How important is the baby's position at birth?
Women who have had surgical deliveries due to "poor" fetal positioning will tell you it is critically important to having the birth you want. Women who have birthed bottom-first, face-first, face-up, hand first or ear first babies without assistance or tearing will tell you position doesn't really matter that much. Who can you believe?
The fact is, both perspectives are valid. Poor fetal position is blamed for many surgical births today. Presenting with a breech during labor is an automatic c-section for many practitioners. Most of the gentlebirth-minded folks will agree that surgical deliveries for breeches are probably the safest choice for a hospital birth. Breech deliveries require patience and hospitals tend to be short on patience (not patients... ha...).
What is the one thing that separates the women who birth "malpositioned" babies in empowering ways (can you imagine the kind of awe you must feel when you realize you delivered an 11 pound breech baby? :) from the women whose children are "rescued" from her womb by a surgeon? OK, there are two things...
1) She trusts in birth.
and
2) She accepts the fact that her baby might die.
If you can't do both of these things completely, you will need to become clear on just what conditions you require in order to feel safe.
Birth is normal, until it is interFEARed with. Normal means babies sometimes die, mamas have been known to die, it's normal.
Hospitals do not guarantee your baby will live. They will interFEAR with your birth in hopes of increasing your child's chance of surviving birth but their track record (at least in the USA) is deplorable. Study after study shows that homebirth with a midwife is safer than hospital birth but many midwives won't handle breech births either. Why? Because they can't accept condition #2 above. Too risky.
So how do you, as a pregnant woman assess the risks to your body and your baby for this particular birth?
This is as good a time as any to think about the bond between the mother and her unborn child. When we look to doctors and midwives to tell us how the baby will handle labor we often forget that the baby knows and the baby will tell us, if we listen.
Build bonds of trust with your unborn child during pregnancy. Ask hir to kick you, once for yes, twice for no. How do they want their birth to unfold? Who do they want to catch them?
Visualize a good birthing position and inform the baby that this position will help make birth easier on both of you. It's not hocus-pocus, it's sharing information on the only level you can with an entity that isn't 100% bound to the physical world yet.
Ask for your baby's input, affirm the birth you want to yourself, your child, your support network and the universe, then accept whatever comes with love.
If you trust your baby to tell you if anything's wrong and listen only for/to that, you are listening to the person who cares the most about the outcome. That's always a good strategy, go direct to the source.
Breech births are "best handled" with a hands and knees delivery or a supported squat and no pulling unless you feel the baby lead you to pull.
Posterior labors (back labor) can sometimes be resolved through position changes (hands and knees, bottom in the air and "two stairs at a time" lunges have been credited with opening the pelvis and letting tiny twisted heads straighten themselves out) but sometimes babies just like coming out "sunny side up".
Transverse babies scare professionals but most of them DO TURN during labor. It's especially important to connect with transverse babies and see if they are genuinely confused about where the door is and how best to get through it or if they are actively trying to impede labor. Some transverse babies are sending clear "it's not safe out there yet" messages to their mothers.
Trust birth, listen to your baby, trust birth some more. The less you fear, the more you rely on yourself and your baby to get through this together, the better your chances of having a safe, healthy birth for both of you.
Birth is as safe as life gets.
P.S. If you feel your baby is crying for help, get help. Being empowered isn't about doing it yourself, it's about making the best choices we can with the information we have.
Silverhawke writes:
The greatest complicating factor in birthing posterior babies, who dont rotate during pushing is that positioning is everything. When a woman is left to her own devices, to listen to her body and baby, she will push in the exact and perfect position for getting her baby out. Most often that is on the hands and knees.
The hands and knees position opens up the pelvis completely, even more than squatting does. The problem with squatting sometimes when you have a baby who is hung up at the entrance of the pelvis is that while it opens up the pelvic OUTLET (the bottom of the pelvis) a lot, it squeezes the pelvic inlet closed slightly, which can hinder the process of a baby in a odd position getting into the pelvis deeply enough for the open outlet to be of benefit.
Technical Gab aside, when a woman is left to her own devices without any yelling, coaching, chanting, direction or interFEARance from anyone, she WILL instinctively push in the right position.
Example... I assisted a mom who labored completely unmedicated. Pushed, coached, on her back and in a squat for over 3 hours. The baby just wouldn't progress into the pelvis. The call was made to do a c-section, but the anestheisologist was in another surgery, so this mom was left to her own devices for about half an hour while they made things ready, and got the anesthesiologist.
Mom got out of the bed, to use the bedside commode, and of course being completely dilated, once she got up, changed positons started instinctively pushing. I just quietly watched her from the other side of the bed. she got into a deep foward leaning slight squat over the side of her bed. After about 3 pushes I started seeing perineal bulging, which we hadn't seen ANY of before.
Sadly, the nurse wouldn't check her before taking her back for surgery and the baby, while directly posterior, was born surgically with a bruise across his nose and eyebrows from sitting with his head under the pubic bone while the doctor had to push him back out of the pelvis to deliver him abdominally.
Posterior babies do complicate things, however, I have seen a number of babies rotate in the birth canal (an amazing thing to watch, this little cyclone going on as mom is pushing), and this is definately facilitated by mom pushing how she instinctively knows how to.
Women are birthing creatures. We are animal, mamal and birth just happens. It is when mom is manipulated, maneuvered, interFEARed with, laid out like a buffet table, with the spotlight, that our instincts take on a whole different function, and that is the fight or flight mechanism. As a doula, for a long time I wold coax mom into a position *I* thought might be more productive. It wasn't until I myself had a completely unhindered birth, that I discovered that we have all the tools inside us to birth just as we were created, all we have to do is tune into that cosmic force within us and let it happen.
Fear blocks up our energies, and makes us behave in a manner that we normally wouldn't, and anything that doesn't directly allow us to tap into our isntinctive self, at that vulnerable time, creates a state of fear.
The midwives archives on fetal positioning
The midwives archives on breech birth
The cbirth archives on breech birth
