Small Pelvis Leading to Posterior Baby

This is part three/last part of the small pelvis issue. . .(for part one, click here. For part two, click here.)

I will be at peace with having a c-section next time IF I know I've done everything else first to prevent it. Granted there could end up being a new issue next time that leads me to need one, and if that's the case then so be it. But at least as far as the "small pelvis" diagnosis, I'll be practicing the tips from my previous post for prior & during labor to hopefully have another natural childbirth--that's easier next time!

As I wrote in my previous two posts, many women who have been diagnosed with a small pelvis also have a malpresentation (as was my case).

When I first went into labor I thought I was lucky because I avoided the typical long hours of contractions. Instead, everything started with my water breaking and then moved super quickly--I was fully dilated within three hours. At first I hoped my next experience would be the same way. Now I've come to learn that the water breaking first is usually a sign of trouble. I need to hope that happens LAST next time.

When the water breaks first (as in gushing out), it's usually because it's been forced--typically by a baby being in the wrong position. This could be because of being breech, traverse, or posterior.

The "catch" with the posterior position is that it's not often known until a woman is in labor. With breech and traverse the doctor can tell by feeling at each check-up, as well as with ultrasound. This can alert the mom prior to when she goes into labor so that she can follow tips to try and naturally turn a breech or traverse baby. With posterior, though, a baby is likely to move back and forth during the pushing phase!!! 87% of face-up babies turn to the proper face-down all by themselves during labor. But, according to the website, Optimum Foetal Positioning, 68% of posterior babies start labor in an ideal position and then turn posterior while mom is in labor.

This was sort of my case. During my last month of pregnancy I had a gut instinct that L.J. was face up, but both my doctor and the ultrasound technician said he was on his side just two days before I went into labor. This is not a bad position, as generally babies ARE on their side in the womb and come out face down. L.J., though, didn't move within my pelvis and so he was actually side-posterior in the end. That is why it's good for all women to know the following tips, because you never know when you're going to need them.

Posterior babies have increased in recent years. This is thought to be due to our lifestyle of "sitting in car seats and leaning back on comfortable sofas, together with less physical work."

I admit I wasn't very "physical" during my pregnancy (all of my pain and discomfort made it hard to be) but I made sure never to lay on my back. Whenever I reclined, I was always on my side. Most of the time when I relaxed I sat straight up. So, personally, I'm not sure I could have improved when it came to this area. I hope that next time my body remembers being pregnant so it won't take everything so hard, which means then I can be more active and see if that makes a difference. If it doesn't, the website says to "try crawling around the carpet for half an hour - while watching TV or listening to music. It is good exercise as well as good for the baby's position."

Other tips:

*Spend lots of time kneeling upright, or sitting upright. 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.

*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 labour.

*Various exercises done on all fours can help--wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.

I didn't do any of these--but you can be sure I will next time!

If your baby is still posterior or ends up being posterior for the first time when you are in labor:

*Walk up stairs - sideways if you need to

*Rock from side to side

*March or 'tread' on a spot

*Step on and off a small stool

*Climb in and out of a birth pool

For second stage labor:

*Use kneeling or all-fours positions. Kneeling on one knee can help.

*Supported squatting with the mother lifted quite high--bottom should be at least 45cm (18 inches) off the floor.

*Birth stool seats should be at least 45cm (18 inches) from the floor.

*Avoid lying on your back, semi-reclining, sitting or semi-sitting. These positions all reduce the available space for the baby to turn. Lying on the side is OK.

In a previous post I discussed that I did do the "hands and knees" position. . .but maybe not long enough, I don't know--I had no concept of time that day, haha! Another good position is "Leaping Frog." According to my HypnoBirthing book:

This position is an easy form of squatting, which some experts believe is one of the most effective positions for bringing your baby into the world. While squatting on your toes, place your arms inside or outside of your legs and support yourself on your hands. When your arms are outside and slightly back at the side of your hips, it is easy to spread your legs wide and allows you a clear view of your baby's birth. Another advantage of the Leaping Frog with arms outside is that your entire lower pelvic area is suspended, leaving your baby to finally emerge without pressure from other parts of your body. This position widens the vaginal opening, utilizes the effect of gravity, shortens the birth path, and places the lower body up and away from any pressure. If you think you may utilize the Leaping Frog position, you will want to practice it reguarly to strengthen your arm muscles, but it is worth any effort you may put into it.

Finally, you should change positions frequently--something else I didn't do. My contractions were so intense (no medication or epidural) that I did best with them while lying in bed. But knowing what I know now, I would have forced myself to stand up, squat, use the birth ball, etc. to see if my activity during labor would have helped.

It's going to be a couple of years before I go through labor again, but I am already super motivated to do the things in all three of these posts!!! Hopefully in the meantime the tips can help someone else, too.