Author: stockportbirthservices

All About The Postpartum: Your Postnatal Recovery

I wrote this blog post for The Daisy Foundation all about what the postnatal period is, and you can help yourself feel better during it.

What is the postnatal period?

The postnatal period is roughly those first 6 weeks following the birth of your baby during which you start to recover physically and emotionally from giving birth. And I say start because although, as we’ll see, there’s an expectation that women heal quickly if not immediately, research has been conducted which shows that women aren’t healed for up to a year – even with a straightforward, low-intervention birth.

What happens during the postnatal period?

If you’ve discussed your postnatal period with your midwives, it’s likely that you’ll have focussed on those first few days following the birth of your baby.

This conversation will probably focus on the care you’ll receive in those first couple of weeks. In the immediate days following birth you will be monitored for bleeding, bowel and bladder function, that feeding is established and that you know how to care for your baby. If you give birth in a hospital the average stay for a vaginal birth is 1-2 days, and for a caesarean section 3-4 days, although if you’re well and choose to leave you could leave hospital within a couple of hours if everything is as it should be. Therefore a lot of that initial monitoring will be carried out in hospital. Midwives will then visit you at home following an individualised care plan and then your care will be transferred over to the Health Visiting team. This will be at around day 10 but might be later if there’s a need for you to stay under the midwifery team.

As your baby gets a little older you will start to see your health care professionals less frequently – this doesn’t mean that they aren’t still there for you though, you can contact them at any time if you have concerns.

Mentally the postnatal period is important too. There’s a transition time between not being a mother and being a mother. Your body is physically transitioning and your mind is transforming too – it can be such a big event that there’s even a psychological label that can be applied ‘Adjustment Disorder’.

Why is it so important? All that matters is a healthy baby.

So what’s so important about this time? Well, it takes this long for your body to start to heal. Even with a straightforward delivery your body has been through some really big changes; growing in size, making new organs, increasing blood volume then releasing baby during delivery, getting rid of the placenta, the extra fluid, lactating…it takes a lot of hard work from your body. And that’s not to mention any other related discomforts such as Pelvic Girdle Pain or gestational diabetes! But a healing body isn’t the only thing.

You will have heard many people say ‘all that matters is a healthy baby’ when talking about birth but is this true? Does this diminish what a mother goes through in having a baby, and all that comes afterwards? Mothers matter too. The postnatal period – that first month and a half – is the time when a woman is particularly vulnerable for developing post-natal depression. So it’s especially important that a woman is supported both by healthcare professionals and other people in her life, to ensure that if she starts developing signs and symptoms of it, she’s well looked after in the most appropriate way. Around 10% of mothers (and 4% of fathers) will develop PND and it’s thought to be a number of factors coming together rather than there being just one cause. These include having previous mental health issues, feeling unsupported by partner, family and friends, having a birth they feel was traumatic, struggling to breastfeed and being exhausted.  If you think that 25% of women suffer mental health issues in their lifetime, 40% would describe their birth as traumatic, and 59% don’t breastfeed for as long as they would initially hope to – highlighting a lack of support to help them breastfeed successfully – you can see that the postnatal period is a really important time to be supporting a mother.

What do women do in this time?

Having seen the importance of the postnatal period to ensure that moms are physically and mentally looked after and healing, what do we as a society think or expect mothers to be doing in the postnatal period?

When baby’s born, how quickly are you asked if people can come and have a cuddle? Pretty quickly, right? And how comfortable do you feel if someone walks into your house asking them to make a brew, or push a hoover round? You don’t, do you? I certainly don’t! So you end up making tea, and pottering about when you should be resting. And I know some of you are thinking that you’re not the type to be lazing on the sofa while people work around you but factor in soreness, tiredness, blood loss increasing if you’re too active…

And you’ve been in hospital for a few days, and not seen the outside of those walls, and you need to get something from Tesco (and admit it, you want to show off your tiny baby!) so you pop to the shops which always takes longer than you think it will. And maybe you have other children who need taking to school… Or your grandma can’t drive so you offer to travel the hour it takes to go and see her…And your workplace want to meet the new baby… It all starts adding up, doesn’t it? And very quickly instead of resting and allowing your body to heal, you’re trying to carry on at exactly the same speed as you were before you got pregnant!

