceandsensibility.org/can-we-prevent-persistent-occiput-posterior-babies/)…therefore, I don’t think OP presenting babies can be ‘celebrated’ as such.
That being said, once we know a baby is in the OP position during labour, adopting forward positions and being active may be helpful and there is certainly no evidence that doing so may be harmful. In my experiences, when women are supported to adopt their own positions during labour, many will lean forward of their own accord, using their own instincts.
Given that we know that babies who remain OP throughout labour and birth are more likely to require some kind of assistance with forceps, episiotomy, ventouse or caesarean section it would make sense that we should at least be teaching women about the benefits of staying active and strong during pregnancy. Over my 22 years of Midwifery practice, I believe I am seeing a rise in the number of babies presenting posteriorly (OP). After discussion with my fellow Midwifery and obstetric colleagues, they too believe this to be the case. We believe this may be the case due to more time spent in cars and sitting at desks, or even sitting in general. Whilst this is not an evidence based thought (as far as I am aware) it does seem to me that advising women of the benefits of staying active and not being sedentary for prolonged periods of times is beneficial for encouraging wellbeing, fitness, and well presented babies…