Rt Occiput Posterior
Baby is head down and the back is to the side- The right side. This position can be deceptively reassuring. ROP is the most common of the four posterior positions.
The ROP baby has the forehead in the front, lined up with the symphysis pubis and bladder. Little baby hands are likely to wiggle on both sides of the center line (linea nigra) just above the pubic bone area, but below the mother's navel.
There are some tips the midwife, nurse and doctor can use to tell whether the baby is right occiput posterior or right occiput transverse (lateral). The ROP baby may need a longer time for fetal rotation in labor.
I found this comment on a forum, the mother is uninformed about right-sided babies. "Last update was that the midwife thinks baby is occiput *right* but I don't think the right/left is too big of a deal. At least the midwife thinks baby is no longer posterior."
The right sided baby is posterior if the forehead favors the front, even if the baby is looking diagonally, between the symphysis pubis and the left hip.
A midwife may not feel the clues or details to tell if the baby is ROP or ROT or ROA. Even an ultrasound technician can ignore certain clues. The easiest clue for pregnant women to feel is whether the baby has limb movements on both sides of her abdomen, right and left. If the hands and knees are on either side of her navel (below and beside it, usually), its a good bet the baby is posterior.
How to tell if the baby is ROP or ROT and does it really matter?
The first baby coming from the mother's right more often has his or her back extended to match the right obliquity of the uterus. Extension is the biggest challenge of any posterior baby who has that posture.
The midwife will feel that the head is narrow and may think it is the nape of the neck.
The difference is that the baby won't play with the hands behind his or her back. So if the head feels narrow and their are hands present you can be confident that the baby is facing forward. The head may remain high in a first time mother. If the baby had been breech recently before flipping head down, this is a common position to "land" in. Heart tones are heard far to the right and with a little difficulty, hearing them, then loosing them, then hearing them again.
The ROT baby's head will feel broader. The hands, if felt at all, will only be on the left of center. Heart tones are heard on the right side.
The ROA baby's hands can not be felt at all. The back is broad and obvious and the heart tones can be heard with a simple fetoscope over a wide area.
The Right Occiput Posterior Baby in Labor
Example A: Baby has not engaged when labor starts
The first baby will use strong contractions to rotate to the Right Occiput Transverse, occasionally taking a day or night of strong contractions. Then there is often a resting period. Then the first time mother's labor will start up again and attempt to move the baby to the left occiput transverse position. Strong contractions will be necessary and suddenly the baby will be left occiput transverse. A second lull or resting time is likely. The mother can sleep with a little encouragement. Labor may have taken a day or two to this point and the mother is not further dilated than 3-4 cm typically, and could be less. It doesn't matter, once the baby is rotated and tucked, the head will come on the cervix and labor will progress as expected.
Next time labor starts up the labor pattern will be just like in the books, because now she has a LOT baby. The baby's head can now tuck and let engagement happen. Labor begins again gradually, increasing in strength and the mother finds this bout of contractions much more manageable and predictable, not suddenly long and strong like before.
Do the routine; Rebozo sifting, forward-leaning inversion, standing sacral release, pelvic floor release and move freely in active birth practices.
Example B: Baby is engaged or "dropped" when labor starts
Labor strength will pick up fairly quickly but dilation may be slow. This will depend on head flexion and how the mother's pelvic floor is and how her pelvic outlet is.
Balance the pelvic floor in early labor so that later, when the baby comes down on it it will be symmetrical and we can avoid an asynclitism (tipped head) or we can make room for an asynclitism if we have one.
With a pelvis that is longer front to back (anthropoid), or with a round pelvis (gynecoid) and a small or average baby we expect labor to proceed well.
If the outlet is small or the mother's tailbone is positioned far inward hiding deep in her glut muscles there will be a need for some intense work to move the baby down to finish dilation and for pushing. In this case, body work including myofascial release and Cransiosacral releases can open the outlet, as well as maternal positioning.
Also, do the routine: Rebozo sifting, forward-leaning inversion, standing sacral release, pelvic floor release and move freely in active birth practices.
More on laboring with any ROP baby
The ROP baby is the classic posterior baby in the literature comparing "long arc rotation" with "short arc rotation>"
In long arc rotation the ROP baby rotates over to an anterior presentation and emerges as an OA baby (when people can finally see the baby they may never have known the baby was OP unless they paid attention before or during labor before the long arc rotation occurred. A few of these babies get stuck in a transverse arrest before rotating all the way to anterior. Where the rotation happens varies and so then does the length and events of the labor accordingly.
In short arc rotation the ROP baby rotates a little ways (45 degrees) to direct OP for birth. Half of these babies can be born with out surgery.