And that’s not to mention the physical things that you need to learn as well! How to care for baby when they’re here; how to recognise their feeding cues, sleeping cues, if they’re over-stimulated, if they need their nappy changing… parenthood is a learning curve and a steep one for you, dad and baby! It’s like walking into a CEO job of a Fortune 500 company knowing you’ve lied on your CV about your A levels – you know you can do it but you’re scared of being found out anyway!

You can see, then, that when a mother is in a vulnerable state anyway any anxiety she has over how she’s parenting (the so-called mommy wars!) could overwhelm her and link into her emotional state and possibly contribute to her PND. Part of this comes from the expectations she has of how life with a newborn is. Perhaps she’ll feel like she’ll ‘bounce back’ like magazines insist on celebrity mothers doing, or carry on her life exactly as before because it looks to her like everyone else is. Perhaps she doesn’t expect the constant feeding, or short bursts of sleep to continue for more than a week or so. Perhaps she doesn’t fully understand the sheer relentlessness of looking after another person who relies on you for everything. It’s easy to look at a snapshot of other peoples lives and think they’ve got it together while you’re in 2 day old clothes and haven’t washed your hair for a week and feel like you’re failing. That your baby is broken. But if we can change your expectation that you have of a newborn and the way your new life is going to be, then it’s a great way to help stop that feeling of helplessness that you’re not doing things ‘right’. One of the overwhelming things we hear from new mothers is ‘I didn’t know it would be like this’ and this is what we’re here to help you with.

What did women used to do?

It’s interesting that as life generally has got faster-paced and more demands placed on us, that the demands placed on a new mother have increased, with a shift in what she would be expected to do and how others would support her.

In a practice called ‘churching’ a woman in the UK would be set apart from their community for 5-6 weeks (or 40 days) while they tended to their new baby and healed, with help from other close women – usually family or neighbours. The timings differ slightly depending on which variant of Christianity they were but at the 40 day or 6 week point they would be reintroduced to their community with a blessing at their church. Although this was primarily a religious ceremony, the 40 day timing linked closely with the time it takes for a mother’s body to have that healing process, and this time frame is seen over and over across different cultures.

This tradition has fallen by the wayside in the UK due to a number of factors; the decline of Christianity, the medicalisation and masculinisation of birth and the birth world, migration of labour creating more fragmented communities, changes to the working patterns of women…many things, but increasingly women are trying to carve back this time for themselves to be looked after.

What happens around the world?

I’m willing to bet that you’ve either said or heard about a woman in a different culture giving birth in a field then getting right back to the work they were doing, right? It’s a trope trotted out frequently but actually it doesn’t have much basis in truth. Most pre-industrial or traditional cultures all honour the 40 day period after a woman has given birth, with additional support being given to her and her family. Nobody is compelled to feel like they have to get right back into the swing of things, and they’re honoured and celebrated for bringing new life into the world.

China – zuo yuezi – sitting the month – a big focus on the warm, nourishing food for the new mother to eat and replenish herself with, as well as practical support

Korea – no cold or hard foods, and no going out into cold weather. New moms are looked after for 21 days but sometimes this increases all the way up to 100!

Latin America – la cuarentena (quarantine) – Approved food, no sex, no hair washing, lots of rest!

Now it’s clear that times have moved on and there’s very few women who would consent to following the full confinement to the full extreme – I definitely couldn’t go without washing my hair for more than a couple of days! But it’s interesting that universally there is an acceptance that time cherishing the mother after a baby is born is really, really important for so many reasons. The way in which we look after the mother and allow her the space she needs to recuperate and to learn how to be a mother shows how we understand and appreciate the newborn baby. And in some respects having that protected time without having to worry about too much of the outside world can make the intensity of life with a newborn seem easier as your focus is on them and not a hundred other things.

Make a plan

When you’re pregnant and planning for life with a baby, think about creating a postpartum plan. After all, we spend time planning our births, planning what car seat and pram we’ll use, what nursery they’ll attend – isn’t planning to protect your wellbeing equally as important? Think about who can help you in the early days, and what they can do that’s practical and will mother the mother; think about what external support you might need and where you could go for that; think about if things aren’t going so well and you need help urgently – what might that look like and have you got people who know what to look for?

Most of all – take care of yourself, and enjoy that lovely new baby.

How To Release The Fear Of Labour Before Birth

I wrote this blog post for The Daisy Foundation all about how releasing your fear in labour can help ease your pain. Fear, tension and pain are in a self-fulfilling cycle, find out how to break it.

So you’re pregnant – congratulations! Now you’ve started to share the good news, we’re willing to bet that you’ve started getting the horror stories – the failed inductions, the 3rd degree tears, the days long labour…right? In the words of Chandler Bing could that BE less helpful?

Think about your reaction when you got the last round of grim labour stories. You winced, you grimaced, you clenched your pelvic floor and tensed your knees together? Oh yes, that’s the good old fear factor – fight or flight – setting in. Fear makes your nervous system produce adrenaline, which increases your heart rate, makes your breathing shallower, blood diverts from your non-essential organs and your muscles tense. Perfectly understandable…but now think about where your baby’s going to come from. Uh huh. Your body being tense from your belly button to your knees isn’t going to help your baby on their way, is it? Your fear leads to tension, and tension leads to pain.

When adrenaline is produced in a labouring person, it inhibits the production of two other hormones; oxytocin and endorphins. It’s these two hormones that are responsible for stimulating the contractions of the uterus, and for blocking the feelings of pain. Without these present in sufficient quantities labour will be longer, more stressful, and more painful than if we allow our bodies to limit the production of adrenaline.

So what if you were told that you can help reduce the pain of labour? Hell YEAH. Let’s start by looking at the fear aspect of the cycle. Fear of the unknown is a well-established phenomenon and it holds true in labour too. Just as each birthing person and each pregnancy is different, so too is each birth experience. For a first-time mum with no point of reference, the thought of pushing a baby out of a hole that small can be pretty terrifying. Reduce the unknown, however, and you can reduce the fear. And that’s where antenatal education comes in. A knowledgeable, informed woman is one who no longer fears the unknown. Now – no woman can plan their birth experience entirely, otherwise we’d all be having two-hour labours with no tearing or pooing (am I right?) but by becoming knowledgeable about the birth process, about the options available to you and about how you can influence the birth to be the best possible outcome on the day by playing the hand that’s dealt, then you can make it all a lot less scary. What’s more, by being so well prepared, this knowledge becomes innate and you won’t have to rouse yourself too much from your birth bubble to give consideration to anything that might need a decision from you. Coming out of that internally focussed zone allows adrenaline to creep up – not good for your oxytocin levels.

We’ve looked at how you can reduce your fear by preparing your cortex (your ‘thinking brain’, responsible for knowledge and decision making) ahead of the big day, but you can also prepare your limbic system (or ‘emotional brain’) to release fear. Now your limbic system is responsible for many things, one of which is your fight or flight reflex…yep, that again. And where knowledge and information can affect your cortex, we need a different language to speak to the emotional brain. Something that will help you exercise the part of the brain which switches on – and off – that adrenaline switch. This is where relaxations and visualisations come in. Using guided visualisations such as seeing each contraction as a wave building up in intensity, peaking and gently rippling away while in a state of pain-free relaxation can encourage your body to return to that state when anchoring itself to those visualisations in labour. Your breathing becomes easier and floods the body with oxygen, your muscles are relaxed and free of tension which makes each contraction more effective, you’re disassociated from feelings of pain which keeps oxytocin and endorphin levels high. Pretty impressive, right?

There’s another way to keep adrenaline, fear and tension out of the birthing room with you, and that’s the room itself. Imagine a stark white, brightly lit room that smells slightly of Dettol that hums with the electric lights. Now picture a dimly lit, warm room filled with your favourite scent and music. It’s unlikely you’re going to be feeling very comfortable in room number one. And if you’re not comfortable, if you don’t feel safe and secure, then your adrenaline will rise and your labour might stall. So really think about preparing your birth space to be a place where you can feel comfortable in. Many hospitals and birth centres are really accommodating at letting you take in goodies from home.

Now, I’m not saying that birth can or should be pain free. But we do know that working with our emotional and physical selves, really understanding the physiology of how our bodies work, can reduce the experience of pain. And that’s a bloody good start to giving birth isn’t it?

Three Ways Of The Third Stage

Once baby has been born the placenta is no longer needed either by the maternal body or the baby. It is this process of being expelled that is called the third stage of labour. There are three ways in which this can be delivered: the physiological, the active or the expectant management.

A physiological – or natural – third stage means waiting for the body to resume a pattern of contractions by itself, causing the placenta to detach from the uterine wall and be delivered by the woman. This can take anywhere from around 10 to 60 minutes. The cord is left intact during this time, allowing all the blood from the placenta to transfer to the baby, and is only cut when the placenta has been delivered – the term delayed cord clamping is used to refer to this. Optimal cord clamping – to mean that the cord is cut only when it stops pulsating – is the WHO recommended practice to best supply the baby with iron supplies until around 6 months of age although any delay does pose an increased risk of jaundice needing treatment in the baby.

