ROP: Cesarean or Natural?

On Nov 15, 2007, Paulina  wrote:

I would greatly appreciate it if you could give me some hints on my baby's position. I am 34 weeks pregnant (first time), and would really like to give birth naturally.

I live in Spain and have had my pregnancy controlled by the State's Health System. (It's worth mentioning this because there is no preventive approach, patient is supposed to be passive, and Spain has [high]  percentages of c-sections, and other medicalized practices that double the WHO's recommendations).

I was told, only 2 weeks ago that I have a tilted uterus and cervix but the midwife said it was not important. My baby has been on a transverse lie throughout most pregnancy. I found your website 3 weeks ago and have been following advice (the 3 principles) since.

Yesterday, I had an ultrasound and they said head is down, but didn't give me any more details (left, right, posterior, anterior...). I asked why I feel legs on my right side (very far out to my waist), and they said it was the legs, in fact, but that her head was down, and that's good enough.

What are the chances for my baby to get into optimal fetal position? There are no places where natural biths are practiced in this city (Madrid), and I will travel to a town 4 hours away. I'd like to feel more reassured on my decision based on the baby's presentation.

Thank you very much,
Paulina J


Dear Paulina,

My heart goes out to you and all Spanish women who are not free to birth as your body is designed, and your spirit desires. This is nearly the case, too, in  the USA. We who decide to travel to give birth, to stay home,  or to say no in general to the over use of technology are preserving our human heritage. Skin-to-skin contact and breastfeeding will heal some of the wrong doing, but it is best to avoid it in the first place. You are well along that goal.

Doing the Inversion for just 30 seconds a day may help improve your chances of natural birth. You don't even have to do it daily for the rest of your pregnancy. But perhaps for 5 days, and then repeat occasionally.

The Inversion will help stretch and then relax the ligaments to your cervix that make the cervix tilted. This is likely to be the same origin of the tipped uterus and the malposition. When a doctor or midwife doesn't know the connection, they will say it doesn't matter. That just means they haven't heard about the connection yet. I was told the same thing by my colleagues when I asked that question years ago. Later, I found out from a Chiropractor/CST trainer that it does matter, it is connected to malposition. And so by addressing it I have seen babies get head down. Now it is possible that your baby would have changed to head down anyway, but you are giving your baby every advantage.

Please follow the video description of the Inversion, which can be done on the stairs or off the couch, too.
The main thing is that your head is not pressing on the floor, neither your cheek, but that your head and neck are mobile. At least, the neck is able to move. It doesn't mean you have to move your neck  while you are inverted.

Be careful getting into position and crawling down from the position, or getting up. Keep your balance.

The next technique that can be quite helpful is the pelvic floor release.
I don't have a video of that. So I would like you to get a friend and go through the instructions carefully.

Do this on both hips to make your pelvic floor symmetrical. If you only do it on one side, it may not work at all, and may make your pelvic floor less symmetrical, so do it for both legs.
You only have to do the pelvic floor release, if done properly, 1-2 times in pregnancy, and maybe once in strong labor (when you are in the location that you will give birth). When you do it in labor, do each side for 1-2 contractions (and in between the contractions) to let your pelvic floor muscles stretch during the exercise. Do it for the same length of time on both sides.
The pelvic floor release is a little uncomfortable to do, mostly, because of having to balance on the very edge of the bed or couch, but helps fetal descent so amazingly much that I highly recommend it.

Now, your baby's current position:

Head down, feet on the right. When you say far to the waist, do you mean, about navel level but far to your side? It may be that the feet are not up by your ribs because you have a month to go and they will get there, or that the placenta is there so the feet rest under, meaning lower, than the placenta. That seems fine and good.

The question is always, do you feel little hands wiggling in front between your navel and the top of your pubic bone?
If the wiggles are far to your right, by your hip and you are rather slender, that is great, but if in front, you
can help the baby rotate to face your right hip by doing the Inversion, and sifting with the Rebozo ( a long woven scarf, or a substitute for one).

When a baby moves out of a transverse or breech position, they are often posterior for a week. If the mother keeps doing her exercises (as described above) and doesn't do things to make the baby descend before rotation, like hula-hooping on a birth ball, taking very long brisk walks or squatting for that first week of the position change, then the baby usually keeps readjusting their position to the LOL [LOT in US], or OA position.

