What to do In a posterior labor

While some posterior labors can go fast and finish with a flourish, others take days and finish with help. If you are experiencing (or anticipating) a posterior labor here are specific suggestions.  Forget what you learned about the labor curve. Put on your hiking boots. You may have a walk in the park, but you may have just entered the "expert's trail."

  Before you read this article, if you have time or interest to, you may want to 

Learn what a posterior fetal position is and why it sometimes changes the labor experience

Compare the Anterior and Posterior Labor Patterns, and/or

Identify whether or not you have a posterior baby.

If you are currently in a long labor, or you know you have a posterior baby and are looking for help in labor, keep reading here.

 

Get your gear together

You need a back pack for this hike with

  • Easy to digest labor food, soup and broths, cooked root veggies, yoghurt, oatmeal, raspberry leaf tea and hibiscus tea popsicles or just as warm tea, honey, etc.
  • Water, drink a little hourly, but no need to over hydrate 
  • Electrolyte drink, such as Alacer Emergen-C, grape juice, or Hibiscus tea
  • Oils for back rubs, sooth dry lips, release calming or energizing smells (essential oils of your choice, like Clary Sage)
  • Hot packs
  • Cold packs (alternate them!)
  • Socks
  • Homeopathic Kali Carbonicum (Kali Carb) 30x is over the counter strength, or see a homeopath before or in labor
  • Homeopathic Arnica Montana 12x or 30x for swollen cervix, perineum, and sore back after birth, take during pushing and after birth as routine, use for swollen cervix if needed.
  • Homeopathic Pulsatilla before or during labor with the guidance of a homeopath
  • Apollo Massage tool or something nice like that, if desired
  • Acupressure chart
  • Foot reflexology chart
  • Breath refreshers for your birth team!

 

Get your team together

Coping with a posterior labor may take patience, special labor activities, and mature emotional support.  

A midwife or doctor who not only supports vaginal birth but actually has skills in natural birth. Even if you choose to have, or need to have, medical interventions, including drugs or an Epidural, their knowledge in natural birth will add so many advantages to help you achieve the most physiological birth -and bonding- you and your baby can have.

 

A doula. And you need your doula to be available 24/7. She (or he) can't have other things going on. Have two doulas if you want a particular doula who can't commit 24/7 so you can have one that can. They may need to trade off so they can sleep a couple hours now and then.  If you can find a doula with experience with natural births and posterior, even if you choose or end up with interventions, she will have more skills to help with a vaginal birth. She should be able to talk maturely with your family and providers about your desires. Her desire should be more about you then about whether the birth is "natural" or not. But skills for natural birthing may be very appreciated!

 

Support for your partner. Posterior labors can stress partners when the labor lasts longer than they can. They may want to be there for every minute, but after a while, a partner with low blood sugar from not eating a decent meal, or a partner who is stressed from lack of sleep starts to waiver, and this is wearing on a laboring woman's ability to cope well. The doula is usually able to help a partner pace themselves, but another birth partner or good friend for the other parent can make all the difference in how long a woman lasts in a challenging labor.

 

The right labor nurse. Nurses are very much a like a forest ranger for your labor hike. Ok, I'm being dorky, but listen. If your nurse likes quiet laboring women who allow her to come in, check her cervix without much discussion and stay in bed, than she is going to work on the psychology of the birthing mother and partner to get an agreement for an epidural or morphine. But if the nurse has pride in helping empower your labor experience and joy in turning babies, like so many of the nurses who visit this Spinning Babies Website, then you have the best advocate you can possibly have in a hospital birth!

 

You can have a great team, but if they haven't slept for a couple nights, their decision making is going to be effected. Let your midwife know you are in labor, but if you and your baby are stable, there's no meconium, or other confusions about what's going on, then let your midwife sleep while you are in early labor. Use your doula or, if at home, another mature homebirth mother, to sit with you and quietly observe that all is well, or help you contact your midwife or doctor when there are questions that need their expertise. A rested team will help you succeed. That said, don't deprive yourself of emotional support, even if you think you can make it longer, because we want you to have plenty of emotional reserve. 

 

Labor With A Posterior Baby

Let's take a look at the common challenges that come up with a posterior baby. Spinning Babies has another more general article on labor progress and I invite you to open Labor Progress with Spinning Babies and compare the suggestions there with these. Those are suggestions for everyone. These are suggestions when labor is more challenging and has specific needs. 

