I've been looking up research on occiput posterior (OP) babies and how to help a mother work through her labor with an OP baby. Basically an OP baby is one whose face is facing to the front of the mother rather than the back. Why is this such a big deal? It creates a larger diameter around the babies head, which makes it a harder fit down the birth canal.
OP babies can lead to longer labors, increased pain, increased use of forceps or vacuums, increased risk of infection(I'm assuming this could be due to the longer labor), and bigger tears. Some studies have shown an increase in c-section rate, but I'm inclined to think that has more to do with the provider you choose.
There are also problems associated with OP babies and the outcome of the baby. An OP baby is more likely to have lower apgar scores, meconium in the amniotic fluid, birth trauma, NICU admissions, and increased NICU stays.
Factors that are associated with OP babies are first time moms , a mom greater that 35 yo, a baby that is greater than 41 weeks gestation, a baby that is greater than 4000 g, artificial rupture of membranes, augmented labors, and epidurals. The association with epidurals could be due to the fact that OP babies tend to create more painful contractions thus leading to more epidural use, but we really don't know. Luckily, 87% of the babies that present with OP in labor, turn on their own.
From what I've read, the best thing to do for the increased back pain, is to be in the hands and knees position. This is a position that has been shown to reduce back pain during labor in general. It also allows room for your labor support to use counter pressure on your hips or back. There has been some research that has shown that this position could also help rotate the baby to a more favorable position. There really hasn't been enough good research done on the rotaion of the baby, though, to come to any conclusions. It is thought to help rotate a baby due to gravitational pull.
Upright positions in general have been shown to be more comfortable for mom, decrease the length of labor, and increase the strength of the contractions. Upright positions as well as side-lying have both been found to increase the intensity and coordination of contractions. It appears that these upright positions also help to facilitate the head coming down into the pelvis. How this effects OP babies is really unknown, but I think it helps to keep these ideas in mind when dealing with an OP baby to help to facilitate labor and birth.
It is also good to note that the sitting, squatting, and hands and knees positions enlarge the pelvic outlet by 0.5-1.5 cm. This could help facilitate an OP birth as it allows more room for the baby to pass through. Being up right and moving also allows the mothers ligaments to stretch and expand more, again, allowing more room in the pelvis.
Some studies offered some interesting ideas on how to get a baby to turn, but again, they really needed to have larger sample sizes and more research needs to be done. Some of positions that showed some promise was turning the mom to the same side as the fetal spine. This appeared to shorten labors and turn the baby also. Positioning in general has not been shown to be helpful when it is done before labor. The positions mentioned above, though, did appear to help once the woman was already in labor.
Besides positioning, manually rotating the baby has shown to help decrease c-section rates at least.
Things you can do to help make sure your baby is positioned well....change positions throughout labor. For those who get an epidural (which is associated with increased risk of OP baby) request a light epidural that makes it easier to move and change position. I have had women with epidurals on hands and knees, squatting, and sitting up. Wait until you go into labor on your own, and allowing the your bag of water to break on it's own may also be useful as both of these are associated with OP babies.
References:
Cheng ,Yvonne W.; Shaffer, Brian L.; Caughey, Aaron; Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001. The Journal of Maternal-Fetal and Neonatal Medicine, September 2006; 19(9): 563–568
McKay, Susan; Maternal Position During Labor and Birth A Reassessment. JOGN Nursing , September/October 1980; 288-291.
Ridley, Renee. Diagnosis and Intervention for Occiput Posterior Malposition. JOGN Nursing, March/April 2007; 36(2): 135-143.
Baker, Karen. Midwives should support women to mobilize during labor. British Journal of Midwifery ,August 2010; 18(8):492-498.
