Occiput Posterior Effect On Labor and Ways to Manage It

As approaching the delivery day, the doctor does an ultrasound scan to check the position of the baby. The ideal position is head-down (vertex) position with the head facing the back. However, the baby is not always in this normal position. The fetus might be in various other positions and one such position is occiput posterior (OP).

In this article:

What Does Occiput Posterior Position Mean?
Is Occiput Posterior Normal?
What Causes Your Baby to Get into Occiput Position?
How Do You Know if Your Baby is in Posterior Position?
Risk Factors that Increase the Chances of OP
Complications of Occiput Posterior
Diagnosis of Occiput Posterior
Management of Occiput Posterior
Prevention of Occiput Posterior
Which Position is Best for Normal Delivery?
Is Posterior Labor More Painful?

All You Need to Know About Occiput Posterior Effect on Labor

What Does Occiput Posterior Position Mean?

A head-down position of the baby facing the abdomen (and not the back) is called an occiput posterior (OP) position. The vertex presentation wherein the occiput (back of the baby’s head) is anteriorly (to the front) positioned, it is called occiput anterior and is considered the optimal position for birthing.

Is Occiput Posterior Normal?

It is safe to deliver a baby facing in occiput posterior position. But it is harder for the baby to get through the pelvis.

What Causes Your Baby to Get into Occiput Position?

Here are some reasons which cause occiput posterior position –

  • The shape of the pelvis – anthropoid and android-shaped pelvises could lead to occiput posterior. Women with the heart-shaped pelvis (android) can have the baby in this position because of the narrower front. A pelvis with an oval-shaped inlet with a large anterio-posterior diameter (anthropoid) with a narrow pelvic cavity may also lead to occiput posterior.
  • Maternal kyphosis – the mother’s kyphosis or hunchback (excessive curvature of the spinal cord) can make the fetal back fit into the curve. Multiple pregnancies (twins or more) can also be a reason for this position. These causes increase the chances of occiput posterior during delivery if belonging to the high-risk group.

How Do You Know if Your Baby is in Posterior Position?

In occiput posterior position usually means the baby kicks right at the front of the tummy, generally around the middle. Also, the tummy looks as though it’s flattened out, rather than being a rounded shape.

Risk Factors that Increase the Chances of OP

Here are the factors that influence the chances of having an OP position during the delivery –

  • Age more than 35 years
  • Nulliparity
  • Previous OP delivery
  • Obesity
  • Decreased pelvic outlet capacity
  • African-American race
  • Birth weight of more than 4,000 g
  • Gestational age of more than 41 weeks

Complications of Occiput Posterior

Here are the possible complications of the mother and the baby could face in the case of OP –

  • Risk of postpartum hemorrhage (more than 500 ml of blood loss) and infections
  • Delivery done using forceps and vacuum can cause a third and fourth-degree perineal tears
  • Longer lasting pre-labour (first and second stage) with a backache
  • Need frequent induction to start the labor and induction may fail, thereby requiring a c-section
  • Chorioamnionitis also called as intra-amniotic infection (IAI). It is the inflammation of the fetal membrane due to bacterial infection
  • Baby delivered in the OP position might have chances of a low APGAR score (less than 7), meconium-stained amniotic fluid, meconium aspiration birth trauma, NICU admissions, and longer neonatal stay

Diagnosis of Occiput Posterior

The OP position is diagnosed through an ultrasound scanning and its management is done only if the fetal heart rate is reassuring.

Management of Occiput Posterior

It is managed through –

  • Operative vaginal delivery from the OP position – it is done if there is sufficient room between the occiput and the sacrum that can allow the baby to turn. Forceps or a vacuum extractor is used to bring the baby out.
  • C-section – this is done when the above method does not help to deliver the baby through the vagina.

Prevention of Occiput Posterior

Here are some postures and exercises that can help keep the fetus in an appropriate position and facilitate delivery –

  • Postures – avoid reclining positions and sit with the pelvis tilted. Use a birth ball to maintain this posture. Sleep towards the left side keeping left leg straight and right leg at 90 degrees supported with pillows between the legs.
  • Exercises – perform exercises that involve pelvic rocking, walking, and swimming. Here is what can be done – 1. During pre-labor – pelvic rocking for 10 times for 2-5 times a day helps in rotating the hips in a circular motion. Get down on the hands and knees and lean forward as much as can, comfortably. Repeat this during the early stages of labor. 2. Towards the end of the first stage of labor – if the baby is moving towards an occiput anterior position, then squatting can help relax the pelvic floor muscles creating more room for the rotation of the baby. 3. During the pushing stage – doing double hip squeeze during the contractions can help the pelvis spread, providing more room for the baby to move back to the right position.
  • Therapies – chiropractic and acupuncture techniques help fix the improper alignment of the body and turn the baby to the occiput anterior position.

Which Position is Best for Normal Delivery?

The best position for the baby to be in for labor and birth is head down, facing the back- so that the back is towards the front of the tummy. This is called the occipito-anterior position. It allows the baby to move more easily through the pelvis.

Is Posterior Labor More Painful?

Posterior labor tends to be slower and more painful. In particular, the mother will often experience severe back pain during labor and sometimes this pain persists even between contractions. This is because the back of the baby is directly against the woman’s back.

Conclusion

Having a posterior baby makes the delivery process tough but with the medical techniques, it has become possible to ease the process of posterior labor. Consult the doctor for proper diagnosis and management.

References

https://www.ncbi.nlm.nih.gov/pubmed/20402724

https://www.momjunction.com/articles/ways-to-avoid-having-an-occiput-posterior-position_0082926/#gref

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