Even if you start labor with the baby posterior, remember, 85% of OP babies at the start of labor have rotated (Lieberman), and about 68% (Gardberg) will be OA at the end of labor. (Some will face a hip with similar chances as the OP for vaginal birth.)

 Your movements now make your soft tissues and pelvis more in line for vaginal birth, no matter the baby's head down position.
Then follow the tips for labor to help the baby rotate in labor. Contractions are a mighty help in rotation. You have an excellent chance for a natural birth. Please let me know how it goes for you.

If you have other questions, please feel free to email again.

Have a great birth!



 Paulina wrote back:

    Dear Gail,
    Thank you very much for your prompt response!
    Please feel free to post these e-mail questions and answers. Sharing these knowledges and intuitions are very important to create community based know-how and advising. That's something I really miss. Besides, none of my girlfriends are having or planning to have children and there is really no maternity culture around.

    As to what you ask regarding my baby's position, her legs feel stretched out to the right at navel level. Today and yesterday I haven't seen bumps swinging across my belly, and rather feel her hands near my pubic bone. (right above).
    I will follow your advice with optimism.
    Be certain, I will let you know about delivery.
    Thanks again, Paulina


 Dear Paulina,

You are doing so well to create this birth opportunity and connect with people as you can around natural birth. I hope your midwife can connect you with another mother in the area around where you live.

Right now your sweet baby is LOP, by your description.
 Inversion will help her face your thigh. More is not always better, though. 30 seconds, 1 minute. Every day for a handful of days, then see.
Plus the sifting, Resting Smart, etc.




    Dear Gail,
    Just a quick update on how things are going with my baby's position. I've been following advice for about 4 weeks now. (I'm 37 weeks pregnant now!!!).
    Drawing and visualizing have been very useful tools to get an idea of her position. I must say she hasn't stayed in the same place for too long, though. From LOP, she shifted her legs to the right, and now I'm having doubts about her positioning.
    I'm getting a little anxious to find out before I travel to the town where I could have a natural delivery. Anyway, as of today, I layed down on my back for 2 minutes to check the shape of my belly and noticed two protruding lumps (horizontal at navel level), forming a small valley in the middle. I was surprised to feel and see little wiggles on my far left.  
    I wanted to ask you if feeling hiccups at a specific place is an indicator of where the head is. And also, do you recommend having an ultrasound done?
    Thanks again for all of your advice.
    Paulina J


Dear Paulina,
Are you indicating, am I reading you correctly, that you wouldn't try for a natural birth unless your baby is LOT? or LOA?
My goodness, any labor is more likely to progress into a vaginal birth than not, especially if the baby engages by labor. If you do nothing but allow labor to begin and proceed, you are likely to give birth, Paulina!

Help the baby engage by  hula hooping on a birth ball or the Walcher's position to bring the baby down. Engagement is more important than OA or OP position. Try and help the baby to the left with hands on the right before trying to get the baby to engage. Naturally your baby would engage between 38-39 weeks.

Are you doing the inversion as shown on the little video on my site? Use that one, not the other methods. This relaxes the lower uterine segment.
Did you get your sacrum adjusted? This will help the baby rotate now to a left occiput transverse (left occiput lateral) position.
A sacrum release by a myofascial person will also help there be more room in the back area of the pelvis.

An abdominal release and a round ligament release helps the baby rotate before engagement.

Paulina in labor by the oranges These are the bodywork things that really seem to make the difference. Oh yes, a pelvic floor release. That last seems to help with any position of baby so the baby can drop.

Then use an active birth approach to labor. Vertical positions, leaning forward, drug free, eating freely, drinking water and an occasional electrolyte drink, these things, and patience, will help you if you do have a labor longer than average. Don't time your self, just keep up on food and fluids and emptying your bladder.

Love your mate and your helpers and let that love be felt in the room. Have some fun with your adventure. Don't measure it and judge it like it is a fire that could get out of hand. It is a flower opening. Pour a little water on it and get in the sun, or in other words, a nurturing environment.

