Labor Prep: Posterior Positioning

Although I wrote fairly extensively about Addison’s birth, one thing that became clear as I was preparing for this birth is that I was either never completely clear on how the posterior positioning affected the labor process or I had forgotten. I knew that a posterior position can happen completely by chance, but it also is more likely to occur in subsequent births and thus they think it can also be related to pelvic shape. So not knowing which was the case for me, I set out to learn as much as I could about how and why it occurs, how to prevent it, and how to labor effectively if it happened again.

The book Ancient Map for Modern Birth, the “sequel” (of sorts) to Birthing from Within, was incredibly helpful on this front with a whole chapter on stalled and back labor and how posterior positions played into those. It was really this small sketch on page 253, though, that kind of explained everything with one look:

It’s illustrating why you should never lie down on your back when you have a posterior baby — because, duh, their skull is now resting on your spine! Ouch! When I saw the figure, it flashed me right back to Addison’s birth and the specific sequence of events wherein I had been in lots of pain, but successfully coping by sitting/swaying on an exercise ball. There had been some encouragement, even pressure, from the nurses and midwife to get me into bed, but I was determined to keep moving as long as I could. Then they came rushing in saying that baby’s heart rate had dropped and they needed me to get in bed immediately so they could insert an electrode in her head. It was around this time that my pain started to shoot through the roof and that picture clearly shows why. It also led to involuntary pushing and “swollen cervix” (backward progress in dilation), which I didn’t even know was common enough with posterior babies to have a name until this round of research.

All this research led me to three conclusions: first, I needed to follow all the guidelines to try and prevent posterior positioning, especially no reclining (boo! I love me some reclining). Second, if I ended up with a posterior baby anyway, I would NOT lay on my back, no matter how much the doctor or nurses pressured me — side-lying would be the most they would get from me. And third, I needed to practice all the various positions for turning the baby so that I could keep moving and progressing like it was second nature when the time came. Thankfully, I had an awesome birth coach:

She was not only adept at timing my ice “contractions” (I’m holding ice in all these pictures), she just happened to be the perfect weight for sitting on my lower back/hips to relieve pain. Over our couple months of practice, she got pretty adept with the labor lingo too. “Are you ready for your counterpressure?” “I think it’s time for the rebozo.” Once she mischievously added an extra minute to the timer and when I reprimanded her, she said, feigning innocence, “I wanted you to try some camelback contractions too. You’ve got to be prepared.” Sneaky birth coach.

I was also religious about taking 30-minute brisk walks since some studies have found a link between that length of exercise several times a week and shorter labors (yes, PLEASE!), and if I was going to avoid laying down I would need lots of stamina. Addison wasn’t quite so helpful with those, as she would alternately stop to collect leaves and pick flowers or complain about how boring the walk was. (Kai Ryssdal is much better company.)

Knowledge is power, and I felt ready to handle another posterior baby if she came my way!