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, and one such position is occiput posterior (OP).

MomJunction tells you about this fetal position, 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 (OP) 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 in this position 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.Multiple pregnancies (twins or more) can also be a reason for this position. 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 weeksAn 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 difficult (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 and induction may fail, thereby requiring a C section.
  • Chorioamnionitis also called as intra-amniotic infection (IAI). It is the inflammation of the fetal membrane due to bacterial infection
  • A baby delivered in the OP position might have chances of a low APGAR score (less than 7), meconium-stained amniotic fluid, meconium aspiration 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 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 posterior baby engages during the laborYour 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:

  • Operative vaginal delivery
  • C-section

Operative vaginal delivery from the OP position: It is done if there is sufficient room between the occiput and the sacrum that can allow the baby to turn. Forceps or a vacuum extractor is used to bring the baby out (8).

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, you may want to have the easier OA position while preventing OP.

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How To Prevent An Occiput Posterior Position?

Following the below postures and exercises can help keep the fetus in an appropriate position and facilitate delivery (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.

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, making you feel tired. In such a case, you may want to 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.

[ 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. Talk to your doctor, ask them questions and clarify all your doubts. Take the special care that they might suggest, and your lovely baby will be out soon.

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

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