A physiological approach to the third stage occurs mostly in midwife-led units and home births, where continuity of care to women can be practised[1]. This is probably due to the birth being seen as a normal life event rather than a medical ‘problem’ that needs to be fixed; an attitude often seen in consultant-led units.

In comparison, an active third stage involves giving a prophylactic uterotonic, i.e. a drug that stimulates contractions of the uterus, cord clamping and controlled cord traction. The drug syntocinon or syntometrine will be injected as the baby is born or immediately after and the cord will be clamped and cut in order for the drug not to transfer to the baby. The midwife will keep a hand on the woman’s fundus to check that the placenta has detached and will either encourage the mother to push the placenta out or will carry out controlled cord traction to help it on its way out.

By cutting the cord of the baby at this stage the baby could be deprived of up to a third of its blood as it has not had chance to transfer from the placenta. On the other hand, there is evidence to suggest that active management decreases the risk of heavy blood loss immediately after the delivery of the placenta. For this reason, it is generally advised that women who have had interventions have an active managed third stage as these increase the risk of heavy blood loss[2].

For some mothers there will be a health risk associated with a decision to pursue a physiological third stage and these women will be offered active management as an alternative. However, if this is declined then ‘watching’ or expectant management may be suggested, which aims to start with a physiological delivery and switch to active management if needed. The main concern is for women for whom a large blood loss would be extremely detrimental, or where there is already an increased risk of heavy blood loss. This is because the drug used in active management reduces blood loss immediately after the delivery of the placenta[3]. However, this method also reduces the baby’s birthweight due to the non-transfer of blood from the placenta and further has been shown to increase the mother’s blood pressure, heighten the intensity of afterpains and cause vomiting and the readmission of the mother to hospital for the treatment of prolonged bleeding (Beglet 2015).

If the mother chooses a physiological third stage there are means of encouraging the placenta to detach in a timely manner and avoid the risk of having to resort to active management. Michel Odent[4] teaches that it is important to keep oxytocin levels up while the placenta is being delivered, to contract the uterus and push the placenta out and there are a number of ways this can be achieved. Keeping the birth environment calm, quiet, warm and dimly lit will inhibit the production of adrenaline and keep oxytocin flooding the body. Skin-to-skin contact[5] and breastfeeding the baby in the ‘golden hour’ post-birth will also help the woman’s body release oxytocin and shorten the length of the third stage. If a woman has received artificial oxytocin during the augmentation of labour it may be more difficult for her body to produce it naturally, making these actions really important for her to have a physiological third stage. If not enough oxytocin is naturally produced, then the injection would likely be necessary.

Being in an upright position may assist the expedition of the delivery of the placenta and without the need for intervention as gravity does its job of easing it out of the woman’s body. It is shortening the length of the third stage that may be the key to reducing the risk of severe post birth bleeding[6].

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[1]Blackburn S. (2008) Physiological third stage of labour and birth at home: In: Edwins J. (Ed.). Community midwifery practice. Blackwell: Oxford.

[2] https://www.nct.org.uk/birth/third-stage-labour

[3] Begley, CM, et al (2015) Delivering the placenta with active, expectant or mixed management in the third stage of labour Cochrane Database of Systematic Review

[4] Odent M, (2001) New reasons and new ways to study birth physiology. Int J Gynaecol Obstet

[5] Marin GMA, LLana MI, Lopez EA, et al. (2010) Randomizd controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatrica

[6] Magann EF, Evans S, Chauhan SP et al. (2005). The length of the third stage of labor and the risk of postpartum hemorrhage. Obstetrics and Gynecology

Birth Positions Which Can Help You Give Birth More Easily

Many women enter pregnancy having only seen labour occur on television, where women are laid on a bed, knees up, chin to chest, ‘purple pushing’ interspersed with screaming. Understandably, this can lead to some nervousness on the pregnant woman’s part!

The weight of research[1] shows that upright labouring positions can provide advantages to a birthing mother. In an upright position, gravity can assist the baby within the uterus by bringing it down and out, as well as helping keep it in the optimal foetal position when coupled with leaning forward. Being upright can also reduce the risk of aorto-caval compression which could result in a reduced blood supply to the baby. Upright positioning uses gravity to bring a stronger connection between the baby’s head and the cervix, releasing oxytocin and giving more efficient uterine contractions. In traditional squat and kneeling positions the pelvic dimensions become wider, allowing the baby to pass through with more ease. As well as increasing the comfort of the mother and improving the overall birth experience, the positive impact of these positions on the pace and efficiency of labour tend to make interventions less necessary and therefore less common.

