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What does it mean for a baby to be in the posterior position?
A baby that is head-down but facing your abdomen is said to be in the posterior position. A small percentage of babies end up in this position at birth. If your baby is in the posterior position, you may be in for a more complicated delivery.
The technical term is occiput posterior (OP) position. This term refers to the fact that the back of your baby's skull (the occipital bone) is in the back (or posterior) of your pelvis. You may also hear this position referred to as "face-up" or "sunny-side up."
How common is it for a baby to be in posterior position?
It depends on how close you are to delivery. While as many as 34 percent of babies are posterior when labor starts, only 5 to 8 percent of them are posterior at birth.
It's common for a baby's position to change during labor, often more than once. Most babies rotate on their own to the face-down position before birth.
How will I know if my baby is in posterior position?
Your caregiver will probably be able to tell by doing a manual exam in the second stage of labor (when the cervix is completely dilated). An ultrasound can be done to confirm the position. (Some providers use ultrasound routinely to determine the position of baby's head.)
If my baby is posterior, does that mean I'll have back labor?
No. Back labor – the intense lower back pain that many women feel during labor – was long thought to be more likely when the baby is facing up. But research using ultrasound (much more accurate than a clinical exam, especially in the first stage of labor) suggests that this assumption is probably wrong. Researchers have found that women whose babies are face up are no more likely to suffer back labor or more intense pain than those whose babies are facing down or sideways.
If my baby is posterior at birth, how will it affect my delivery?
Mothers whose babies are face-up at birth:
- Tend to push longer.
- More commonly need Pitocin to stimulate contractions.
- Have a significantly higher risk of having an assisted vaginal delivery or c-section.
- Are more likely to have an episiotomy and severe perineal tears than moms whose babies are in the more favorable face-down position, even after taking into account the higher rate of forceps and vacuum-assisted delivery.
- Have a greater risk of postpartum hemorrhage.
Some practitioners may attempt to turn a posterior baby by manual rotation. Once you're fully dilated, the practitioner reaches into your vagina, puts his hand or fingers on your baby's head, and tries to rotate it. (Sometimes this is done while using ultrasound.)
It may take a few contractions to get the baby into a face-down position and it doesn't always work. Still, manual rotation has been shown to reduce the need for cesarean section and severe perineal tears.
How will delivering in a posterior position affect my baby?
The posterior position at birth is associated with a higher risk of short-term complications for the baby, such as lower five-minute Apgar scores, a greater likelihood of needing to be admitted to the neonatal intensive care unit (NICU), and a longer hospital stay.
Risk factors for posterior position
You're more likely to have a baby in the OP position at delivery if:
- This is your first baby.
- You're 35 years of age or older.
- You're obese.
- You're African-American.
- You've had a previous OP delivery.
- You have a small pelvic outlet.
- You're 41 weeks or more.
- Your baby weighs 4,000 grams (8 pounds 13 ounces) or more.
- Your placenta is attached to the front of your uterus (anterior placenta).
There's some debate over whether epidural anesthesia is a risk factor. Many studies (but not all) show a link between having an epidural during labor and having a baby who is posterior at birth. Some research suggests that it's because the epidural relaxes mom's pelvic muscles, which in turn keeps the baby from rotating out of the OP position.
Some argue that having a posterior baby (and often a longer and possibly more painful labor) makes it more likely for a woman to request an epidural. But there are studies that refute this idea, concluding that women who request epidurals (and those who don't) have a similar proportion of babies in OP position during labor.
Is there anything I can do to make it less likely that my baby will be in the posterior position?
Probably not. You may have heard that being on your hands and knees during late pregnancy or labor helps rotate your baby face-down, but current research suggests that being on all fours won't reduce the likelihood that your baby will be in the posterior position at birth.
That said, if your back aches, you may want to give this position a try anyway. Research shows that being on your hands and knees during labor may offer some relief from back pain.