Its hard to tell baby's head position from a simple vaginal exam. The baby's skull is made up of portions of the skull that move and overlap somewhat. These are called "plates" and they have names. The borders between them are mobile and are called "sutures." Sutures lines are supposed to reveal fetal head position. Is it worth an ultrasound in a difficult labor?
The angle of the head can put a suture or soft spot in an unexpect place or, often out of reach. A baby's skin makes wrinkles as the baby's head molds and can hide a portion of the suture or the soft spot. Sometimes, when space is an issue, the baby's head will swell where it presses down. These alterations can confuse a person. Provider's fingers come in different lengths and sensitivities. Skill varies. All in all, "digital" vaginal exams, meaning those with the digits or fingers, are not as accurate or as fast as a laboring woman would hope.
Babies turn their heads to get through the pelvis. Every once in a while, a baby will turn his or her head so far as to be in the opposite direction as the chest! I've seen it at least 3 times myself, and now that I get it, probably more in the past than I knew.
Before a doctor decides to put a vacuum on a baby to bring the head out of the pelvis or before the doctor or midwife (in unusual cases) decides to manually rotate the baby's head, it is advised to get an ultrasound to double check the baby's head position with a more accurate tool than touch alone.
Minerva Ginecol. 2007 Aug;59(4):459-64.
The purpose of this review is to summarize the available evidence on occipito-posterior fetal head position and maternal and neonatal outcome.
The occipito-posterior fetal head position is the most common malposition, but there are not so many data about it in literature. Its incidence is ranging from 1.8% by Fitzpatrick, to 4.6% and 5.5% by Yancey and Sizer, to 6% by Ponkey.
Only two trials studied the occipito-posterior associated factors. There are lower incidence of premature rupture of membrane, arterial hypertension pregnancy-induced, induced labour, increased of episiotomy, instrumental delivery and a decreased of vaginal birth without a difference in neonatal Apgar, and with a neonatal bigger weight. The occipito-posterior fetal head position persistence compared to anterior position, has a statistically significant association with low maternal stature, previous cesarean section, longer first and second stage of labour, oxytocin augmentation, epidural analgesia, instrumental vaginal delivery, chorion-amniositis, vaginal perineal injures, loss of blood and post partum infections. A highest incidence of occipito-posterior fetal head position may depend by nulliparity, malnutrition with pelvic deformity, pelvic immaturity in the teenager and anterior placenta. Epidural analgesia is a risk factor for fetal head malposition. The majority of occipito-posterior fetal head positions is not due to a malrotation, but to a persistence in this position of the fetal head. In fact, this persistence leads to a failure of the fetal head rotation. The prolonged second stage is often the result of occipito-posterior fetal head position and instrumental delivery is required.
The traditional vaginal examination is not useful for the determination of fetal head position, so and instrumental method is needed, such as ultrasound, for a correct evaluation of fetal head position, particularly if a vaginal instrumental delivery is necessary. This is recommended by the Canadian Society of Obstetrics and Gynecology. The evaluation of fetal head position is important in the prediction of labour induction.
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.