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
