Chances are good that you know someone or have heard of someone who had back labor. If you have, or you have experienced it yourself, you know that back labor can be much more painful than normal labor, even excruciatingly painful. Yet chances are also good that the only fix for back labor that you have been told about is the epidural. The good news is, there is an easier and safer way to avoid or stop back labor, but first you must understand what back labor is, and what causes it.
During most of pregnancy, your baby is small enough that he can do somersaults and stretch his limbs without too much effort. Sometimes he will be head up, sometimes head down, or even sideways, but that’s okay because birth is far enough away that there is plenty of time for him to settle down.
By the last trimester though, your baby will have gotten big enough, and old enough, that he will not be able to do all the gymnastic tricks he had been able to, and he will naturally seek the most comfortable position to stay in. This is essentially the baby’s way of “nesting” in preparation for birth. The normal, best position for him to choose would be head down with his face looking toward your spine (medically termed Occiput Anterior).
Multiple challenges surface if your baby decides that he likes a different position, such as butt down, facing your belly, or lying sideways in your womb. Any one of these would be medically termed “malpositioned”, although the most common malpositions are the baby facing his mother’s belly (Occiput Posterior) or facing her hip (Occiput Transverse). Because pelvis’ come in all shapes and sizes, sometimes a baby in the posterior or transverse position can be born just the way he is with no problems at all. Most of the time, however, moms (especially those having their first baby) have more pain and difficulty in giving birth to them.
Back labor, prolonged labor, lack of cervical dilation, lack of descent on the baby’s part, and fetal distress are all possible complications of labor with a malpositioned baby. Malpositioned babies also have a harder time entering the pelvis and becoming “engaged”, thus prolonging the start of labor, perhaps well beyond the estimated due date. Typically, the plan of action in this case is to provide the mother with an epidural to relieve the back pain and pitocin to speed up the labor. If the baby gets too stressed or no progress is made, a cesarean section is performed. Malposition of the baby is becoming a more and more frequent indication for giving a cesarean section.
Such a situation can not only be painful in several aspects, but it can be stressful, scary, and more dangerous than it has to be. Why? Because as I said before, there is an easier and safer way to avoid or reverse malposition of the baby.
What is this magic fix? Very simple: encourage the baby to find a good position for birth before he settles into your pelvis, and then encourage him to stay there. A woman who already has a malpositioned baby, even in labor, has a very good chance of turning him (87% of babies who are OP at the start labor will turn before birth, Gardberg-1998), if she follows the principles included here.
A group called Spinning Babies discovered that following these three principles can many times turn a baby who is not in the best position for birth:
1. Balance. Years of bad posture and chronic body tension affect the balance of the uterus. When a woman’s body, including the ligaments, muscle, and fascia around her uterus are not aligned well as a result, her baby will naturally mold to this imbalance in her uterus and become “malpositioned”. It has been said that the couch, a contributor to bad posture, is a leading cause of cesarean section.
2. Gravity. If you have been using the first principle to relax your abdominal and pelvic muscles, use of gravity-enhanced positions (i.e. upright positions), especially in labor but throughout pregnancy as well, will encourage your baby to settle head down in your pelvis, and to maneuver the turns through your pelvis to be born.
3. Movement. The pelvis is made up of four different joints, all moveable. Even the sacrum can move if you are not sitting or laying on it. If you are relaxed and balanced, upright, and moving, your pelvis will open easier to turn the baby and move him down and out.
Here are some techniques that Spinning Babies recommends to incorporate the three principles into your every day life, and into your labor and birth experience:
* Spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.
* Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.
* Use yoga positions while resting, reading or watching TV – for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)
* Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.
* Don’t cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front
* Don’t put your feet up! Lying back with your feet up encourages posterior presentation.
* Sleep on your side, not on your back.
* Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way round. Jean Sutton recommends squatting on a low stool instead, and keeping your spine upright, not leaning forwards.
* Swimming with your belly downwards is said to be very good for positioning babies – not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
* A Birth Ball can encourage good positioning, both before and during labor. Swaying in great circles while sitting on a birthing ball is one way to help the head slip into the pelvis.
* Various exercises done on all fours can help, eg wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down (also known as a “pelvic tilt”. This is described in more detail in an article on http://www.wellmother.org – ‘Exercise for relieving backache’ by Suzanne Yates.
* Once a woman has a baby or two, or six, relaxation is rarely a problem. She may be too loose. Supporting her belly with a pregnancy belt can substitute for any missing tone in the abdominal muscles. A good pregnancy belt supports the baby’s angle into the pelvis. The belt adds a slope to help the baby to aim and then, later, rotate into a good starting position for labor.
* Walking regularly helps baby make slight adjustments to his position, and encourages him to move down into the pelvis.
* Some women will request that their amniotic sac, or bag of water, not be broken by the doctor or midwife in labor. This will help the baby rotate her head more easily during birth.
* Throughout pregnancy movement and exercise helps improve muscle tone to help with engagement and helps the pelvic joints stretch and relax, which will help descent once labor begins. In labor, movement helps the baby descend through the pelvis.
* Do pelvic rocking any time when your lower back is achy. The movement of your lower back releases strain there. The pelvic tilt is a good comfort measure. Pelvic rocking is more likely to be effective if the abdominal muscles and ligaments are relaxed first. Do about 20-40 pelvic rocking movements each time, 1 or 2 times a day. If you do them while baby is active, there may be more benefit to fetal position improvement. But start early, in the first trimester! Do the pelvic tilts after doing the maternal Inversion exercise.
* Visit a chiropractor who can use the Webster Technique to help turn a baby who is malpositioned, or an osteopathic doctor.
* Ask your doctor/midwife what position the baby is in at each visit after 35 weeks. Don’t be satisfied with just “head down”, ask what direction the baby is facing. You can also check your chart, which you have the right to do. The position will be labeled as LOA, ROA, LOP, ROP, ROT, LOT, LSP, RSA, LMT, or something similar to that. Ask what the abbreviation means, ask your doula, or look it up in a medical dictionary.
* Eat well, avoid eating foods that will encourage a large sized baby (baked goods, potatoes, pastas, sweet dairy products (ice cream, frozen yogurt, milk shakes), and try to choose better protein and veggie choices. Eat enough, but make good choices about the foods you eat.
* The baby’s back is the heaviest side of its body. This means that the back will naturally gravitate towards the lowest side of the mother’s abdomen. So if your tummy is lower than your back, eg you are sitting on a chair leaning forward, then the baby’s back will tend to swing towards your tummy. If your back is lower than your tummy, eg you are lying on your back or leaning back in an armchair, then the baby’s back may swing towards your back. So find resting positions that encourage you to keep the front part of your pelvis open, and your belly leaning forward. Leaning back in armchairs and car seats are good examples, and anything that keeps your knees higher than your pelvis.
Here are some other good resources on fetal positioning:
2) You can also purchase the booklet Optimal Foetal Positioning which will give you more insight into encouraging your baby to choose a good position for birth, complete with pictures. You can purchase a copy through this website: http://www.homebirth.org.uk/ofp.htm or http://www.capersbo okstore.com. au/scripts/ shop_item. asp?by=fla& item=334
3) Sit Up and Take Notice by Pauline Scott is another book worth reading.
Here’s a good video I found that shows how to use some excellent positions for labor: