Facing forward makes the baby’s head seem bigger. This is because the head angles in to the pelvis in a larger diameter than the baby’s who is curled up and facing the mom’s back (OA). Baby can’t help with the birth because their neck is already extended, they have less spinal movement because of spinal extension.
|Left Occiput Anterior position|
Anterior babies have the room for more flexion to get into the pelvis (at the brim) and can then help with the birth better. Spinal flexion and extension helps with the birth – when they occur at the proper level of the pelvis.
Posterior babies may have their chin up and when so, can have their forehead on the front of the mother’s pelvic brim. Even if the dome of baby’s head is low in the pelvis, the fact that the forehead remains overlapping the pelvic inlet means that the baby is not actually engaged.
Baby has to flex, or to flex and turn, to fit into the pelvis. We hope the baby turns to face mother’s right side, putting their back to mother’s left. Baby being hung up on the brim is a common reoccurrence in VBAC (Vaginal Birth after Cesarean) labors when the first labor was due to lack of engagement.
Baby must turn or all the Pitocin, pushing or contractions will not bring baby down. The rotation solution is to help baby turn to the oblique diameter or to face the back directly to fit.
- Sidelying Release softens and lengthens the pelvic floor and other pelvic muscles temporarily. Follow with lunges with one foot flat on a chair through 3 contractions on each leg.
- Rotation off the protruding spines while lying down requires a “bed lunge,”
- A peanut ball to straddle while on a sort of hands and knees position to open the pelvis,
- Few doctors, nurses, or midwives know to manually turn the baby, but that is another option. If a cesarean is the only solution known and if baby can’t fit or turn, then the cesarean is a lifesaver. If these techniques are tried first, there may well be another cesarean avoided!
Pitocin may help if the head isn’t actually caught on the bones. Give the list above a try first if you can. Be precise with the Sidelying Release. You may be able to solve the issue within an hour and if not, then give the Pitocin a try (if in the hospital).
Immobile Sacrum or one that is pulled inward by ligaments:
An immobile sacrum doesn’t move out of baby’s way in labor. All the exercise and most of the self-care suggested on my website and in my workshop is not likely to help if the sacrum is pulled in by a short (due to a chronic spasm) ligament pulling it into baby’s path.
Pitocin is unlikely to help bring baby down.
Mobilizing the stuck sacrum outward takes a specific release from a body worker or physical therapist. Trigger point release may help. It takes about ten minutes generally. In tougher cases, longer. But once done the sacrum swings out and, if the baby was held back by it, now descends to give the birthing mother an urge to push.
Would it happen again? Yes, unless the sacrum was mobilized to swing out into its neutral position. Recheck the sacrotuberous ligaments periodically in the later part of the next pregnancy AND during birth.
A little less than half of persistent posterior babies are born vaginally in modern university settings (See Lieberman, 2005). With better knowledge of how to open pelvic diameters, soften and lengthen pelvic muscles and ligaments, I believe we can increase the rate of vaginal birth for persistent posterior babies.