Let’s face it, momma. When you see the words “occiput posterior“, your brain goes a little numb. Right? Unless you’re a studied and learned woman of science, chances are you probably just wrinkle your forehead a bit and then move on to something you can actually pronounce–even in your head!
First things first: if you ever have to say it out loud, pronounce is OX-uh-puht pah-STEER-EE-uhr. Prepare to amaze both your doctors and your friends by rattling this one off in casual conversation, momma. You deserve it.
Whether you’re a newly pregnant momma-to-be or a seasoned veteran of the birthing process, there are bound to be things out there you just didn’t know. There are things you didn’t KNOW you didn’t know. There are even things you didn’t know you NEEDED to know.
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**As always, and with any of these recommendations, you can always try to diagnose and solve for it at home, but the very best advice is always ALWAYS what you can get from a medical professional under clinical circumstances. **
We have all heard of baby positioning. They always shout on the movies about a baby going breech or portraying other perfectly normal medical conditions as these sudden and critical medical emergencies, for which the staff seem ill-prepared to combat.
Didn’t we all take a biology class? Wasn’t there something about posteriors and anteriors? Didn’t someone make a joke about your teacher’s posterior?
Well, ok. Maybe not everyone had the same high school experience that I did.
Regardless, momma, let’s talk occiputs and posteriors and #allthethings you NEED to know, even if you didn’t know yet.
What is occiput posterior?
The literal terms used here are occiput, meaning (generally) the back of the head or skull. You know, that occipital lobe thinger they talked about in human bio? It’s the part of the brain that is at the BACK.
So, good! we can assume that the occiput in “occiput posterior” means the back of the skull. Probably the baby’s skull, since you haven’t ever found much need for a medical term to refer to the back of your own head.
And then there’s posterior: posterior refers to the back end of something. The back half, if that something were to be divided symmetrically down the front-to-back axis.
Some crazy words there, so let’s get a little more visceral.
Let’s imagine you are standing with your side to the screen. Suddenly a laser shoots out and splits you from head to ankle, separating your front half and your back half.
Graphic, I know. Let’s say they split you metaphorically so it isn’t so gross.
Your front half is an anterior. Anything that is “anterior” to your personage means located toward the front half, ahead of that line we drew with our little metaphorical laser.
So let’s put them together.
Occiput: the back of the baby’s head.
Posterior: located generally at or toward the back half of your body.
Plain and simple: The back of baby’s head is pointed toward the BACK END of your body.
Put more specifically (or at least officially), the baby is lying–or presenting–headfirst (or upside down) inside your body, and is facing out toward your tummy instead of backward at your lower spine.
Note: the opposite, it follows, would be the occiput anterior position, which is headfirst and facing backward, toward your spine. This is the most common and typically considered the safest way to birth a baby.
Some confusion I see a lot is that mommas are looking for a different answer when trying to define the persistent occiput posterior position definition. People think that persistent means again and again–presumably over multiple pregnancies.
The truth is that this is simply describing occiput posterior positioning that LASTS. Babies can often get themselves swirled around into this position throughout pregnancy. If discovered early during labor, the little one tends to resolve their position before or early in the second phase of labor.
The term persistent in this case simply refers to the fact that the baby persists in being positioned in occiput posterior all the way down the tube.
At least you know your little one is persistent, if this is you. Right? See what I did there?
Occiput posterior delivery
Labor is still possible and potentially 100% safe with a baby in occiput posterior positioning.
It DOES mean that your little one will have a harder time getting through your pelvis.
Through the first few stages of pregnancy, you may be able to move around or use different initial birthing positions to encourage the little rascal to roll over.
When in doubt, the doctor should have a few tricks up her sleeve. Forceps might help her shimmy the little on into a barrel roll or help the doc pull her out. Otherwise, there’s always THE VACUUM.
That sounded kind of funny, but I mean it. There’s a vacuum device that doctors can use to literally suck your baby out.
Obviously it’s a little more gentle (and probably more complicated) than that sounds, but knowing it is an option might help you appropriately plan your birth in the case of a persistent occiput posterior position.
Be sure not to let this one freak you out, especially outside of the labor and delivery unit. It’s actually pretty rare for baby to stay occiput posterior for long.
Proof for the pudding? In a study of more than 6000 women in 2003, doctors identified that only about 5.5% of the studied population gave natural (spontaneous) birth in occiput posterior position.
This was a little higher for first-time mommas at around 7%, and a little lower for ladies with previous kiddoes, sitting at around 4%.
Occiput posterior position risk factors
Regardless of how many options we have these days, it has to be said that occiput posterior position ABSOLUTELY DOES come with more potential complications. Don’t let anyone try to convince you otherwise.