Think carefully if you would give up on your child's birth. This choice will last generations. You may have a need for a cesarean, but nothing you have shared with me shows that you do at this time, or likely will. Labor improves the hormonal function of you and your child.
I probably sound a bit forceful. It is just such a surprise to me that women are in your position. I believe you that your community birth environment has got you to this point. Let me say that I believe in you, in the design of birth within us both, and in your ability to give birth to your little one.



    Dear Gail,
    Thank you so much for being so clear and determinant. I guess I really needed to hear/read something like this.
    Definitely, I think my doubts were fed from the lack of encouragement to have natural pregnancies and deliveries in this environment. As a woman, one must go through a process of empowerment, which is not always easy. Pregnancy takes you back to places of one's childhood where fear and impotence were experienced. I've been going over the biography of my body trying to rewrite it and recreate it, putting emphasis on empowering and beautiful experiences in order to believe in myself. I haven't been taught to celebrate my body, to recognize its voluptuousness. As I've become an adult, little by little and thanks to feminism, I've done this, mostly as an act of disobedience and exploration, and have harvested happiness.
    Natural birth is part of that process.
    The situation in this country, has historical and political explanations. Spain has been in a rush to 'modernize' itself after a 40-year dictatorship. They've tried to get over an inferiority complex in respect to the rest of Europe, and for that, they're eager for what some call 'progress', which is really nothing but devastation. Science has been a 'male' issue, and that includes gynocology. So here we are, 'covered' and 'protected' by a patriarchal health system, which yes, it is free and universal, that's a point, but alienates us body from soul and mind.
    I say all this just to illustrate the State's  'pre natal classes' that I attended 3 times and had to stop going because it was tremendously disempowering. I don't know how many women in the class were considering a natural birth, but if any one was, no one dared to admit it. As I told you, it is not an option in the public health system; you either deliver at home and pay a midwife out of your own pocket (quite expensive), or you go to one of the few hospitals in the country where deliveries are respected (and pay as well). The midwife asked who was planning to avoid epidurals, and I shyly rose my hand. As an answer, she said that hospital staff refer to women like myself as the 'hot potato', because 'we' only give trouble.
    Throughout the few classes I went to, she said 'not to play around with the lives of our babies', what is science for? She literally showed a doll and asserted that no vagina can handle its passageway without an episiotomy. When I asked her about 'vertical pushing positions' (if they would allow me to do that) she said, 'practitioners haven't gone to school and get diplomas to end up practicing their career in a position as if they were changing the car's oil'. The list is long.
    I kept telling myself it was all lies, until I noticed I was getting scared so I decided not to bother to go anymore.
    I've only shared my feelings about my decision with close people because it's really hard to hear people deliberately give their opinions on this issue. So yes, I guess the environment can get to one.
    Another issue was money. It's almost embarrassing to put it this way. I was and am willing to use up all of my savings for this, but I started getting anxious when I saw the price of a c-section in the place where I'm planning to go. Basically, crudely and horribly as it sounds, I was thinking, 'I can't afford a c-section'. But, reading you has been so clarifying and I understand I can not think this way.
    Anyway, you have really given me nice fresh breeze and I see things differently. Thank you so much for your advice and encouragement. I'll continue with exercises and use the birth ball as you indicate.
    (Professional massage or chiropractors, is something I haven't tried. I've searched directories for professionals in Madrid, but haven't found any one yet. My partner gives me some nice back and sacrum massages, it's energy!).
    Once again, thank you so much.


Dear Paulina,
I am so moved by your description of birth in Madrid. What a challenging birth class! You did well to stop going to such indoctrination classes. Technology is wonderful when it is necessary, but it makes a joyless environment when technology is put in the place of the foundation of care practice.

Did you find a doula? A woman who not only trusts birth but is well versed in labor and patience?

As you dilate in labor you will feel the emotions of the hormones releasing into your body bringing up many emotions. You will also be letting go of cultural myths about how a woman is supposed to be. Sounds, body fluids, convention, passion, fear, strength, courage. Remember, the cure for fear is courage. And courage comes from the heart, not the facts. Not the thinking brain.

Be in the Rhythm of the labor. That is where your strength lies, if you can only let go and be present in it. Remind yourself that this is you and your baby working together, now in the current time. You are no longer a child. Each contraction brings you a new affirmation of your personal power. You will also be in the power of nature which knows you and wants everything to work well for you.

You are recreating the culture of birth. All you have to do is breath. Breath like the natural rhythm of a child. Breath how your body shows you. You will do well.

Let me know how it is going.



 And on to Christmas:

    Dear Gail,
    I'm back home from the tiny southern village where my daughter was born. I had a wonderful experience and couldn't be more satisfied with how things went. I must say your advice and positive words were present and contributed to my optimism.
    When I arrived I had an appointment with the obstetrician who told me natural childbirth was of course possible with her in a ROP. She would rotate, he assured.  My due date was Dec. 30th, and that was Dec. 20th. On December 24th, I felt a sudden raise of energy and cheerfulness. I even got  superstitious when we went out to admire the full moon. That night contractions began at 3am (about 12 minutes apart)
    Contractions were a sharp burning pain in my coccyx. I tried resting and sleeping in between and breathing when they came. By 8 am, they were 5 minutes apart. Surprisingly I felt very calm and excited. I didn't want to get my hopes up in case it was 'false labor', but when we arrived to the hospital by 10 am, the midwife checked my cervix and I was 5 cm dilated!!! That was great news. That got me even more excited. She asked me if I wanted to get in the water, but I decided to go for a walk in the country instead. She asked me to return in 2 hours and I did. The walk in open air, with beatiful weather and the sun hitting my belly and spine was wonderful. Intuitively I rocked by hips and hung from my partner in each contraction with a bear hug.
    When I returned to the hospital I went in the water. At that point I was 7 cm. It was 1 pm. The next 45 minutes were getting tougher and the rest of dilation and transition were heavy duty, but went great. At one point I saw my obstetrician in the birth room, and did not associate his presence with something going wrong. Usually, if everything is just fine, only the midwife and assistant are present. I guess that when pushing phase came, the midwife new that my daughter's head was not fully aligned, but still a little sideways. They didn't say anything, except that I was I doing fine.
    I decided to get out of the water and push in a squat position. After some time, and with her head practically crowning, the obstetrician offered to help to rotate with a vacuum extractor. I accepted, and pushed two or three more times, and Manuela was born. It was 4pm.
    I'm very happy. I'm doing great, I recovered very quickly including a small tear I had. My daughter was born with 10 Apgar [a newborn assessment score of 0-10 done at 1 and 5 minutes], was put immediately on me, and began breastfeeding in 15 minutes. She's healthy, beautiful, and in peace.
    I had to share this with you, and thank you once again.
    PaulinaPausing along the road to have a rush of birthing energy.



 Paulina pauses in her walk for a contraction



Dear Paulina,
You are so wonderful to email and share this glorious news! Oh, how beautiful your story is!

I feel the love of the walk with your partner. I would so much love to include these emails, now, under the heading of the stories. I won't include your name now, but if you would like to have it added it can be added. Also a jpeg of you and your baby would be lovely. Did anyone take a picture of you on your walk?

Walking in trust is an amazing journey. I am so glad for you to have taken that walk into birth!





Paulina with her baby. She did it!


Paulina's final email,

    "Sorry for not answering earlier.
    Feel free to post this story. I hope it inspires more women to have natural births and trust their bodies. This experience has definitely empowered me in that sense. I was fornutate to choose to do it my way, and find a great place and team that not only respect women's role but encourage them to believe in them. I remember at some point saying outloud, 'I'm exhausted, I'm not sure I can do it.' The obstetrician answered in a very calm way, 'sure you can, like your mother and grandmother did'. I needed to hear that and took a deep breath and continued with labor."



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Hi Gail, 

I want to say thank you! A first time mother's posterior birth went well [with] a short labor. Membranes ruptured about 8am. Her labor started about 6pm: 3cm dilated; LOP station -1; cervix soft and effaced. 

We did rebozo sifting, sidelying release, abdominal lift and tuck, standing sacral release, Dip the hip, circling on the birth ball, lunge and she birthed at 9.58pm in sidelying position with hands around the husband's neck.

Baby's head showed more molding on the right side. What you taught in the workshop and website made a difference!

Chiew Gin, Doula, Singapore