A Labor and Delivery Nurse’s Guide to Occiput Posterior Positioning and Your Birth

Let’s face it, mama. When you see the words “occiput posterior“, your brain goes a little numb. Am I right?

First things first: if you ever have to say it out loud, it sounds like OX-uh-puht pah-STEER-EE-uhr. Prepare to amaze both your doctors and your friends by rattling this one off in casual conversation, mama. You deserve it.

What is occiput posterior?

In short, it’s when baby is head down, but facing out towards your belly. You may have heard it called “sunnyside up”. This is NOT considered optimal positioning for birth. Ideally, you want baby head down and looking at your spine.

But, as you can imagine, there’s a little more to it than that. So read on, mama. We’ll learn all about occiput posterior positioning, optimal positioning for birth, and what you can do to try to turn baby!

Get more support from the @mommy.labornurse Instagram community! Join over 530k mamas for tips and solidarity on all things pregnancy, birth, and postpartum!

**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. **

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.

Occiput Posterior Positioning

Occiput posterior plain and simple

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.

What is persistent occiput posterior position?

Some confusion I see a lot is that mamas 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.

Really, persistent occiput posterior position just means occiput posterior positioning that LASTS. Babies can often get themselves swirled around into this position throughout pregnancy.

Even if this positioning is noticed early during labor, babies often resolve their position as labor progresses.

The term persistent in this case simply refers to the fact that the baby persists in being positioned in occiput posterior throughout the entire birthing process.

Occiput posterior delivery

Labor is still possible and potentially 100% safe with a baby in occiput posterior positioning. Even if this isn’t considered “optimal” positioning.

It DOES mean that your little one will have a harder time getting through your pelvis.

During the begin and early parts of labor, you may be able to move around or use different initial birthing positions to encourage the little rascal to roll over on their own – and many do!

Forceps and vacuum extraction to help guide an OP baby out

When in doubt, the doctor should have a few tricks up her sleeve. Forceps might help her shimmy the little one 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.

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How common is persistent occiput posterior positioning?

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 mamas at around 7%, and a little lower for ladies with previous kiddoes, sitting at around 4%.

Related: How To Have a Natural Birth? 25 Tips From A Labor Nurse!
Related: Scared Of Giving Birth For The First Time? The Top 6 Labor Fears Answered

Occiput Posterior Positioning

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.

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.

This is why it’s a good idea for ALL mamas to learn about the C-section process, even if it’s not the birth you’re expecting. You never know how things might end up for you.

Occiput posterior position interventions

It’s a good idea to ask your provider how they handle occiput posterior positioning at one of your prenatal visits.

The key points you’re looking for here are a few of the facts, but most importantly, the PROCESS. If baby is presenting OP early in labor does your provider:

  • Lean more heavily towards C-section to avoid ANY of the risks associated with delivering a sunny side up baby
  • Lean more heavily towards a wait and see approach to see if baby will turn on their own, accepting that forceps or vacuum extraction may be necessary

Thinking about occiput posterior in your birth plan

Occiput posterior is the most common malposition that can occur in labor and delivery, and it’s only a 7% chance at that. It’s more likely than a breech or other positioning complication.

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, mama.

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.

belly mapping during pregnancy

Myths and Thoughts about OP that don’t totally hold up (or aren’t well researched)

  • 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. This is called an external cephalic version which I shared about over on Instagram!
  • Your providers can detect occiput posterior positioning prenatally–maybe! Many women do not get late third trimester ultrasounds, but external belly mapping can totally help you figure this out
  • It’s generally believed that once childbirth begins, a fetus will not move from occiput anterior (ideal positioning) once they’re in it–this is usually true, but rotating out of this position is not impossible, so keep that in mind!
  • Back pain in labor is a reliable sign that your baby is in occiput posterior–back labor can indicate a sunnyside up baby, but it can also happen in ideal positioning.. It can’t be counted on 100%, but if you have back labor it can give your provider a clue that occiput posterior might be in play
  • Your nurse can use a digital vaginal exam (with fingers) to tell if the baby is in occiput posterior position–If you are far enough along, sure, you can probably start feeling for features, but it’d be pretty late in the birth game

(source)

Well-researched approaches to OP

  • 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 when you arrive at the hospital in labor.
  • 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 limit many of the complications that can result.

Related: Postoperative Care After Your Cesarean Section
Related: A Labor and Delivery Nurse’s Birth Story!

Childbirth education can make a difference

tips to prepare for labor infographic

As you are probably realizing, there are so many fluid and dynamic aspects of birth. Even if you think you know the general flow of things, there are just so many unknowns.

Unknowns you may not have even known you needed to know about!

This is why I’m such a huge advocate of childbirth education. In a good birth course you’ll learn more details about things like occiput posterior positioning, this way you’re not caught off guard if it does happen to you.

You’ll be made aware of possible complications or ways that things could progress so that you can ASK about them ahead of time and plan for them mentally.

It’s why I created an affordable, online birth course. Because I want mamas to go into birth with more knowledge, confidence and empowerment. And knowledge is power y’all.

In my course you’ll learn about a typical labor and birth progression, but also what to expect if things don’t progress so typically. You’ll learn about belly mapping, and labor positions to get that baby turning and moving down into the optimal position for your vaginal birth.

Go check it out! It’s going to make all the difference. And I want that for you.

OP 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.

Occiput posterior positioning can be scary, but if you have all the knowledge, you’ll come through this swinging.

Happy Baby Birthing, mama.

Related: Scared Of Giving Birth For The First Time? The Top 6 Labor Fears Answered

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Liesel Teen, BSN-RN
Founder, Mommy Labor Nurse

Meet Liesel Teen

Hi there. I’m Liesel!

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

When you know what to expect and have the tools to navigate the experience, you’ll feel confident and in control.

I believe you deserve a better birth — no matter how you deliver.