Whether the ROP baby has a hard time rotating and descending through the pelvis has to do with the usual things: balance in the mother's soft tissues, symmetry in the pelvic floor, pelvic size and shape, and how well the baby's head is tucked... oh yes, and whether the mother labors actively, upright when she isn't resting and free to move and eat in labor.
Blythe's Blissful Birth Story of her third baby, which I palpated and painted the night before! She has a fast labor, even though her baby started out ROP. Her earlier labors were fast, her pelvis roomy, so this fetal position wasn't the challenge that it can sometimes be for a first-time mother. See her baby painted on her belly and how fun this is as she lowers into the birthing tub. See her with her baby after the birth! http://onbeingblythe.squarespace.com/journal/2011/7/23/born-at-home-peppers-birth-story.html
A co-venture video experience with Spinning Babies and Blooma Yoga! Coming Soon!
Spinning Babies; Daily Essentials For Pregnancy Video.
Together Sarah Longacre, international prenatal yoga instructor and birth doula, and Gail Tully, yours truly, created a unique instructional video for flexibility and comfort in pregnancy and to support better fetal positioning in time for birth.
Here are daily activities for stretching and balancing a pregnant body. Start early in pregnancy to prepare to make the most space for baby's best birth position and the most ease for mother's opening during the birth process.
We begin the program for women of average flexibility (or just plain stiff to start with) and beginner tips. But soon, you'll be ready to move freely! That's when Sarah brings the stretches all together into her easy to follow, playful, sensual, and flowing "Blooma Style" daily routine.
Sarah's "dance of opening," moves joints and ligaments to come alive under the delightful melody and percussions of Carin Vagle. This isn't about core strength; its about freedom of movement and creating space in the body.
Sarah plays along with Gail's little game of "Flashlight" to show pregnant women how to evaluate their own posture and positions. Smart Maternal Positioning helps baby snuggle their backs into the front of the womb for Optimal Fetal Positioning.
The Daily Essentials For Pregnancy includes tips for using Maternal Positioning around the house. Actual scenes in the bedroom, living room -and even the bathroom- gives practical instruction like no other video. You will be sleeping more comfortably immediately when using these tips. Within a week or two many pregnancy discomforts of the pelvis and lower back may be reduced when all these nurturing techniques are integrated into your daily lifestyle. Spinning Babies and Blooma Yoga-- a natural collaborative!
Spinning Babies Childbirth Preparation Class.
Soon pregnant parents around the world can take a Spinning Babies class from their own monitor! Join six couples as they learn the reason why Spinning Babies works and how it can enhance your labor and birth.
See techniques to do daily or weekly. Actual, real consultations with two couples right at our class location, one with a breech baby (head up) and one with a baby in a transverse lie (lying sideways).
Couples do the techniques together and show you how to do these at home.
Used alone or with the Daily Essentials, Spinning Babies Childbirth Preparation Class goes beyond the basics. Simple props show complex concepts sweetly. Little-known anatomy is linked to childbirth and the role of fetal positioning.
The section on labor discusses two labor patterns- the one "promised" in other books and the unexpected one associated with the posterior labor. Learn the common causes of long labor and techniques to help baby through the pelvis.
Be empowered; be prepared. After using this video throughout your pregnancy, while we can't promise, of course, you may not need the tips for labor progress. You can use that knowledge to help your neighbor. This video is all Spinning Babies.
Blooma Yoga Prenatal Yoga for AM and PM.
Warm up in the morning and cool down in the evening in two 30-minute sequences. Sarah Longacre shares her own blossoming pregnancy, Blooma style, to the exquisite music of Carin Vagle. Sarah's affirmations will carry you through labor with emotional strength and encouragement. Play this video when the others become too basic and you just want to dance and have fun. Wait, dance? Isn't this yoga? With Blooma and Carin Vagle, your spirit won't know the difference. Soar to greater freedom of movement. Bring your hormones into harmony with the day. Begin your day with serious play. Cool down at night with a sleep enhancing stretch before bed. This video is all Blooma!
Sarah's video is ready for you now! Get Blooma's AM/PM Yoga here
All three videos are professionally produced by Melissa Koch of Grey Duck Productions, with stills by Tanya Villano Photography, each of these three videos are dynamic on their own. Together they will enhance your pregnancy and labor experience with fun and empowerment in the most practical manner. Feel hope for your birth abilities, this is support for your journey. Gain the confidence and flexibility to fully bloom. I believe these videos carry the potential to bring your best birth dreams into the gentle reality.
Compassionately priced. Estimated Due Date for Daily Essentials March 2014; for Spinning Babies Parent Class, Fall 2014.