Wednesday, February 25, 2009

Optimum foetal positioning

So I had a baby in today who had one painful delivery into the world. The mother, trying to hide her distress, was trying to convey her whole ordeal with 'back labour' for 24 hours and how the child proceeded to get stuck in the pelvis, due to its 'anterior positioning' with the cord around the neck. This child, needless to say, needed a little help.

So what was this 'back labour'? what was the 'anterior' positioning of the child? and what is the optimum positioning for the baby pre-labour?

Optimum positioning of the baby prior to labour should be a position called 'left occiput anterior' (LOA). This is where the child's occiput (base of the skull) is halfway facing away from the mother's back. Hard one to explain: see photo:
LifeART (and/or) MediClip image copyright 2008Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

When the child is in this position, mothers usually complain of the child kicking the right ribs. Plus, you'll see the majority of the weight being on the left side of the pelvis/tummy.

The postion that the mother was talking about was the child being in the left occiput posterior position. It appears like the child is looking out forward and the child's back is more against the mother's spine.
In this position the mother will usually take longer to go into labour and the pelvis will be pushed to its limits with trying to expand to allow baby to engage. Its not that the baby is too big for the pelvis - it's just in the wrong position.

Due to this LOP positioning, the child's head will have the widest diameter, and cannot flex its head to get through the birth canal. Either way, its not good for mum and not good for child.
LifeART (and/or) MediClip image copyright 2008Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

This is one of the positions that leads to 'back labour'. Meaning all the pain and contractions are felt in the back. But don't worry. Aparently it has been found in studies that up to 87% of occiput posterior babies turn to occiput anterior positioning during labour. Great!

I'll talk about trying to avoid posterior positionings in another blog. There's too much!

I also had one mum talking about 'star gazers'. This is the also another word for the posterior positioning. Basically meaning the child is looking out towards the belly.

Good website found for explaining the whole postioning thing is:http://www.homebirth.org.uk/ofp.htm


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