According to the National Institutes of Health, around 18% of all c-sections are listed with occiput posterior position as the cause. That’s a fair chunk of cesarian operations, to be sure.
But the important thing is that C-section IS an option. Before that, occiput positioning was much more risky. Thanks to modern science, you don’t have to go through this without a potential alternative.
Occiput posterior position interventions
This would be a great question to ask your provider at one of your checkups. Ask what position they prefer to deliver in, and why. Ask them what they prefer to do with an occiput posterior delivery.
The key points you’re looking for here are a few of the facts, but most importantly, the PROCESS. You need to know upfront if your doctor leans heavily toward C-section in lieu of the complications that MAY arise with a position like occiput posterior.
Occiput posterior is the most common malposition that can occur in labor and delivery, also per the Institutes of Health: like we said before, you’re sitting at about a 7% chance, maximum. It’s more likely than a breech or other positioning complications.
If I had a 7 in 100 chance of winning the lottery, I would probably play a lot more often. 7 out of every 100 powerballs and I’m guaranteed to win? Count me in, momma.
Because of that, let’s be prepared with some good instructions in your birth plan, and make sure the right crew is running the ship around you. Not that you’re a boat, per se. You know what I mean.
Here are a few of the things you can watch for to really identify whether or not your provider is prepared to deal with occiput posterior positioning (thanks to this article from Penny Simkin, PT). These are the historical and more modern beliefs about occiput posterior positioning, from the medical side of this.
Common but unresearched prevailing concepts regarding occiput posterior positioning:
- Prenatal maneuvers can be used to rotate the occiput posterior fetus to an anterior (REAR-facing) position–a good provider knows this but recognizes that it will not always be possible if caught too late in the pregnancy… otherwise, we’d always just do this…
- Your providers can detect occiput posterior positioning prenatally–unfortunately, it isn’t necessarily common practice to use the sort of imaging technology that makes this a done deal.
- It’s generally believed that once childbirth begins, a fetus will not move from occiput anterior (the safe way) once they’re in it–likely because of the shape your body takes as they get squished toward the exit. Unfortunately not a silver bullet–just not enough research to back it up, honey. Sorry.
- Back pain in labor is a reliable sign that your baby is in occiput posterior–that seems like a nice thing to think. Suddenly all that back pain you’ve been having since what seems like forever is literally only to be caused by one thing.
- Your nurse can use a digital vaginal exam (with fingers) to tell if the baby is in occiput posterior position–I imagine this one’s on the fence. If you are far enough along, sure, you can probably start feeling for features.
- The epidural analgesia (local nerve deadener) facilitates rotation--basically, because you don’t feel anything, the baby feels the need to turn over. Seems legit? Ish?
Less commonly used but very well-researched prevailing concepts that may indicate a more modern approach:
- An ultrasound scan is a reliable way to detect fetal positioning–it’s served you well throughout pregnancy; it’s hard to say why more L&D units don’t do this as a primary and standard part of the process.
- Different maternal positions (labor positions for mommy) CAN facilitate rotation of the occiput posterior to the anterior–if you paired different positions with the ultrasound, it would be a small matter of time and patience before baby will naturally just flop over. Like a little fishy.
- Manual rotation of the fetal head from occiput anterior improves the chances that your baby will flop over on the way out–this would certainly limiting many of the complications that can result.
So, it seems to stand to reason that the latter points are more likely to be a good gauge of your provider’s practices.
Regardless, they are seasoned experts, so be sure you’re acknowledging that you aren’t the expert (even if you think you actually are) and that you’ll defer to their wishes during childbirth (as far as you feel comfortable doing so).
Speaking of seasoned experts, though, if you’re at that point where you really do want more information about labor, I just happen to have the perfect solution.
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Sunnyside up babies
Just for fun, I thought I’d throw this little tidbit in.
I find it very charming to imagine your little one in terms of how an egg is cooked. There are literally providers out there who will refer to the occiput posterior position as “sunny side up”.
Doesn’t take a genius to figure out why. But it does poignantly bring home the importance of being willing and prepared to do a C-section if it becomes necessary. You don’t want your baby to be “hit in the head” instead of “sunnyside up”, after all.
There are lots of baby born face up superstitions and myths. For the sake of time, maybe we’ll examine that a little later…
Occiput Posterior in review
So at this point, you should now have a firm grasp on what it means for that little one to be upside down and aiming the wrong direction.
Occiput posterior positioning can be a significant source of complication, so be sure to ask your provider questions WELL in advance of the L&D unit.
If you ultimately have to make choices regarding some of the risks or potential consequences of having an occiput posterior baby, hopefully you will be fully prepared for the season that this little munchkin will be coming home.
Occiput posterior positioning can be scary, but if you have all the knowledge, you’ll come through this swinging.
Happy Baby Birthing, momma.