Occiput Transverse

ROTOcciput Transverse (OT or OL)

The baby is facing the hip. (Occiput Lateral in the UK, AUS and NZ.) 

"Please explain why it is better for a baby to be positioned LOT (Left Occiput Transverse) as opposed to ROT (Right Occiput Transverse) for birth? What can be done to encourage baby to turn from ROT?"

 

Left Occiput Transverse (LOT) is when the occiput is towards the mother's left and baby faces and kicks towards her right side.

No kicks are felt on the left of her belly, but the baby's buttock may rise up on her left which she may have thought was a kick until comparing that bulge with the smaller parts on the right. Sometimes both feet kicking together, though, can feel as big as baby's hips when they push upwards and outwards.

 

Right Occiput Transverse (ROT) is when the occiput is towards the mother's right and baby faces and kicks towards her left side.
 
 
I consider ROT to be one of the posterior positions, first upon Jean Sutton's advice and also on my observations.  Typically the ROT baby, and especially the first baby when ROT, will rotate to the posterior as labor proceeds. The reason is that the ROT baby more often has an extended back which then extends the head.
 
Whether Your baby has his or her chin up depends on your pelvis, which baby this is for you, whether you labor in bed on your back or up and moving freely, how tight or symmetrical your pelvic floor may be, the amount of extension of the baby's head, and so on. A previous vaginal birth makes this position less troublesome. Fetal chin tucking regardless of parity makes the ROT (ROL) position less troublesome, too.  READ a doula's story about a birth in which the baby "got stuck" for a while in the Occiput Transverse late in labor, she used inversions to prevent a cesarean.

 

 

When labor begins, the OT baby, especially LOT, but to a degree, the ROT baby, too, can be a fine position. More on ROT in a few lines. But during pushing, most women do not have enough room in there mid pelvis or lower pelvic tunnel to allow a transverse baby through the bones. Some do, but most don't and if the baby is facing sideways then, a cesarean may be done, unless something can be done to help dislodge the baby and turn the baby to where it fits the pelvis much better.

Right occiput transverse is called right occiput lateral (ROL) in UK, AUS, NZ.

Midwife Jean Sutton cites the firm liver sharing the room on the right and making an extended back likely in a first time mother.

The top of the head rather than the crown may enter the pelvis, making the head diameter larger than when the chin is tucked (flexed, flexion).

If a pelvis is smaller than average a baby has a greater chance to become wedged in the pelvis stopping descent. This is true for all the posterior positions. Read more about posterior positions if your baby is ROT (ROL).

 

The Right Occiput Transverse Baby in Labor

To avoid a stall in labor progress, body work on the abdominal ligaments now is good. Inversion on the stairs for 5 min.s a day will help release a twist in the lower uterine segment that is caused by sitting in cars, crossing our legs, holding a toddler or other weight on one hip, twisting to work, whether at our computer or doing care for others who are lying down.

The drawings on the left are of what I call the four posterior positions. You can see the Right Occiput Transverse baby is the one in the third circle from the top.

I consider ROT to be one of the Posterior fetal positions. The course of labor for babies starting in a transverse head down position (not the transverse lie, from which a baby always needs a cesarean for survival) has not been reported upon in the medical literature.

You can encourage rotation before descent in labor. Be upright, leaning forward, and doing the 3 Principles of Spinning Babies. If the baby descends before rotation, try the lunge and other things that keep the pelvis open in the middle. Eating small amounts of good food every two hours will help keep contractions strong. Be sure to sip electrolyte drinks, like Recharge, Alacer Emergen-C, diluted gatorade or the like.

 

  Give yourself time in labor to let the baby rotate before you expect much dilation. Especially if this is your first birth.

 

During pushing, squatting will help as will standing and hanging on to a person's neck or a sheet thrown over the bathroom door and knotted so you can't pull the sheet over the closed door. Try a vertical position change every 3-6 contractions, moving your legs in between contractions. When you find one that really works stick with it for 6-10 contractions and if the baby isn't born, be sure to keep changing positions. Keep a straight back during pushing, don't curl, as commonly instructed.

 

In general, it is easier to help the baby in a left-sided position in your 2nd trimester. Most women can achieve this goal in the third trimester with body work and maternal positioning with gravity. But some can not.

Labor helps baby's rotate. If you loosen up any tight ligaments and get your pelvis joints loosened up and labor in vertical positions with good support, periodic small meals and electrolyte drinks, you are likely to find that your baby rotates as he or she needs to get through the pelvis. It may or may not take a long time.

Individual differences in pelvic shape and size, baby's head flexion (chin tucked), amnioitic fluid levels, location of the placenta and relaxation of the pelvic floor and abdominal wall are some factors that determine whether or not this will be an issue or not. Too loose in the abdomen and you may need to wear a pregnancy belt to support the baby's proper descent.

My observations, like Jean Sutton's who proposed the association of ROT with an posterior result, show that if labor is treated with typical habits of resting in bed, semi sitting, lack of food, lack of movement, that labor is often longer, babies can turn posterior easily and instruments, medications or even a cesarean is more likely than when the baby STARTS labor on the left.

ImageLeaning forward during contractions is an amazingly effective, and so simple, way to help a baby rotate to the left to create a progressing labor. With active labor habits, most ROT babies will succeed in coming out OA at the end.