The benefits of upright positioning don’t stop there either. Studies have shown that an upright position during the first stage can both reduce pain in the labouring woman[2] and shorten that stage, reducing the need for pain relief and preventing exhaustion in the woman. Interestingly the physical position a woman is in to give birth can also have a psychological impact: being able to find a comfortable position and knowing that the woman’s own movements are helping the baby be born more easily can give feelings of control and stem any fear and anxiety arising from the situation. By reducing stress and discomfort, these psychological responses to a good birthing position can make the whole experience more positive.

Despite the considerable evidence for the benefits of upright birthing positions, the actual positions that women give birth in do not reflect the evidence or national evidence based practice guidelines and nearly half of deliveries are made in a semi-recumbent position[3]. In developed countries where pregnancy and labour has become medicalized, interventions such as foetal monitoring and different types of analgesia can limit the options for position of a birthing woman[4]. A Cochrane review theorises that women are encouraged to push in supine or semi-recumbent positions simply because it is more convenient for the healthcare professional to gain access to the woman rather than being beneficial to the woman. Women ‘choose’ these positions on the basis that they think it is expected of them when presented with a bed in a hospital setting, coupled with the cultural expectation ingrained in them as seen previously, through the medium of television[5]. It is important that the woman knows what positions will help her and to have the confidence to try these positions without being led by the healthcare practitioner in attendance.

A Cochrane review[6] compared the risk of interventions and birth outcomes for upright birthing positions in comparison to non-upright birthing positions and concluded that upright positions can be associated with a shorter length of first stage of labour; a reduction in the use of epidural analgesia; almost a quarter less likely to have an assisted delivery; 20% less likely to have an episiotomy but 35% more likely to have a second-degree tear; 50% of births are less likely to have an abnormal foetal heartrate and 65% are more likely to have a blood loss of more than 500mL. The review found that there was no difference in birthing positions on the length of the second stage of labour; emergency caesarean rates; third or fourth-degree tears; blood transfusion rates; neonatal admissions or perinatal deaths. As there is only a negative impact on second-degree tear rates and blood loss by being in an upright birthing position, it seems clear that upright birthing positions really are the most beneficial, especially as tears can heal more quickly and neatly than episiotomies and there is no knock-on effect on blood transfusions needed.

The birth position chosen by the labouring woman may have a specific purpose. Different positions can bring relief to different complications. For example, if shoulder dystocia presents then the Gaskin Manoeuvre[7] of turning onto all fours and being on hands and knees will cause changes to the pelvic shape which will allow the shoulder to release and the baby to be born.  All fours positioning will be useful for women whose baby is or has turned occiput posterior in labour. Gravity and rotations can help the baby rotate to anterior position[8] although Balaskas points out that when the baby begins to crown each woman should become as vertical as possible to help it out. The use of these positions and a mother’s existing familiarity with them will help to reduce the need for interventions.

There is not just a physiological impact from birth positions on a woman, but psychological too, and these can prefigure the birth itself. Knowing that she can speed up her labour or slow it down if she feels overwhelmed puts her in a position of power. A woman who feels like she is in control of her birth, who feels as though she has a variety of tools at her fingertips to assist a range of experiences she may encounter, will be more empowered to deal with how her labour goes. In contrast, being in a supine position promotes a vulnerability in a healthcare setting that the woman must shed in order to birth most effectively; being upright will automatically help with that.

Ultimately a woman must birth in the position in which she is most comfortable, and the care providers around her must work with her to help her accomplish that goal.

[1] MIDIRS (2008) Positions in labour and delivery. Informed choice for professionals leaflet Bristol: MIDIRS. See also: Gupta, J et al (2012) Position in the second stage of labour for women without epidural anaesthesiaCochrane Database of Systematic Review

[2] Miquelutti, MA, Cecatti, JG (2009) The vertical position during labour: pain and satisfaction Revista Brasileira de Saude Materno Infantil

[3] Royal College Of Midwives (RCM) 2010 The Royal College of Midwives’ Survey of positions used in labour and birth London : RCM

[4] 2016, W.H.O. (2015) Position in the second stage of labour for women without epidural anaesthesia. Available at: http://apps.who.int/rhl/pregnancy_childbirth/childbirth/2nd_stage/tlacom/en/

[5] The Royal College of Midwives (2012) Evidence Based Guidelines for Midwifery Led Care in Labour: Positions for Labour and Birth

[6] Gupta, J et al (2012) Position in the second stage of labour for women without epidural anaesthesia Cochrane Database of Systematic Review

[7] Gaskin, I.M. (2003) Ina May’s guide to childbirth. New York: Random House Publishing Group.

