OP (Sunny Side Up), Cervical Swelling and Slow Dilation

Posted on November 14, 2009. Filed under: AROM, doula, Epidural, occiput posterior, Premature urge to push, Swollen Cervix, Vaginal Tear | Tags: , , , , , |

OP (Sunny Side Up), Cervical Swelling and Slow Dilation…These are a few of the issues my last client had. With her permission, I want to talk about her birth. It’s actually a pretty amazing story. In addition to what I mentioned, she also had a 9lb baby with a very large head and managed to get out with only a 2nd degree tear.

So this client had been complaining of back pain for a couple of weeks. She works at a desk so I was worried that her posturing may have aided in her baby positioning himself OP (occiput posterior) or what some people call sunny side up or face up. When a baby is OP, the back of the head, which is the largest and hardest part of the head, digs into the moms back in utero. This sometimes causes chronic back pain. Some moms never feel any back pain at all when their baby is OP. I had talked with her about this and suggested that she do pelvic rocks daily and spend as much time as possible in the open knee chest position. Open knee chest is when mom puts her head and breasts on the floor and sticks her butt up in the air with her knees about hip width apart. Sounds easy but when you are very pregnant it is quite difficult.  I also suggested that she sit on a birth ball that was inflated enough so that her thighs where parallel to the floor in the hopes of relaxing her pelvic floor and encouraging baby to turn. She is quite tall and I don’t think she found the ball very comfortable. I also told her no reclining on the couch.  I feel as if I should have done more to encourage her to encourage the baby to turn but her back pain came and went and she didn’t feel fluttering indicating hands in the pelvic area and I couldn’t see her tummy (She was two hours away from me) to see if she had the dip in the stomach that OP babies often make.  I guess I didn’t want to freak her out with all the optimal fetal positioning techniques when in reality babies that are OP before labor almost always turn before labor or in labor.

This is a baby that is occiput anterior, the optimal fetal position for easier birth…

190px-Smellie_XIV

This is a picture of  an occiput posterior baby. Notice how the back of the head is in the mother’s back…

10929W

This woman, who we will call Alyssa,  began her labor at 4am the morning that she was 41 weeks and 3 days pregnant. At around 5am or so she began to have leaking that she believed was her water.  I joined her at 9:30am. The time line for her birth m my arrival goes as follows…

9:30am: I arrive
Contractions about five minutes apart, less than one minute long
You were breathing through them very well
10:00-10:30am: We walked, contractions started getting longer and more intense
10:30-11:30am: Complaining of back pain, we do pelvic tilts and open knee chest, I worry baby is OP
Breathing well through contractions but growing more intense with each one
You rest in bed for a few contractions
11:30am: Contractions are very intense. Still around 4-5 minutes apart, a minute long.
You are ready to go to the hospital
12:00pm: We arrive at hospital. Staff is busy. We walk for half an hour and take it one contraction at a time. Back pain is  intensifying and you are feeling a lot of pelvic pressure
1:00pm: You are admitted. You are 4cm and 100 effaced and your water is leaking. Baby is at a +1 station. You are monitored for half an hour and the baby looks great. You continue working through each contraction one at a time.
1:45pm: You are taken off the monitor and get into your labor room. Labor is very intense and you labor standing while leaning on the bed for an hour.
3:00pm: Labor is so intense and contractions are coming every three minutes for about a minute and a half. You have a lot of  pelvic and rectal pressure. You are a bit shaky and very hot. We put ice cold towels on you.
Because labor is so intense, the nurse figures you must be very progressed and asks if you want to be checked.
You are 8cm dilated. You are having urges to push.
4:30pm: Contractions continue at 3 minutes apart and about 2 minutes long. Your back pain is much worse as is the rectal  pressure. We try many positions to help complete your cervix. A check shows that you are stlil 8cm. Midwife breaks  your water and your cervix closes to a 5 or 6 and the baby retreats back to a zero station. We talk about the baby possibly being OP but she cannot confirm with exam. We spend the next hour trying to get the baby to turn.
5:30pm: The nurse checks and says you are 9cm with a lip. We spend half an hour getting you in positions to aid dilation.
6:00pm: Labor has become unbearable and you are having urges to push, your back pain is very intense. Midwife checks you and you are 6cm and your cervix is swollen. She again is almost certain the baby is OP. She offers and epidural and you accept. You also have a shot of Nubain to  hold you over until the epidural is placed.
7:00pm: Epidural is in place. You feel pain on one side for an hour or so.
8:30ishpm: You are 10cm
9:30ishpm: You begin pushing. The baby is at a +2/3 station when you being. After an hour is becomes clear that the baby is OP. It is also clear that he has a very large head. You push for another hour holding the squat bar and/or sheet tied to it  while his head molds.
11:30pm: Baby is coming down but getting hung up on the pelvic bone. You push flat on your back with your knees pulled far  back and   apart. He is able to descend past the pubic bone and begins to crown. The doctor uses baby shampoo as  lube and supports your perineum as you push the final few pushes before he is born.
just before
12:00am. Baby is born!!!! He comes out crying and looking around and after being checked out for a
few minutes is brought to you for skin to skin contact. You try to nurse immediately but he was interested just yet.
12:20am: Less than half an hour after being born, your baby is successfully nursing!!!
12:30am: The doctor is finished tending to you and leaves. You and dad bond with your baby.
1:30am: I leave

So the time line is a synopsis and not the birth story with all the details. What I’d like to include in that is that as her back pain intensified and the midwife agreed with me that the baby was probably OP, we began to get Alyssa into every position we could to get the baby to turn. The bed was broken down with the squat bar attached because when she was 8cm we tried to get her to sit on the bed with her legs on the lower portion with her upper body on the bar in a semi squat position in order to put pressure on the cervix to complete it. She didn’t like it because she had so much rectal pressure, so we took the bar off but left the bed broken down. Once the OP presentation because very obvious, we had her lower body on the bottom part of the bed with her upper body on the middle so that she was basically on her hands and knees.  We tried to apply counter pressure but Alyssa didn’t like it. She had not wanted very much massage or touch so we didn’t not try to relieve her back pain that way. She mostly responded to cold on her lower back.

Another point I’d like to talk about is that she was at 8cm for more than two hours before the midwife broke her water.  She had been in active labor for about 13 hours at that point and was ready for things to move along. By this point her labor had become all but unbearable.  I believe that the baby’s OP presentation was making labor much much more painful. She was already beginning to lose control during and even between contractions and I think that even though AROM (artificial rupture of membranes)  was not part of her birth plan, it really did sound like the best idea at the time.  Of course, once it was done and the midwife  felt her cervix close and the baby retract, she had this “OH SH!T” look on her face. And also of course, once it was done the contractions became even more intense.

I am not sure if the midwife breaking the water at 8cm is what caused the  chain of events that followed. If it would have broken on it’s own, the same thing could have happen. I had it happen with another OP baby client. Her bag ruptured spontaneously at 8cm and her cervix went back down to 7cm and the baby retracted from +1 to -1/0 station. I also think that after having been at 8cm for two hours with transition strength contractions after having labored all day, that Alyssa was running out of both steam and motivation, understandably.

The former OP client I mentioned who went from 8cm to 7cm took SIX FULL HOURS to get from 8cm to complete.  She had no option for an epidural as she was in a Korean hospital that did not offer them outside of business hours. The doctor was also performing c section so she didn’t have anyone offering to end the labor for her and her cervix wasn’t swelling either.  She managed and made it through it but it was incredibly difficult. I have no doubt that in that scenario that Alyssa could have continued her labor without an epidural.

What made Alyssa’s labor even more difficult was to spend two hours at 8cm with pushing urges, eventually get told she was 9cm and still have pushing urges and then learn that she was 6cm with a swollen cervix. I think that hearing this was incredibly difficult for her.  Maybe there were too many vaginal exams, maybe she didn’t have to know all of that was going on with her cervix but the fact is, she was pushing involuntarily even at only 6cm.

I have read that premature pushing does not always make a cervix swell and that her swelling was probably more the result of fetal positioning. It could also be a combination of the two, it’s hard to say. At any rate, with the intensity of pain she was feeling the midwife thought it best that Alyssa get an epidural to relax enough to be able to dilate. I was incredibly worried about this because it would be hard to get the baby to rotate with the epidural but I really do believe that at this point it was necessary. Her cervix wasn’t going to get a break and she was in too much pain to be able to invert her with open knee chest to pack the baby out of the pelvis some.

The midwife was right, the epidural helped and she dilated quickly. As the time line mentions, she pushed for nearly two and a half hours. The head was large and had a lot of molding at birth. He did get hung up under the pubic bone but the McRoberts maneuver, flat on back, knees far apart and up as possible dislodged him and within a few pushes he was out.

The most amazing part of this birth is that mom had only a second degree tear. OP babies are often associated with a higher incident of third and forth degree perineal tears and considering the size of this baby as well, I think this mom was incredibly lucky. I think that the fact that Alyssa had a successful vaginal delivery is a little bit of a miracle. We had THE BEST nurse on staff that day who helped me encourage Alyssa to move through her labor before she got the epidural. We had her doing a lot of things she didn’t want to do but she trusted us and we helped her and she did it.  All of these things helped, I really believe this. They helped her baby move down so that when she did get the epidural, labor continued to progress.  The support continued after the epidural in that we continued to help her move to help the baby move down.   The woman used a squat bar to push with an epidural, THAT is a feat in and of itself.  It took three of us (nurse, dad, me) to support her through it but she totally did it.

Here are some facts that I found regarding OP babies…

  • The incidence of persistent occiput posterior babies at delivery is about 5.5% overall

  • With a persistent posterior, both first and second stages are prolonged (Ponkey et al). However, longer second stages do not in themselves cause worse maternal or neonatal outcomes; in one study, as long as the fetus was stable, the second stage could continue without harm to mother or baby (Kuo et al).
  • The likelihood of cesarean section or instrumental delivery (forceps or vacuum extractor) is greater when there is a persistent posterior position; in fact, the 5.5% of persistent posteriors account for 12% of all cesarean deliveries performed for dystocia (Fitzpatrick et al).
  • Persistent posterior positions are associated with an increased incidence of premature rupture of the membranes, oxytocin induction and augmentation, epidural analgesia, chorioamnionitis, , episiotomies, severe perineal lacerations, vaginal lacerations, excessive blood loss, and postpartum infection (Pearl et al, Ponkey et al).
  • Worse, there is a sevenfold increase in the incidence of anal sphincter injury, that is, third- or fourth-degree perineal lacerations (Fitzpatrick et al). Babies delivered from the posterior position were more likely to have Erb’s Palsy and facial nerve palsy than those delivered from the anterior position (Pearl et al)
  • Occiput posterior babies often times cause a premature urge to push (pushing before 10 cm dilated)
  • Occiput posterior babies can cause cervical swelling due to the hardest part of the head bearing down unevenly on the cervix. Cervical swelling can cause a stall in dilation or not allow the baby to descend enough to be pushed out despite the mother’s best efforts.

This study also explains the implications of epidurals with OP babies…

Epidural Analgesia Linked to Increased Risk of Occiput- Posterior Babies
Lieberman, E., Davidson, K., Lee-Parritz, A., & Shearer, E. (2005). Changes in fetal position during labor and their association with epidural analgesia. Obstetrics & Gynecology, 105 (5, Part 1), 974-982. [Abstract]
Summary: This prospective cohort study used periodic ultrasound examinations during labor to evaluate changes in fetal position and their relationship with epidural analgesia. The researchers sought to determine whether epidural analgesia is responsible for higher rates of fetal malposition (occiput-posterior (OP) or occiput transverse (OT)) or whether women experiencing labor with a malpositioned baby have more painful labors and are therefore more likely to request epidural pain relief. A total of 1562 nulliparous, low-risk pregnant women were enrolled in the study.The researchers found that the position of the baby (occiput anterior (OA), OP or OT) at the time of enrollment (in the early part of active labor) predicted position at birth poorly. For instance, of the women with an OP baby at birth, only 31% had a baby in the OP position at the initial ultrasound scan. Similarly, sonograms done later in labor were also poor predictors of position at birth. The data demonstrated that changes in fetal position were common during labor, with 36% of participants having an OP baby at the time of at least one scan. More than one-half of the women who gave birth to a baby in the OP position never had an OP baby at any ultrasound assessment in labor. Overall, 79.8% of babies were born in the OA position, 8.1% were OT, and 12.2% were OP at birth.

Epidural analgesia was strongly associated with delivery from the OP position: 12.9% of women with epidurals gave birth to babies in the OP position versus 3.3% of women without epidurals (relative risk 4.0, 95% CI 1.5-10.5). Transverse position was not related to epidural use. In a statistical model that controlled for various medical and obstetric factors that could affect outcomes, epidural use was still associated with a 4-fold increase in the risk of OP birth.

The data suggest that the association between epidurals and OP babies is not because women in labor with an OP baby are more likely to request an epidural. Women who received epidurals were no more likely to have OP babies at prior to or at the time that the epidural was administered. Furthermore, women with OP babies in labor or at birth reported the same degree of pain as those with OA or OT babies and were no more likely to report “back labor,” which is commonly thought to be related to the OP position. Finally, women with OP or OT babies at birth were much more likely that those with babies in the OA position to give birth by cesarean section, with 6.3% of OA babies born by c-section versus 64.7% of OP and 73.8% of OT babies (p<.001).
Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural “wear off” has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.
In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman’s pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself.

Ann Tumblin also sent me this regarding OP (face up) babies. It was done by Penny Simkin who is basically the mother of all doulas. It is very informative so if you have ever had an OP baby and are nervous about it a second time, I highly recommend you taking a look at it.

I believe that Alyssa’s birth outcome was the combination of her determination and trust that we were supporting her in every way we could and we were. I was sore the next morning which isn’t saying much compared to how she felt but more of a testament to the work I was doing. We were incredibly lucky to have the staff that we had and  I also believe that if any piece of the puzzle had of been missing that her birth story would be very different. I think the point that I want to make about her birth is that if a mother is supported completely and if epidurals are not done too early that even very difficult births can have a great outcome. Mom is satisfied with her experience which is, other than healthy baby and mom, the best thing.

If you had an OP baby, please share your experience with us.

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39 Responses to “OP (Sunny Side Up), Cervical Swelling and Slow Dilation”

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Congratulations to Alyssa and her team! What a miracle! Without her committment and the support of the team she would have had a c-section for sure.

I think you are right. I almost cringe saying it but if her circumstances would have been any different she most likely would have. I’ll tell you, I was worried for her during the birth, she had me all kinds of nervous!

This was such an eye opened for me! This sounds so similar to my birth experience except that my doctor and hospital staff were not as willing to work on options. After 12 hours with only 1 cm increase in dilation to 4 cm and excruciating back labour I asked for an epidural. Unfortunately in the Korean system I was to heavy(over 90kg) to have an epidural and was forced to have a C-section.
Reading this birth story really gave me hope that my next pregnancy will end in a VBAC.

Ok Mommy Cha, over 90kg i s the cut off for epidurals? That is only 198lbs! At full term with my son I was 214lbs. Now granted, I gained 65lbs which is ridiculous and excessive but that would have risked me out for an epidural had I wanted one. I too had a c section but I had a spinal for anesthesia. Would I have had general because of my weight?

Also, I am sorry that you did not have the support or the options. I know you can totally VBAC next time. I am going to be blogging about my own experience as I just found out that I am pregnant again. I am exploring my options to birth here in Korea with Dr. Chung in Apjugeong. I hope that some of the info is useful for you when the time comes. And also, HIRE A DOULA! It doesn’t have to be me 😉 just hire someone and utilize Karen as much as you can!

This is a comment submitted by Lanae, an internet friend, who came to me during her second pregnancy for some advice because her doctor recommended she have a cesarean. She had an OP baby the firs time and suffered a 4th degree tear. This comment is in response to the post “Avoiding a Tear After a Prior Episiotomy”. She commented there because even though she didn’t have an epi, the fourth degree tear left substantial scar tissue. This comment is relevant here in that she experienced what I am so glad my client did not.

With my first pregnancy my son was born face up. Because he was face up there were some problems during delivery. He got stuck on my bone and once he got free he literally shot out of me. I ended up with a 4th degree tear and a horrible recovery.
I found out I was pregnant with my second when my first was 10 months old. My doctor’s told me that I should have a c-section because of how I delivered my fist son. They were worried that I would tear again. They used a lot of scare tactics to try and persuade me that I needed a c-section. And they worked at first. I came across Amy’s blog and started to ask question and get informed. I realized I didn’t need a c-section I just needed to know different things that would help the baby to get in the right position.
October 2nd at 2:30 am I woke up not feeling too good. I told my husband that I thought I might be in labor. We laid on the bed for a little while to time the contractions, they were about 5 mintues apart. Once I was sure it was the real thing I got up and started to walk around (remembered your post about getting up). My husband and I got our stuff together so we would be ready to head to the hospital once the contractions were closer together. We left the house around 4:45ish. On the way there I was timing the contractions again and they were about 2 minutes apart. We got to the hospital and they made me sit in a wheelchair while my husband filled out all the paperwork. We walked up to labor and delivery, which took a little bit of time becuase I had to stop to lean on the wall every couple minutes. We arrived at L&D at 5:15, they weighed me and made me pee in a cup. My husband gave the nurse our birth plan. They had to hook me up to the fetal monitors just to get a reading to make sure things were okay and then they were going to take them off. The nurse checked me and said that my cervix was almost gone (at the time I wasn’t sure what she meant). I figured we would be there a few more hours before things got going, but I was wrong. I started to feel a lot of pressure so I had my husband go tell the nurse. She came in and told me the doctor was on the way so try to wait til she got there. She had me breathe fast during my contractions so that I wouldn’t push, but after about 3 of them I told her I had to push on the next one. The next contraction came and I pushed, which broke my water. After my water broke I could feel the baby’s head so I pushed again. The nurse told me to try and wait to push since I had tore so bad last time, they wanted to allow me to stretch but I couldn’t hold back. On the second push my son’s head came out and on the third push his body came out. He was born at 5:57. The doctor got there right after my placenta came out. I ended up with a superficial second degree tear, which was much better than the fourth degree one I got previously. I had very little pain and recovery was a breeze.
Just because you tear bad once doesn’t mean you’ll tear bad again.

Amy, the story of Alyssa is almost an exact replica of what happened to me when Jackson was born. If I had been more educated at the time I would have known that he was OP from the description of the belly that you gave. That is the exact way that my belly looked. In fact, everyone would comment that they were surprised I was having a boy because I was ‘carrying high’ when infact it was just his positioning. The back pain and loss of control that you described Alyssa having during labor again is a description of me. I also ended up with an epidural when it was my plan to labor naturally. I am very thankful that I was able to push to get Jackson to change positions during delivery, but I still ended up pushing for 2.5 hours because the of epidural I didn’t have enough feeling. I also ended up with an episiotomy because I refused the forceps and vacuum and my OB felt that I was running out of energy to push. I have learned so much through your blog and other infomation that I am hoping to avoid another OP baby in the future!

Megan,
Thanks for sharing your story. OP births are TOUGH. I am glad you were able to vaginally deliver but I know how had it was for you both before the epidural and even after with 2.5 hours of pushing. I am sorry that you had an episiotomy. I am glad that you are finding useful info to hopefully prevent another persistent OP baby. There definitely are things you can do to get the baby to turn both prior to labor and during. Good luck next time!

And also, the doc didn’t ask to use forceps or vacuum with Alyssa but the vacuum extractor was brought out and laying on the table. I am not sure that she ever saw it but it was on stand by. Thankfully this doc was not episiotomy happy or she would have had one. Like I said before, the stars aligned on this one!

Wow, this was an enlightening post. I read it this morning and my jaw dropped open. I had a very similar labor with my son that ended in a c-section after being “stuck” at 8-9 cm for several hours. I say 8-9 cm because at one point the dr checked and said I was complete except for a cervical lip and then then the next time I was only 8 cm again… let me tell you those are words I never want to hear again! I had no idea you could progress backwards!

Amy knows my birth story but only recently did I mention that my son was OP… wanting an unmedicated birth that ended in a c-section was rather traumatic for me and I blocked a lot of it out, until I recently became pregnant again and ordered all my labor / delivery records for my new doc to allow me to VBAC. Several key words jumped out at me – OP, prodromal labor, PROM…

There were several clues that I missed before labor began – the fluttering in the lower part of my stomach (I could feel kicks up high but punches below my navel). I had a desk job and sat at least 8 hours a day. I also spent about 2 hours a day on the labor ball when I got home (wish I’d had it at the office). I avoided reclining in any position because I heard it can lead to malpositioning (my big fear was breech) but dr said baby was head down…

I dreaded being weeks overdue – like all women in my family – so you can imagine I was anxious to get that baby out within a reasonable amount of time! I did tons of pelvic tilts even while at work and also on the labor ball. My stomach was also odd shaped – you mentioned a “dip” and I’d like to see a diagram to make sure, but my stomach was “odd shaped” if that makes sense – definitely not your typical basketball preggo tummy. I started dilating at 37 weeks but progress was slow and I managed to be 3 cm and 75% effaced when my water broke at 9 am – I was 41 weeks 6 days. There was yellow meconium. I wouldn’t have headed straight in even though I was “supposed to” per hospital policy except that I already had a 10 am appt. When I arrived they immediately switched me to the on call dr, who was my least favorite and not supportive of my natural birth plans like my doc had been (she was going to let me go 43 weeks if baby continued to look good on the monitors, knowing I wanted to avoid induction).

The hospital dr on call insisted on starting pitocin to “throw me into labor” when my water broke (didn’t know PROM was a clue to OP either til I read this) and I didn’t realize I could refuse pit even though I was devastated (in my mind, induction and epidural were the worst case scenario. A c-section was not even on my radar). After several hours hours on pitocin, I was still 3 cm. The dr came in and broke a second bag of water at 4 pm (7 hours after PROM) – this time the meconium was nasty green… it still took me forever to get to 4 cm, then 5, but contractions were instantly painful after the water broke. Oddly, though, ALL the pain was in my back – I never felt pain in my belly during the entire labor but my back was KILLING me. I began to doubt my ability to “do this” and had my mother come in the room about 6 or 7 p.m. She applied constant counter pressure to my back which was my only sense of relief. Also at some point after 5 pm the nurses changed shifts and the new shift allowed me to move around, so I made them drag out the labor ball and I sat like a rag doll on it with my head on the bed in front of me. I felt lots of rectal pressure and the urge to push from 6 cm… I remember my mom asking if I got to push when I hit 7 cm, LOL… I guess it’s been a while since she had children (5 natural births, including a VBAC, and 1 c-section, blessed woman). I had an early transition that started between 5-6 cm with double peaked contractions that were 60-90 seconds long and 2 minutes apart (they had been 2 min apart all afternoon). I was not getting a break and was exhausted. Surprisingly I went from 6-8 cm in an hour and then 8 cm to the “lip” within 30 minutes or so after that, only to drop back to 8 cm and never make more progress (it was at this point that the nurse told me the baby was “posterior”). The baby never got past +1 station.

After 16 hours of labor, I decided to cave and ask for the epidural to help me relax. I was relaxing as much as I could, but I had stopped dilating at all for several hours. The baby’s hb was up and down and I was on oxygen a lot of the time. I actually liked the oxygen – it helped with the pain. The dr said it was too late and I needed a c-section. I begged for another hour. He agreed. 30 minutes later the baby’s hb deceled badly and they rushed in and dragged me into the OR. I got one shot for the spinal and fortunately it worked. Long story short, my 9 pound, 15 inch head son was “stuck” – he looked like a baby from the conehead factory when he was born. It took drs 11 minutes to tug and pull him out (rather than the 30-60 seconds they told me) and they had to use forceps which scraped his face.

I often wonder if I had decided to get an epidural earlier (at some point after the 8 cm stall) if I would have dilated fully and gotten a vaginal birth… possibly with a huge tear, which is also terrifying, or most definitely an episiotomy.

Thank you for this post and for the info that nearly 65% of OP babies are born by c-section… honestly, it kind of makes me feel better. 🙂 As you know, I kicked myself over my c-section for a long time until you gave me permission to stop. ;o) At the time I was in labor I was more worried about dilating and avoiding an epidural than about positioning – he was head down, and my mom had delivered several OP babies, right? I wish I had been more educated about getting him to move positions… or the dr had tried turning him (I was OP but the dr successfully turned me).

Anyway, I know a lot more now and will be entering L&D next time with much more information. Sorry for the comment of epic proportions here… I’m not known for being concise… ;o)

You made so many points that I want to touch on, I hope I remember everything. Yellow meconium with PROM indicates either prior fetal distress or baby just had to poop. Alex was a 42 weeker, I think he just had to poop. Yellow means old by the way so would have still been ok to stay home most likely. Sounds like you were doing everything right prior to labor to give your body the best chance but there are positions that you can do that will make an OP baby turn. There are also rebozo techniques. The key this time for you is recognizing it earlier and working daily. I would also recommend prenata chiropractic care. Look for someone trained in the Webster method. The adjustments are such that it opens your pelvis to allow maximum space for your uterus which in turn gives baby as much room as possible to rotate. You should start asap as it takes a while for things to ‘stick’. I would also get a prenatal massage therapist who can work on helping release your pelvic floor, losening the muscles to allow maximum room. Charge it on your credit card, cut off your cable. whatever you have to do, these two things are that important.

I think learning stats on birth scenarios can be very healing. The more we can all learn about our body and it’s ability and the issues that can happen and how to correct them, the more confident we become. It is not that something was wrong with your body, it is that your baby, for whatever reason and also for one that you did not cause, was in a bad position. I think that is something that you really need to believe because with that self forgiveness you will develop more confidence with your VBAC. Keep reading and talking and GO READ THOSE BOOKS I KEEP TELLING YOU TO READ!

Also, great point on head down is not good enough. I cannot stress this enough. I tell my clients this and I try to give them the info they need. There is a fine line because I do not want to freak peopel out and sometimes there truly is nothing you can do. Alyssa’s baby is proof. He.was.not.moving. So maybe we could have done more before labor but there is not guarantee that he would have turned then. Sometimes, they just won’t. Period. At that point we have to do the best we can with what we have been dealt and like I said before, in her case, she was truly supported the way a laboring woman should be. Maybe things would have been different for you otherwise but there are many pluses to your story, like avoiding a 3/4th degree tear like you mentioned which was also very probably. Again, Alyssa got lucky there.

As far as wishing you’d have known more, I DID know more and I still had a face first. mentum transverse presentation that was a vaginally impossible delivery. I have since learned that rebozo sifting could have resolved the face first presentation, but again, no guarantee and no way to tell.

You are getting there Desiree, I can see it, baby steps but getting there 😉 I am so proud of you.

Watch me call you during my next labor and have you walk me through the Rebozo on the phone, lol. I read about that on spinningbabies.com and I am on it! 🙂

P.S. Currently reading Hypnobabies; Ina May is next on the list. 🙂

The Thinking Woman’s Guide is the one I am really houding you about. Maybe Birth Without Fear also 😉

OMG, I so need to teach James rebozo. A lot of this stuff is stuff you do before labor so that you don’t start labor with an OP baby.

TTWG is the one my mom has… I’m picking it up tomorrow. Yes, James is really good at practical maneuvers and OMT therapy too. 🙂 He just treated my shoulder today. Are there any sites with video on how to do Rebozo? I guess I could look that up. Maybe spinningbabies… can’t remember.

I’m glad I happened upon this post! It made me feel better about my birth experience. I delivered a sunny-side-up baby vaginally with a lot of medical intervention in June of 2008. I WISH I’d had such an amazing support team during my delivery, but sadly I didn’t.