 Remember to begin any series of maternal positioning activities with the list in the 1st Principle of Spinning Babies,  "Balance" --even where not mentioned specifically.

 

What to do When

Getting Baby to Engage

The first challenge is getting baby to engage well so that latent or early labor kicks into active gear. When a woman's first labor (first baby) begins before the baby could engage she has nearly a 50/50 chance of needing a cesarean. Because if a baby can't get INTO the pelvis, it can't get THROUGH the pelvis.

  1. Do the activities of Balance listed on the Labor Progress with Spinning Babies article.

Goal: See if you can help the baby ROTATE TO Left Occiput Transverse or Left Occiput Anterior through the Rebozo, Forward-leaning Inversion, and Myofascial Releases and, if that hasn't worked yet, than having a Chiropractor come in and do a pelvic adjustment.

Then, with either the baby rotated or the chin flexed, do 

  1. Vigorous circles on a firm Birth Ball that is equal or slightly higher than the mother's knees. Can be done before or with regular contractions begin.
  2. Ten contractions in a row with the Abdominal Lift and Tuck. This needs a predictable labor pattern to be managible. The contraction makes it work.

And if that doesn't engage baby, do

      3. Walcher's Brim Opening position for the mother to open her pelvic brim. Do this through and between 3 contractions.

 

Early Labor stalls and starts

The mother may feel that her labor is underway. Midwives may wonder if it really is labor or is it warm up... or is it that the uterus is trying to engage the baby. Contractions may be strong and close, and then slow down. Start and stop, start and stop. 

Let's look for the baby, where is the baby? 

Is the baby above or at the pelvic brim? Yes? Then, what position is the baby? One of the posterior positions? Then let's get the chin tucked and the baby rotated.

Look above for "Getting Baby to Engage."

Once baby is engaged, the uterus may require a rest. 

  • As long as mom and baby have no clinical signs of trouble, no fetal distress, continue with Balance activities.  
  • Go for the "snore."  A good nap is just the thing to protect the labor later. 
  • After a good nap, or a collection of short naps between contractions, have a bowl of oatmeal. 

The uterus will pick up again once rested and fed. If baby has rotated and/or engaged, labor will start again.  See more descriptions and reassurance in The Long Labor

 

Posterior Baby Stuck in Active Labor 

We expect steady progress during the part of labor called "active labor," when the cervix opens from 4 cm to 10 cm dilation. 
 
 

A stall at 4 cm, when baby is posterior, may happen when

  • Baby is between the brim and the midpelvis in a smaller pelvis.
  • Baby has come unto the pelvic floor muscles in the posterior position and is having trouble rotating
  • The posterior baby has the chin up a bit
  • The mother doesn't feel safe/uninhibited in her location or with the people with her, and needs the social situation calmed down, cleared out, and fears or issues addressed (which may be confused for a stall due to fetal position, but may be about emotional safety to let go into the birth process)
  • People are fussing about with the laboring mother

What to do at 4 cm when baby is posterior:

Make sure the mother's birthing environment and emotional support are physiologically beneficial for labor.

Start with the Rebozo sifting and "jiggle" the mother between contractions, lifting her belly in the rebozo steadily during contractions to continue the support. Count to ten when the contraction ends and gently start jiggling again.

 

A stall at 6-7 cm, when baby is posterior, may happen when

  • Baby has come unto the ischial spines, the narrowest part of the pelvis, while facing the mother's hip.
  • The posterior baby still has the chin up 
  • The fit for the posterior baby is tight and baby needs to mold the head
  • People are fussing about with the laboring mother

What to do at 6-7 cm when there is a stall in a posterior labor:

  1. Standing Sacral Release or Diaphragmatic Release or both
  2. Sidelying Release (Pelvic Floor Release)
  3. Roll-Over
  4. Rest Smart positions when resting
  5. Lunge
  6. Dangle or Lap Squat

 

A stall at 8-9 1/2 cm, when baby is posterior, may happen when

  • Baby has come unto the lowest part of an android pelvis (which has a bit more narrow outlet)
  • The posterior baby is molding the head
  • The fit for the posterior baby is tight at the outlet and baby needs to mold the head
  • The head is asynclitic 

 

