Occiput Posterior: Does It Affect Labor And How To Manage It?

Occiput Posterior Does It Affect Labor And How To Manage It

Image: Shutterstock

As you are approaching your D-day, your OB/GYN does an ultrasound scan to check the position of the baby. The ideal position you and your doctor would hope for is the head-down (vertex) position with the head facing your back. However, the baby is not always in this position.

The fetus might be in various other positions, posing challenges to your delivery. One such position is occiput posterior (OP).

Momjunction tells you about this fetal malposition, its causes, and complications.

What Does Occiput Posterior Position Mean?

A head-down position of the baby facing your abdomen (and not the back) is called an occiput posterior position.

The vertex presentation, wherein the occiput (back of the baby’s head) is anteriorly (to the front) positioned, it is called occiput anterior and is considered the optimal position for birthing.

There are two OP positions:

Right occiput posterior: ROP has the baby’s back facing towards the right side of the mother and the back of the head facing towards the mother’s back.

Right occiput posterior

Left occiput posterior: LOP has the baby’s back facing the left side of the mother and back of the head towards the mother’s back.

Left occiput posterior

The baby can also be in a straight OP position:

straight OP

OP occurs due to certain physical and lifestyle reasons.

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[ Read: Stages Of Childbirth ]

What Causes A Baby To Get Into Occiput Position?

Here are some reasons for occiput posterior:

  1. The shape of the pelvis: Anthropoid and android-shaped pelvises could lead to OP. Women with heart-shaped pelvis (android) can have the baby positioned wrongly because of the narrower front.

A pelvis with oval-shaped inlet with a large anterio-posterior diameter (anthropoid) with a narrow pelvic cavity (1) may also lead to OP.

  1. Maternal kyphosis: The mother’s kyphosis or hunchback (excessive curvature of the spinal chord) can make the fetal back fit into the curve.
  1. Lifestyle effects: Sitting on a computer chair or the couch for long hours can cause the pelvis to tilt towards the back. Moreover, the baby gets enough room to rest his/her head comfortably on the pelvis, putting more pressure on the spine.

These causes increase the chances of OP during delivery if you belong to the high-risk group.

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The Risk Factors That Increase The Chances Of OP

Here are the factors that influence your chances of having an OP position during the delivery (2).

  • Your age is more than 35 years
  • Nulliparity – you haven’t given birth before
  • Previous OP delivery
  • Obesity
  • Decreased pelvic outlet capacity
  • African-American race
  • Birth weight of more than 4,000g
  • Gestational age of more than 41 weeks
  • Artificial rupture of membranes (AROM)
  • Epidural anesthesia

An OP position complicates the labor by prolonging it. Let’s know more about its implications.

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How Can An OP Position Affect The Labor?

Here are the possibilities with posterior labor:

  • Mostly, babies positioned occiput posterior before labor rotate to the occiput anterior (OA) position after the labor sets in.
  • Some posterior babies may get delivered without any slowdown in the labor while some may take time but require no obstetric interventions.
  • When the posterior baby cannot turn or the possibility of vaginal delivery is low, then the mother may have to undergo a C-section.
  • Deliveries with babies in the OP position, usually, need assisted methods such as a C-section, or use of vacuum and forceps.

In some cases, the babies don’t turn and make the labor complicated (3).

[ Read: Baby Crowning ]

What Are The Complications Of A Posterior Labor?

Here are the possible complications the mother and the baby could face in the case of posterior labor (4) (5):

  • A risk of postpartum hemorrhage (more than 500ml of blood loss), and infections
  • Delivery done using forceps and vacuum can cause a third and fourth-degree perineal tears
  • A longer lasting  pre-labor (first and second stage) with a backache
  • Needs frequent induction to start the labor
  • Chorioamnionitis also called as intra-amniotic infection (IAI). It is the inflammation of the fetal membrane due to bacterial infection
  • Postpartum hemorrhage
  • Endometritis, an inflammation of the uterine lining caused due to bacterial infection
  • A baby delivered in the OP position is at a higher risk of low APGAR score (less than 7), meconium-stained amniotic fluid, birth trauma, NICU admissions, and longer neonatal stay (6)

These complications make labor difficult in OP cases. Some women are likely to have a tougher time than the others.

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Who Are Likely To Have A Tough Time With Posterior Labor?