Hi Susan,

Thanks for stopping by. I wish you would have had an amazing support team as well, I truly believe it makes a HUGE difference. I am glad you were able to vaginally deliver. I hope your recovery was not too bad and I hope in the future you are able to be proactive with any OP babies you may have.

I am 4 weeks post-partum today, and still having a really hard time dealing with my delivery experience. In my hopes of finding something on the internet I came across your website; after reading a couple different articles I decided to “share my experience” in hopes that someone could tell me something to make me feel better about everything that happened. Here’s my story:

The day before I actually had my baby I just didn’t feel well. I had a Dr’s appointment that day, which was my “due date”, and was still only 70% effaced and between 2-3 centimeters dialated. The next morning, my actual delivery date, I still just wasn’t really feeling 100%, but didn’t think much of it–I had gotten used to being tired and having an achy back. My dad and I had a couple errands to run that morning, so I asked him to drive. We went to have breakfast, during which I had to go to the bathroom three times in a matter of about 10 mins. Afterwards we did our errands and started heading home which was about 30 mins away. About 10 mins from home I asked my dad to stop so I could go to the bathroom. As soon as I got out of the vehicle and walked into the door of the place we stopped, I felt a trickle down my leg. Uh oh!! I did actually make it into the bathroom, but sure enough my water had broken!! “Stuff” went everywhere, and I say stuff because there were all kinds of colors and “chunks” of things. We went straight to the hospital!! Of course I was immediately admitted about 0930. At this point, the only thing really going on was water leaking and me being scared. My contractions really weren’t happening, relatively speaking, until about 20 mins after being admitted and being hooked up to the monitors. When the contractions did start, they made there prescence very known–they were quick and intense! And my back REALLY started hurting. I already knew I had wanted to have an epidural, and the nurse told me when I was admitted that if I wanted an epidural I needed to let her know because it would take about 2 hours to not only get me ready for the epidural (she told me I would have to have at least 3 IV bags in me first), but also to give them time to have someone up there. So when the contractions were coming quick and hard, and my back was hurting more and more, I told the nurse I wanted the epidural. At this point, about 1030, the nurse gave me a shot of stadol to help take the edge off while we were waiting. About 1200/1230 I was really in pain, and still waiting on the epidural. My nurse decided to give me another shot of stadol to help. I received my epidural about 1330. My labor was progressing at a pretty steady rate, about 1 cm dialtion an hour. I was still miserable. I was hungry, I was tired of laying on my back, and my back still seemed to be hurting or more uncomfortable than I thought it should, but what did I know, this was my first time doing this. And the nurse wouldn’t let me move around–I forgot to mention that as soon as I was admitted they had me lay in the bed on my back without walking around because they told me since my water had broken I stood a chance of my baby’s chord coming out first if I walked around versus laying. This went on until about 1930 or so. I was dialated to 9 1/2 cms, and the nurse wanted me to “try” a couple pushes to encourage the last 1/2 cm. One of the other things we did at this point was have me get up on my hands and knees and rotate my hips a bit. At this point, the only people in the room were me, the nurse, and my husband. I did finally dialate that last 1/2 cm and started pushing. I would say probably an hour after I started pushing the doctor came in. Please keep in mind, I am still on my back, and with each contraction I am having to sit up, pull my legs up, grab behind my knees, and push. Not to mention that by this time my epidural had worn off, so I was hurting worse than anything I had ever felt in my life!! There were other people in the room with us at this time, another nurse, the anastesiologist (sp?), all encouraging me to push, about 4 times with each contraction (hold breath, push for a count of 10). About 2 hours plus into this, I am exhausted, I am hurting, I am screaming, and everyone is yelling at me that I am the only one who can stop the pain, I have to push her out!! I was begging them to let me change positions, let me stand up, let me sit up, something!! Please do something!! I was really getting discouraged with everyone, including myself, because it seemed like nothing was helping me to push her out, and all it seemed they were doing was yelling at me to calm down and push. But at the same time, with every push, they said how good I was doing. I was also told there was a “lip” of my cervix around her head and that was what was holding her in, but I had to push through it. And my doctor kept her hands in me after each contraction trying to help “pull” the baby down–it felt like she was splitting me into. After about 3 hours plus of pushing and not getting anywhere, I told them I could not do it anymore, just get her out of me, I was done, I had no energy left, I was hurting too bad to be able to do anything, they had to do something!!! The doctors and nurses all told me they could not give me anything for pain, they told me if I had a csection my husband would not be able to go back with me and they didn’t think I wanted her born and her dad not be there. But I honestly just could not do it anymore–I apologized to my husband immensely. So they got everything ready they needed to in order to complete a csection, had me sign papers, had my husband sign papers, prepped me for surgery. Afterwards, a few days afterwards to be honest (I was so upset about the entire delivery that my husband dare not bring it up), my husband let me know they had come out after all was said and done to let them know how I was doing. The doctor told my husband our baby was actually sunny side up, and quite honestly that I could have pushed until 0500 and probably still not been able to have her vaginally. I was so upset!! Why #1 did they not know that beforehand and #2 why couldn’t they tell ME that?? They had all yelled at me so much, and made me feel SO bad, why couldn’t they have told me that? And why couldn’t they have done anything more to help me have her? Why couldn’t or wouldn’t they have broken the bed down and tried a different position, maybe one where gravity could have helped me a little bit? Why couldn’t they have put me into a position where I was not having to use all of my energy just to raise my big self off the bed and pick up my legs?

I had been through two deliveries with very close friends, so it was not like I had no knowledge of what was going to happen in there. Their deliveries were so drastically different from each other, so I felt like I was at least somewhat prepared for what basically was going to happen. However, I was NOT prepared for how my entire labor/delivery experience was.

And even though I have the knowledge that my daughter was sunny-side up…I am still angry and bitter, and feel terribly disappointed that I could not even deliver my daughter–they had to do it for me by cutting me open.

Hi Jamiee,

I am sorry that your birth did not go as planned. I am not sure if you read my birth story or not but I can truly sympathize with you in both how things ended up and how you feel about it. I think it’s great that you are admitting your feelings about your birth rather than bottling them up. So often we are told “at least you have a healthy baby, that’s all that matters” when in fact it’s not the only thing that matters. I do not think you should have any guilt at all for mourning your birth because unplannned c sections by a mother who preferred a vaginal birth can be very traumatic and hurtful. Psychologically it can be damaging. The data has already shown that c section mothers have higher rates of postpartum depression and I experienced it myself. It took my a full year to really process what happened. For me the biggest thing that helped me was to learn about what happened and why what happened happened. The more I learned the better I felt. I had to fully understand all aspects of my situation before I could forgive myself for it and let myself off the hook. I don’t know if that will work for you but that’s what worked for me and it’s what ultimately led me to training as a doula. By the time I had learned as much as I could about my own circumstances, I had learned a lot of other information along the way and I like to share info so there was a chain reaction and one thing led to another. I also had to learn to trust birth and my body and I had to do that before i could even think about getting pregnant again. It all takes time but you are going in the right direction by seeking the information and support that you need.

As far as the circumstances of your birth is concerned, this is a very familiar story I am afraid. Epidurals are known to increase the risk of an OP baby (sunny side up) and also to keep an already OP baby OP. It is harder for the baby to rotate and descend when the mother has an epidural. It does sound as if you had to wait a while to get one though but unfortunately you were forced (unnecessarily in my opinion, do you know the baby’s station or how low it was?) to stay in bed on your back, again without the help of movement and gravity to aid in rotation and descent. You were also terribly under supported and I am truly sorry for that. I feel like every woman needs support in labor but especially in these difficult ones. YOu obviously read the story of my client with an OP baby and the amount of support she had and I feel like had any piece of that support puzzle had been missing, she too would have had a c section.

I have another post about fetal positioning, I am not sure if you have read it but here is the link…

https://doulamomma.wordpress.com/2009/06/10/optimal-fetal-positioning-for-a-better-birth/

It discusses OP in depth at the bottom of the article in an excerpt about epidurals and there is also a link to a slide show discussing OP babies. Here is the link…

http://www.pennysimkin.com/articles/HO_OP_Fetus_how_little_we_know09.pdf

The main thing I want to tell you is that it is ok to be upset about everything. You do not have to feel guilty. Of course, be thankful for your perfect baby, appreciate that but it is perfectly ok to feel angry and bitter and pissed off and hurt and everything in between about what happened. But I do promise it will get easier in time. *HUGS*

Amy

Let me add this in addition to the above…

My beautiful, perfect little daughter arrived that night at 2341, healthy, weighing in at 7lbs 11 oz, 20 1/4 inches long. And quite honestly, that is all that should matter I know.

But I am carrying a lot of guilt and anger that I can’t shake, and I am hoping someone on here can help me.

Amy!! If I knew wehre you were at and I could, I honestly think I’d find you and give you the biggest hug ever!! Holy cow at the information and the stories and YOUR replies to ALL of them!! I am SO happy I found your website!!!! The sense of comfort, for lack of a better description, is truly a great feeling. THANK YOU!!

The fact that your first response to me wasn’t oh you need to talk to your doctor about getting some anti-depressants for the baby blues, or telling me that what I am feeling is just the baby blues, truly means the world. Don’t get me wrong at all, I very much am a fan of some “modern” medicines, and I honstly believe that anti-depressants are truly a great thing for some people and I am truly appreciative of the fact that the “baby blues” or post partum depression is recognized and actually talked about quite a bit these days, but, and this is a big BUT….I don’t think that every mom who has just given birth needs an anti-depressant. For me, and I understand it’s a personal event in every aspect, for me I don’t believe in taking medicines for every little thing. I think the human body can work through some things without the intervention of chemicals all the time. And for me, having someone to talk to who can not only sympathize with where I am at and what I am going through, but says you know what, the way you’re feeling is OK, helps more.

The more I read, both the articles you have, and the stories on here….the angrier I get at “my” doctors and the more I am starting to let go of blaming myself!!! The only thing/s I wish is that I had found this website and knew more than what I did before now. Hindsight 20/20 though. However, I don’t think that takes away from the fact I feel that “my” doctors, and from the posts on here, EVERY OB doctor, should be a little more educated or up to speed on baby positioning and what moms can do well before they get to the labor process.

So many things that I was told while I was pregnant–don’t sit with your legs crossed, you need to “put your feet up”, literately, no your baby’s hands aren’t going to just come out, you haven’t “dropped” yet. If I had only KNOWN then what I know now!! Everything in the world was letting me know what position my lil girl was in weeks before she got here. And I, I being a person who normally listens to their body more than anything, listened to “everyone” else because I thought they knew more than I did since they were doctors or they had been there, and I was SO afraid of screwing up that I went against my own instincts.

I could go on and on forever, but I am going to wind up this blog for now. Bottom line is, Amy I think your website and the information and all the women on here are GREAT and I appreciate it!! I will definitely keep my eyes on here for a while because emotionally this website helps. And too, 😉 I just read this morning that you are pregnant again Amy–that is awesome!! Congratulations!! Please keep your posts up on here and let me know how this one goes for you….might just change my mind one day after all about “doing this” again.

You’re welcome Jaimee!

I am glad you are finding some useful information. First births often times (and unfortunately) end up being learning experiences but at least you are going on to learn more so that you can eventually think about doing it again. We have to take responsibility for our bodies and our babies and our births but culturally we just aren’t supported to do that. We instead end up being terrified of birth and think that we have to have drugs and that everyone else knows more about us that we do. It’s sad really but I think that in your journey you will find that you have a lot more confidence that you thought and that you can even go on to VBAC when you are ready. I’ll be blogging my VBAC journey so stay tuned!

Take care,

Amy

My son Maverick was born OP. My labor was only 8 hrs from start to finish. It was VERY intense, but I’m glad it went so quickly. When the Dr checked me and told me I was 10 cm he also told me the baby was OP so he wasn’t going to have me push. He said he was going to have me “labor down” and just breath through the contractions because it was going to take me a long time to push him out since he was sunny side up which freaked me out and I was anticipating a LONG hard pushing process. However, about 5 min later I started having tons of painful pressure. When the nurse checked me the baby was right there so they called the Dr in real quick and 4 pushes and only a couple minutes later he was out. The dr was amazed I was able to push him out so quickly and kept telling me so over and over. Maverick was a normal sized baby at 7lb 13oz and I only ended up with a 2nd degree perineal tear which isn’t to bad as far as I’m concerned. My first baby was not OP and I ended up with a vacuum assisted birth, a 3rd degree tear and I bled badly during the delivery so all in all I counted myself very lucky.

Thanks Andrea! It is good to know that OP baby labors do not have to be horrible and that it is possible to actually have a pretty easy birth. I think I remember that you didn’t get the epidural until very late in your labor. Where you moving around and upright prior to getting the epi? I think waiting so late much have helped Maverick move down much easier. When did you get the epi in your first birth? I didn’t know you had a 3rd degree the first time, I am sorry to hear that. I bet you do feel lucky this time!

My original plan was to get the epidural ASAP, but it didn’t end up that way LOL. The first half of my labor was spent at home walking around and putting on my makeup…yes, I am that vain haha. I got to the hospital at 3am and since I wanted an epidural they made me get in the bed right away so they could check me and do my blood work and so on…that was excruciating! The contractions were unbearable while laying in the bed on my back and I was writhing in pain the whole time. To make things worse they had to try 3 different times to get my IV in. The first 2 time they blew my veins and I ended up with huge bruises that lasted a month. Once they finally got the IV in and my bloodwork back they called the anisthesiologist and he didn’t come so they had to call him again. He FINALLY got there and did my epi and when they checked me right afterward I was already 8cm and an hour later the epi wore off on its own for some reason so besides that one hour of pain relief I had a natural birth. With Mylee I was induced and I had the epidural when I was only 4 cm cause the nurse kept pressuring me about it even though I wasn’t really in any pain. I think the fact that my epi had already worn off made pushing Maverick out much easier cause I could feel everything.

Well, if you were having any more I’d say plan for a full on natural birth and stay upright the whole time 😉 It does sound like all the moving and the epi delay really helped you with your OP babe though, good for you! I am glad it went so well, it could have been very different for you.

Thanks for the post and info – I also had an OP baby that ended in a c-section…I had a fast labor with no back pain, didn’t get an epidural, pushed for 4+ hours until my midwife asked if we could get an ultrasound, and then it was discovered he was OP. Even though the midwife I had seen for most of my appointments told me – and marked my records – that he was probably OP, no one thought of it when I pushed and pushed and nothing happened…
Jaimee, I feel like I had good support, and was with midwives, had helpful nurses, and I was still incredibly pissed and disappointed I ended up with a c-section. It took me a full year to process what happened. My son’s 2 now, and I’m pregnant once again, and planning to do my best to prevent this one from ending up OP. Wish me luck…
Thanks for the blog! I’m glad I stumbled upon it tonight!

Jaimee

Hi jaimee,

Be sure to check out this post…

https://doulamomma.wordpress.com/2009/06/10/optimal-fetal-positioning-for-a-better-birth/

It has several links to http://www.spinningbabies.com. I wish you the best of luck. I just had my first client to have a c section and her baby was OP. 30 hours + labor 2 hours of pushing and baby never descended past 0 stations. It’s a tough thing to go through. I am glad you are seeking out info to help this next time around. I too had a malpositioning (face first/mentum transverse) and ended in c section after 52 hours. I am pregnant with #2 as well and will also be working hard this pregnancy.

Amy

Loved your thoughts on the subject! I am a birth doula myself, and just delivered my third child, this time posterior. My first two were both OA, but this big guy (9lbs 9oz) stayed OT until I started pushing and then turned OP. I had tried to encourage him to turn OA, but because of the contractions feeling so crampy I had a hard time leaning forward without causing more discomfort. I pushed on my side for about 25 minutes at the peak of contractions, then really pushed for another 25, then got onto all fours and pushed another 5 minutes before he was born. And amazingly, I only reopened the 1st degree tear I had with both my first and second children. The labor I felt was easier then my first two, but I did have to push longer then with my second birth. Overall a good experience, and I’m very proud of myself!

I had a OP baby the second time round, over 3 hrs of pushing, I think i was lucky that she was only 7.13 1/2 pounds, as they didnt encourage me moving and trying other posi’s other than to get me on my knee’s for the last 15mins of pushing before they made the decision to do an emergency c-section, lucky for me that lil bit of gravity worked and i had a natural birth with only one small tear which did not need stitching, about 2hrs after the birth I hemmoraged, I didnt feel right after my daughter was born i still had alot of pressure and pain in my bum which was a kind of throbbing, i just put it down to the whole birth, then while i was trying to breastfeed her i felt this gush and i knew i had just filled one of those hosi pads that are huge, i waddled up to the midwives office not wanting to be a pain and ring the buzzer, i told the midwife and she said oh well you shouldnt of filled one yet go to the toilet and see, just as i feel another gush and a pool of blood runs around my feet, everything goes slow mood the nurse takes a step forward stretches her hand towards me and says put the baby down!!! I get her in the lil cots they have and she ushers me back into my delivery which lucky for the cleaners hadnt been cleaned up from yet as it was a quiet night! I crawl up on the bed the midewife is calling all these ppl in, someone removes my soaked pants (which luckily were black) and then i start uncontrolable shaking, by the time my doc gets to the room there is already 4-5 other nurse’s/midwives, one is giving me needles, one is trying to massage my uterus much to my complaint, and another is putting another drip in, doc puts me in stirrups and for want of better wording scoops out my huge clot i swear it felt like passing the placenta all over again, they place an oxygen mask on my face and i pass out after they put hot blankets on me, my last thought was ‘If i die my parents will look after the kids’ at about 8 am i wake up and busting for the toilet, no one is around so i wheel my two drip machines into the bathroom as i come out i get in trouble for getting up and moving as they were still watching how much blood i was loosing, they estimate i lost over 2litres of blood, i had to have a blood transfusion the next day, and because of the blood loss my milk didnt come in until 6days later by which time i had started bottle feeding to help flush jaundice out of her systum.
Now i am worried about repeatsof both these things, plus both my babies have suffered with jaundice in my sons case he was rushed back to hosi with reli high readings, then rushed to another hosi because they kept going up. That was prob the most scary as i couldnt do anything to help him i could even hold him.

I’m incredibly grateful for this story. Like many of the women here, my unmedicated birth ended up in a C-section. And I too am harboring enormous amounts of guilt, anger, and what ifs.

I labored to 9 cm and within an hour, had gone back down to 7 cm and stayed there. I had researched so much except for cervical swelling. I didn’t know why it was caused and I don’t even remember the nurses knowing why. If even one person had said, “it’s probably due to fetal positioning”, I would have thrown myself on the floor with my butt in the air to get that baby to turn.

Honestly, I don’t know if an OP baby is the reason my cervix started swelling. But knowing that this could be the reason, really does help in the healing process of my traumatic experience.

I still have lingering questions that I hope will get answered in time. I just had my baby 5 months ago so I don’t know yet if there will be a second (I’m scared to death of a repeat C/S), but in the chance we decide to have another child, I will most certainly go the midwife route and research like a wild woman.

Thank you again for sharing this.

my first baby was OP- and some part of me wishes that someone had noticed that BEFORE i pushed him out!
labor started slowly one night, i was just over a week late and had a bio-physical scheduled for the next morning. we went in and during the bio-physical, they saw a minor jump or dip during one contraction in the 30 minute observation period. so i was then sent from the birth center to the hospital to have an ultrasound (my 4th during the pregnancy, though i had requested that we have no ultrasounds at all) to verify position, amniotic fluid levels, and other things about the baby’s state of health. fluid levels were good, baby head down, moving a bit, and we were admitted to labor in the hospital. this was mid-morning. steady contractions (not painful, but every 5-10 minutes) had started the morning before. i was not dilated at all, or effaced. i labored. walked all over the hospital, since my water hadn’t broken, went up and down stairwells, couldn’t really sit, so i just kept moving. alone or with my husband or sisters. i drank fluids, but ate no foods.
i couldn’t sleep, and hadn’t slept the night before either because of the crazy excitement of birth. at 1 am, the contractions started being painful. not in my cervix, but in my spine. it felt like someone was smacking my tailbone with a hammer every contraction. for an hour or so, i walked, moved, and took a bath (all alone since everyone else was sleeping), but then couldn’t get out of the tub because i hurt so badly. then i got some help, and cried silently with every contraction. the next morning i was only 3 centimeters dilated.
the back labor continued, but i don’t think i expressed exactly how much pain i was in to anyone. i figured it was just what contractions were. my husband was terrified because he had never seen me so scared and hurt, and he couldn’t help. everyone else just kept pushing him aside and tried to get me to have a baby.
by late afternoon, i was still only 3 centimeters, my water hadn’t broken, i was beyond exhausted, and it was made clear to me that the moment i stopped fighting, i would be sectioned. on juice alone, (and even that looked down upon) i kept fighting the most intense pain that i couldn’t imagine or explain. then the choice was given to me, epidural or pitocin. i was more scared of getting the epidural because i thought that would make me one step closer to a section, so against my gut instinct, chose pitocin. which then made the most intense pain in the world become completely unbearable. after an hour, i got the epidural, which eased the back pain, but left a window in the entire front right half of my uterus for me to feel contractions through. then i fell asleep. which was the only thing that would save me.
i woke up because i had wet myself, but realized i had a catheter, so called the midwife- my water had broke and i was dilated to 5 cm. the epidural wore off quickly, but i was so happy that something was finally happening that i didn’t care that much. but then it seemed like nothing more happened. and i started to quit, because the pain was too intense, and when i pressed the button to get more drugs in my epidural, nothing happened.
at 8 or 8:30 pm, a new midwife came on duty (i think during this labor i saw at least 4 different midwives during their shifts at the birth center) and she was one that i had really bonded with during prenatal care. she walked in, looked at me, and said “we’re going start pushing that baby out, i’ll be right back!” WHOA! finally.
and hour and a half later, i pushed out my 7 lb 15 oz son, tearing only my upper labia, no muscle tears, and then we lived in the hospital for the next two weeks following up on a giant bruise he had on the top of his head from smashing into my spine for days. i should have been a section. i was so glad i wasn’t. and now he’s 4 1/2, and is clever, funny, adorable and has no problems from the terrible birth experience.

My daughter came out facing up and a little to my left so I’ve been interested in this topic. Maybe I’ll post my story (I had a great birth) when I have more time. Have you read this blog post “In Celebration of the OP baby?” http://midwifethinking.com/2010/08/13/in-celebration-of-the-op-baby/
I think it’s an interesting perspective. I like this midwife’s blog in general.
Here is the summary paragraph:
“An OP position is not wrong or a problem. It is not caused by anything the woman does or does not do. Instead it is a common variation occurring when a baby gets into the optimal position for his journey through his mother’s unique body. After all he has more knowledge about the interior of his mother’s pelvis than we do. If we want to improve the experience and outcomes associated with an OP position we need to rethink our approach to it. Let’s celebrate the OP baby’s wisdom and allow the birth to unfold as it needs to.”

There’s obviously a whole lot to know about this. I think you produced some beneficial factors in Features also.
Keep operating , fantastic work!

I came across this site after watching “The Business Of Being Born” the second one they did which was a series. I watched the first one while I was pregnant with my son, who is now 16 months old. When I had my daughter almost 6 years ago, I never concidered home birth or midwives and have your run of the mill male obstetrision. I ended up having demerol and and epidural, fetal monitoring, a catheter, lots of lghts, people everywhere and a generally highstrung very unrelaxing environment. She was alittle over 4 weeks early and ended up 5 lbs 2 oz and an episiotomy…. I said that right, he cut me for a tiny head. Why? I don’t know. I don’t remember him asking me or even telling me he was about to do it. After she was born they took her away from me, I hardly even got to look at her. She went to the special care nursery and my husband followed. I was worn out, numb, and sad. I believ I fell asleep and they later rolled her in on her little mobile crib so I could see her after what seemed like forever and I finally got to breastfeed her which was difficult because she was so sleepy being premature. The kept trying to convince it would be best for her to be bottle fed. I was dead set of breastfeeding her. So I kept to it, despite their reccommendations and I succesfully did for 18 months. After that whole experience at the hospital and with the doctor, I knew I didn’t want that again.

With my son, I went to a midwife whom a friend of mine went to. I had met her already and seen her several times while taking my friend to her appts so I was sure she was who I wanted. Throughout my pregnancy I was well informed, she spent may more time with me than the md ever did. I still did have a hospital birth but under the direction of a midwife. He too was born before term but hat met the cutoff to be considered a premature baby, thankfully. If I had had him 2 days earlier I would have been required to have an ob take over. I had lowback pain several weeks prior to my onset of labor, lots of braxton hicks that were consitant but never progressive. I was put on nifedipine at 34 weeks because they thought I was in preterm labor again like I had with my first. At 36 weeks and 6 days I stopped taking it because I was ready to have this baby. After stopping, it took 3 days for real progressive contractions. I was also put on bedrest when I was given the medication but I am terrible with that kind of adherance so instead I was just taking it easy. My midwife wasn’t happy with that decision but I was hardheaded so I did it anyway. I do believe there isn’t very good evidence based research to support the affectiveness of bedrest so I choose not to follow it strictly but rather pay attention to my body and the signals it gives me. Anyway when I went into labor it was really early on a Saturday morning and it was still dark. I lied in my bed next to my husband and felt my contractions slowly get harder, longer, closer together, and intensify. My first labor was 16 hours and I knew I could handle it by myself for awhile so I tried to fall cack asleep. I think I did off and on for a few hours, then I took a shower, soaked in the tub and just walked around my house. I don’t remember how long I waited to call my midwife but when I was feeling really intense back pain with every contraction I decided it was time. When I went, she offerred ice water and warm cloths. My husband walked around with me and pressed on my back through every contraction. After several hours the back pain became unbearable and I decided to get an epidural. Originally my plan was not to have one but the back pain was so much different and way more painful that I expected and I knew it would only get worse. My midwife was supportive of my decision but stopped and asked me if I was really sure which I appreciated. Once I had it, I lied on my side in the bed and a couple hours later I was came to see if I was dilated and his head was already crowned. She went and got one nurse to assist her and with only a few pushes there he was. No tearing even though he was bigger than my last and I had scar tissue from a previous episiotomy. I can say with 100% certainty, if I didn’t have a midwife, it would not have gone as smoothly. It was a wonderful experience, she did everything right and respected what I wanted. It was just me, my husband, my midwife and a nurse. I would NEVER go with an md again and I will always advocate for women to seek a midwife or home birthing option as long as they are low risk and able to make that decision.

I wanted to add also, that I did get to hold him directly after birth. My chest was the first thing he touched when he was born. It was so much more magical to see him right then and give the comfort of hearing my beating heart and feeling the warmth of my skin, rather than waiting for everyone to do their assessment and bring him to me later.

I have to apologize for the typos as well, I am on my phone and it won’t let me go back and edit.

I create a comment each time I like a post
on a site or I have something to add to the
conversation. It is triggered by the passion
displayed in the article I browsed. And after this article OP (Sunny Side
Up), Cervical Swelling and Slow Dilation Doula Momma.
I was actually moved enough to drop a comment 🙂 I actually do
have some questions for you if you usually do
not mind. Could it be just me or does it look as if like a
few of the remarks appear like they are left by brain dead visitors?
😛 And, if you are posting on other places, I would like to keep up with everything fresh you
have to post. Would you list all of your shared pages like your twitter feed, Facebook page or
linkedin profile?

I live in Loohof, Switzerland and my work in fact deals with this field.
Passion in what you think and in putting it into words is a true
talent. Your insightful article possesses the optimal mix
of passion and well-written, interesting content that
I’ve grown to appreciate and admire.

Can we use our own hand to change a fetal position from posterior occipital to anterior occipital when the mother is fully or almost dilated . I am medical student.


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