What to do at 8-9 1/2 cm when there is a stall in a posterior labor:

  1. Standing Sacral Release or Diaphragmatic Release or both
  2. Sidelying Release (Pelvic Floor Release)
  3. Rest Smart positions when resting
  4. Lunge when up and up to the bathroom
  5. Dangle or Lap Squat when working with the contractions 
 

A stall after 10 cm when pushing, when baby is posterior, may happen when

  • Baby has come unto the lowest part of an android pelvis (which has a bit more narrow outlet)
  • More molding is happening 
  • The fit for the posterior baby is tight at the outlet and baby needs to mold the head
  • The head is asynclitic 

 

What to do after 10 cm when pushing, when there is a stall in a posterior labor:

  1. Quit pushing and Rest Smart for a few contractions, even if you have to breathe through it
  2. Sidelying Release (Pelvic Floor Release)
  3. Standing Sacral Release or Diaphragmatic Release or both
  4. Lunge when up and up to the bathroom
  5. Dangle or Lap Squat when working with the contractions 
  6. Rope pull

Protect the health of mother and baby with food and rest for the journey. See more in The Long Labor for general guidelines, this section is for the posterior issues, a narrow dialogue in the greater discussion of long labor issues and needs. 

 

Posterior labor patterns.

This section is similar to the "Long Labors have a couple different patterns" section in The Long Labor, but with my comments about suggestions for the posterior presentation.
 
Contractions in a posterior labor may come in double peaks, a big one with a lingering second peak, like a hiker pulling a dog on a leash. And sometimes a cluster of big contractions may come and then some not so strong ones follow until the next big trio of waves return. These are contraction variations that tell us the uterus is working to fit the baby through the pelvis.
 
 

Long and steady: This is the labor pattern in which the contractions come at regular intervals, or fairly regular, like every 3-4 minutes with a little variation, and then every 2-3 as the cervix opens more than 7 cm, perhaps. 

The contractions come pretty steady, but the cervix opens slowly due to a close fit between the mom and baby. 

Nutrition and fluids, emotional support, and gravity and movement for the pelvis will be the normal support for the woman in this pattern. Address the stall according to when and where the baby is (see below).

 

Start and stop: Sometimes the uterus gets tired and stalls. The contractions are less painful and the mother can sleep. Sometimes this happens after the uterus has accomplished a goal, such as fetal rotation or engagement. Fetal rotation is labor progress even when the cervix hasn't changed or hasn't changed much. After the rest, the contractions will return with strength and the labor is very likely to advance faster and more like a "normal" labor, meaning, as it had been expected before the stall.

 

Strong and stronger with no descent: Sometimes the uterus is working so hard, really trying to get the baby to rotate and descend. The mother gets no break. We want to see if labor is advancing by bringing the baby lower, even if so gradually that it takes a few vaginal exams to notice, that's fine as long as mother and baby are fine.

Compare that to the baby that can't fit at all. The baby will be in the optimal, ideal or perfect position. Your efforts will have brought the baby to LOA and yet the baby remains high, where ever the pelvis was too small to let baby down. Can the pelvis be opened enough to let baby through? If yes, you will have progress.

 

Many women can give birth to a baby who is coming brow first. Here is a brow first (forehead first) birth story with pictures of the molding of this alert little baby from the ever dynamic Navel Gazing Midwife blog. 

 

If no progress can be made in any of these situations, after techniques for rotating and flexing baby, then, thank God there is the cesarean. It's telling the true difference that requires experience.

 

 Labor can be long without the cause being the baby's fit. See more in the Long Labor article in the next category, In Labor.

 

Is the baby known to be posterior? When labor is long due to the baby coming INTO the pelvis in the posterior position, we want to know if the baby will continue to fit in the posterior position or be able to rotate. We don't usually get to know this, so we can have an educated guess. If labor is moving along readily, we can assume it will continue to do so. If labor is slow, we can hope the baby fits. We can choose to be patient or we can try to rotate the baby.

Spinning Babies is the active side of Patience. And, Patience has Her Perfect works.

 

 The three goals of the 3 Principles of Spinning Babies.

  • Help the baby's chin tuck to get a smaller head circumference.
  • Rotate the baby so the head is coming down from a different angle. 
  • Open the pelvis wider with mother's own positions (these activties and postures are called maternal positioning)
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