Posterior labor is likely to be more difficult in the below cases:

  • An android pelvis, which is common in taller women with narrow hips
  • The baby does not change the position during the third trimester
  • An early epidural during labor as it reduces the baby’s possibility of rotation and flexes (7)
  • Lack of any help during labor

Some lucky women might have easy labor even in the case of an OP. See, if you are one of them.

Who Can Easily Get Through The Posterior labor?

Posterior labor is likely to be less difficult, if:

  • The baby is smaller or average in size
  • The baby is moved into the right position using appropriate rotational techniques
  • The posterior baby engages during the labor
  • You get a pregnancy bodywork done by a trained professional

Your OB/GYN does everything she can to manage the OP position, and avoid any complications.

[ Read: Position Of Baby In Pregnancy ]

Diagnosis And Management Of Occiput Posterior Position

The OP position is diagnosed through an ultrasound scanning, and its management is done only if the fetal heart rate is reassuring.

An OP is managed through:

  • Manual rotation of the baby to an OA position (8)
  • Operative vaginal delivery
  • C-section

Manual rotation: It is usually done during the second stage of the labor i.e., during full dilation. You need to empty the bladder before this procedure is done.

The doctor inserts her hand with palm upward into the vagina. Using the tips of the thumb, index, and middle finger, the fetal head is slightly rotated to the OA position. This fetal head position is held in place for a few contractions and you are encouraged to push. Holding the fetal head in place prevents the baby from going back to the posterior position.

Operative vaginal delivery from the OP position: It is done if there is sufficient room between the occiput and the scrum that can allow the baby to turn. Forceps or a vacuum extractor is used to bring the baby out (9).

C-section: This is done when the above methods do not help you deliver the baby through the vagina.

Occiput posterior may not be as serious as a breech position but it not as easy as the occiput anterior either. Therefore, do whatever you can to avoid an OP position during labor.

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How To Prevent An Occiput Posterior Position?

Here are some ways you can try to turn the baby into the anterior position (10):

  1. Postures: Avoid reclining positions and sit with your pelvis tilted. You can use a birth ball to maintain this posture. Sleep towards the left side keeping left leg straight and right leg at 90 degrees supported with pillows between the legs.
  1. Exercises: Perform exercises that involve pelvic rocking, walking, and swimming. Here is what you can do:

i. During pre-labor: Pelvic rocking for 10 times for 2-5 times a day helps in rotating the hips in a circular motion. Get down on your hands and knees and lean forward as much as you can, comfortably. Repeat this during the early stages of labor. Using hot and cold packs on your belly and back respectively can help in turning the baby to OA position as babies tend to turn towards warmth.

During Pre-Labor

Image: Shutterstock

[ Read: How To Push During Delivery ]

ii. Towards the end of the first stage of labor: If the baby is moving towards an OA position, then squatting can help relax the pelvic floor muscles creating more room for the rotation of the baby.

Towards the end of the first stage of labor

Image: Shutterstock

iii. During the pushing stage: Doing double hip squeeze during the contractions can help the pelvis spread, providing more room for the baby to move back to the right position.

  1. Therapies: Chiropractic and acupuncture techniques help fix the improper alignment of your body and turn the baby to the OA position.

Note: Ensure that the exercises and therapies that you consider are approved by your doctor.

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Frequently Asked Questions:

1. How to deal with posterior labor pain?

During posterior labor, the process may get prolonged for long hours, making you feel tired. In such a case, you may go for an epidural to get relief from the pain. However, an epidural can also decrease the chances of your baby’s rotation to the anterior position. This, in turn, causes the second stage of labor to prolong or increases the chances of forceps delivery.

  • You may also try breathing techniques.
  • Try to lean forward during the labor as it helps in relieving the back pain to some extent.
  • Use a hot or cold compress.
  • Get your lower back massaged.

2. If my baby is posterior during labor, does that mean I’ll have back labor?

It is not necessary, but your chances are high. A study has found that one in four women experienced back labor, but not all of them had a posterior baby (11).

3. What is OP C-section rate?

Around 18% of the OP cases result in emergency C-section or assisted delivery. The doctor might consider a manual rotation. There is a 9% chance of a C-section if a manual rotation is done, and 41% chance when manual rotation is not done (5).

[ Read: Back Labor: How To Get Relief ]

Having a posterior baby makes the delivery process tough. But, with the medical techniques, it has become possible to ease the process of posterior labor. Manual rotation is the best way to turn the baby but that needs to be done by an expert who has experience in it. C-section is mostly the last option in OP cases.

Do you have something to say about posterior labor? Share it with us in the comment section.

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