[8] Balaskas, J (1989) New Active Birth: A Concise Guide to Childbirth,London: HarperCollins

What Is The LOA, The OFP, And Other Acronyms.

The presentation of baby in labour is extremely important for how that labour progresses. Most women know, or come to know, through their pregnancy that their baby should be head down in preparation for birth: but even a head-down baby can be in an optimal or suboptimal position depending on where their spine aligns. The baby’s position is important as it affects their ease of rotation and descent as they travel through the birth canal.

The occiput anterior position is the most effective way for the baby to travel down through the pelvis and make its way into the world. The baby is head down, facing the maternal spine which gives space for the chin to be easily tucked in onto their chest allowing the smallest part of their head to fit through the cervix first. The soft bones at the fontanelle fold to make their head smaller still. This position allows the baby to travel through the pelvis as easily as possible. There is less likelihood of a baby in an occiput anterior position needing medical assistance in being born.

The occiput posterior position, while head down, is not so effective at helping the baby on its way through the pelvis. The baby’s spine is aligned with the mother’s such that the baby is facing towards the mother’s naval. As the baby descends they have to rotate all the way around so they’re facing the back, often making the labour longer and more painful, with the pain being felt at the woman’s back caused by the hard surface of the baby’s skull pressing on the mother’s back. It is more difficult for the baby to tuck their chin down, meaning that the diameter of the presenting part of the head is bigger (approximately 11.5cm) than if presenting in an anterior position (approximately 9.5cm).

There needs to be a good connection between the baby’s presenting part and the cervix in labour in order for oxytocin to be released – oxytocin being the stimulus to the uterus contracting. An occiput anterior position allows the best fit of the baby’s head into the cervix, resulting in good contact and hence causing a good flow of oxytocin to be released. When in labour, kneeling positions can encourage this contact by allowing gravity to assist in putting pressure between the baby’s head and cervix. If the baby is in an occiput posterior position, these movements will not be working as effectively for the baby or mother. This can result in a long latent phase of labour for the mother or having a stop-start pattern to contractions.

It was Jean Sutton and Pauline Scott in 1996 who coined the phrase ‘optimal foetal positioning’[1]. Through their work they showed the importance of the mother’s posture and position in pregnancy and labour. They showed that babies who start labour from a left occiput anterior position seem to birth easier. Babies in that position tend to curl the crown of their head into the mother’s pelvis better, allowing a flexed vertex presentation of the skull with a diameter of approximately 9.5cm.

Sutton and Scott noted that the number of left occiput anterior presenting babies are decreasing in recent decades, and attributed this to the change in lifestyle of women. Women are less likely to spend substantial time in active physical housework (often leaning forwards or on all fours) and more likely to spend their time relaxing on laid back sofas. Gravity does the rest in pulling the heaviest part of the baby – its spine – down towards the mother’s spine. By paying particular attention to the encouragement of a left occiput anterior position during the stage of pregnancy where the baby is beginning to start engaging (around 36 weeks for a first time mother and slightly later for biparous or multiparous women) women can help themselves have the most efficient labour possible.

There are ways for women to help position their baby optimally by building in things to their everyday lives. These include: changing their sitting style to ensure their knees are lower than their hips; not crossing their legs; kneel over a birthing ball while watching television; not putting their feet up; sitting on a birth ball not a sofa and swimming using breaststroke or front crawl.

Babies who are right occiput anterior may rotate away from that position as they travel through the pelvis and become posterior during labour. Indeed, Gardberg (1998) states that the majority of occiput posterior babies in labour start off as occiput anterior[2] – likewise the majority of posterior babies will turn in labour too. This, then, would lead to the conclusion that while there is an optimal position to begin labour in, it really isn’t a defining moment for the mother if baby turns away from this position.

[1] Sutton, J. and Scott, P. (1996) Understanding and teaching optimal foetal positioning. 2nd edn. Tauranga, New Zealand: Birth Concepts.

[2] Gardberg, M. (1998) Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries.