Fetal Dystocia – Occiput Posterior

What the heck does that title mean??? That’s a really good question. It’s actually a fairly common occurrence, and according to medical literature (see references below) can often end up with laboring moms having such a long labor and so much pain that they ask for medical interventions that result in cesarean. But … what is it? “Fetal Dystocia – Occiput Posterior” means that the baby is facing forward in mom’s pelvis and the back of their head and their spine are pressing along mom’s spine as they descend during labor. It’s sometimes referred to as baby being “sunny side up”. This can be EXCRUCIATING for mom! So, what does a mother do in such a circumstance? Well! We have a story for you.
Recently, Deb was called to the aid of a mom in labor at Best Start Birth Center. This mom had already been laboring for 12 hours and was stalled out at 6-7 centimeters dilated. She wasn’t progressing because her baby’s head wasn’t pressing evenly on her cervix, because baby was facing forward and not back – mom and baby were spine to spine. She had been laboring like this for several hours without change and was having increasingly severe back pain with each contraction. She was really concerned she would have to transfer to the hospital and didn’t want to go. This is Deb’s account of the event:
“I arrived at the birth center at 3:30 am after receiving a call from Midwife Erina Angelucci. As soon as I arrived in the birth room, I was warmly welcomed by the laboring mom, her husband, and the birth doula. I asked if she had acupuncture before and she said yes. She was happy I was there and willing to let me do what was needed. Her husband and doula were eager to learn how they could assist me. I started by placing ear seeds on her left ear as she was laying on the bed on her right side. I explained that I was putting these seeds on to help calm her mind, ease her pain, and get the birth hormones flowing more. I squeezed the points strongly for approx 90 seconds. I taught her how she can press on the points herself and showed the support team as well. I encouraged them to press with each contraction she had.
Next, I placed magnets on her hands and ankles to help ease the pain and to progress her labor, and seeds on points on her little toes. I told the support peeps these were the most important points to move this baby into a more optimal position and asked if someone could press or tap on these whenever she is contracting. It was ok to move around between any of the points, stimulating them as much and as strongly as possible. I explained that this is not a massage, it’s acuPRESSURE, and this is trying to help her avoid transferring to the hospital. It has to be STRONG to be effective. Once the magnets/seeds were all on, I started the hip rocking massage. I rocked all along her left hip, starting close to her spine and rocking toward her front. I made sure she was positioned with a pillow between her legs and under her head. Comfy. Steady even movements all along the crest of her hip from the Posterior Superior Iliac Spine (SIS) to the Anterior SIS. I did continuous rocking for 20 minutes. This provided a deep, restful state for the mama. Her pain lessened significantly. She went within and only moaned with each surge. She could tell it was helping and said “thank you” every so often in a tired voice.
Next, I did some acupuncture. I used her left ear and, as less is more, did just a few more points on her left hand, left hip and right inner ankle. It’s difficult to do acupuncture in labor and delivery because the mama could move suddenly or need something to change quickly. Thus, I use a small number of needles in laboring ladies. I am always on extreme alert and ready to pull them all in a moment’s notice. These needles weren’t in for long.
Mom needed to move so we switched sides and did more hip rocking. This time, I did it with more force and also did a special maneuver of strongly rocking the available hip first superiorly, then anteriorly, then inferiorly, and finally posteriorly. I repeated this jerky movement 3 more times. The doula was squeezing and tapping on points and the husband was whispering loving things in the mama’s face. It was beautiful. I have to say this was the most supportive and involved birth team I had ever seen for the dad and the doula and I were all in bed with her working hard to shift this baby’s position. I did this strong hip rocking and then the mom needed to be checked because there was a huge shift in the pressure in her pelvis and she was making a lot more noise. The midwife checked her and she was 10 cm. This was 90 minutes after my arrival.
I stayed for another 30 minutes but realized the sun was going to come up soon and I needed to get back home to get ready for my busy clinic day. The family was elated as the mom climbed in the tub to birth her baby. I left as the pushing began and her baby boy was born in the water 1 hour and 6 minutes later, impressive for a first time mom.
She avoided a hospital transfer. All of us, including myself, the family, the doula, and the midwives, were happy to see such an obvious shift happen so quickly. I was happy they called me to attend.”
The moral of this story is that it IS possible to help a baby turn and get into a good birthing position, even during active labor. With the right guidance and support, amazing things will happen. This first-time mom went from not progressing at all to giving birth just 3 hours after her acupressure/acupuncture support began. Her entire labor was 15 hours. And her baby boy was born healthy and strong. This was another happy ending we were so happy to hear!
So, when diagnoses such as Fetal Dystocia – Occiput Posterior are presented, you’ll know that there are options available and outcomes possible that don’t have to end in surgery. We are here for you – please give us a call!

Biomedical Description/Definition

When fetal dystocia with occiput posterior occurs “the baby’s spine is aligned against the mother’s spine. Flexion of the head is more difficult, and if the head is not flexed it has a more difficult job ahead entering the pelvic brim.” There is also the risk that baby’s head will be deflexed, or facing the cervical opening with their neck bent backwards. This means contractions won’t be as strong or effective, and the pressure on the mother’s cervix from baby’s head won’t be as firm so the cervix may not dilate evenly (West, 2001).
According to the Merck Manual Online (Moldenhauer, 2018), occiput posterior is the most common malposition within the fetal dystocia category.  It notes that usually the baby’s neck is somewhat deflexed thus presenting a larger diameter of the head to pass through the pelvis than if the baby’s chin were tucked to their chest.  It also notes that many of these deliveries require operative vaginal delivery or cesarean section.
Standard of care: The typical standard of care for this presentation at this stage of labor would be monitoring for fetopelvic disproportion (or when the baby is “too big” for the mother’s birth canal), and attempting to deliver the baby vaginally as long as mother and baby are stable and progressing.  Or, an immediate cesarean section should be performed if mother’s or baby’s health declines (Moldenhauer, 2018).
Additionally, discomfort and backache, as well as long labor, typically accompany this presentation.  Often with first-time moms, this can lead to more medical interventions, especially if labor lasts for several days (West, 2001).

Biomedical References:

1. Moldenhauer, J. (June 2018). Fetal dystocia.

2. West, Z. (2001). Acupuncture in pregnancy and childbirth. Edinburgh, Scotland: Churchill Livingston.

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