Dear Jo and all,
I find the whole idea about optimal fetal positioning an
interseting one. I have attended in the past, a session with Jean Sutton
discussing it and found it very interesting and indeed sometimes use the
positions she suggests to suggest to women in labour. The interesting and
amazing thing about midwifery practice is that it is the women who teach you so
much. So many women I have been with in labour will adopt these positions
themselves ie put one foot up and rock into the side the baby needs to rotate
into, sit on the loo, rock etc as long as they are given the space to do it.
They do what their body's tell them to do.
I understand Jo the logic of wanting to know or be told about
this but I fear that we are turning another part of normal childbirth into an
abnormality and if not careful in years to come these women will not be allowed
to birth with midwives as they are high risk (I know I sound paranoid but I am
sure if midwives or hundreds of years ago were now told that breech and twins
were considered high risk they would laugh at us). So many women now come into
the antenatal clinic and look worriedly at you as you palpate there tummies and
ask if the baby is in the right position. Some of these women are only 28 weeks.
I have looked after women in labour with OP babies and thought that this will be
a long hard labour and the next minute the woman wants to push. And conversly
the baby who is the "perfcet position" what ever that is has a baby that takes
forever or comes out face to pubes and you wonder how that
happened.
In the last MIDIRS there is and article titled "Malpositions
and malpresentations of the occiput: current research and practice tips" that
discusses the research around this. It states that a "Gardberg and
colleagues research into op found that 68% of babies presenting as persistant op
at birth had developed from a malrotation during labour from an initial oa
position. Only 32% of persistant op cases were op at the start of labour". This
confirmed for me some of the things I have experienced. I just fear that we are
putting fear into women antenatally and blaming them and/or their babies when
perhaps this is not true. It is like when someone says to a woman antenatally
that her baby is too big to fit through. It is more difficult to work with that
woman when she is having a long labour as she doesn't trust her
body.
My sister (the one I sent that champagne charged email about
in December) started her labour in op. She niggled and contracted at home for 3
days and when she finally came to the BC in established labour she was 3 cms at
3am and gave birth to her boy at 0930am. Now I would have thought with the start
she had not to expect a baby at best till the afternoon. So I think this is
another example that we just have to trust the process and inspire in women the
confidence to birth their babies.
We can only learn from women if we give them the space to do
their best work. THis can only happen within midwifery models of care. Working
with women having an OP labour usually means a slow start and getting them
through that is the key but you only see that when you work in a midwifery
model. Keeping those women at home until the active part of labout starts is
vital and then supporting them with encouragement, privacy and time. The more
you care for women the more you learn about the amazing things they do and it is
this experience that helps you with the next birth and also gives you the
stories to relay to women when they are concerned.
Sorry this is so long
Jackie
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- RE: [ozmidwifery] OP labours (long) Jackie Kitschke
- RE: [ozmidwifery] OP labours (long) Vicki Chan
- RE: [ozmidwifery] OP labours (long) Malavisi, Pete
- [ozmidwifery] Pete Malavasi Vicki Chan