Saturday, February 16, 2008

Posterior Ponderings

My second baby came into this world upside down, or "sunny side up" as some people say. She was posterior (facing my front side) rather than the normal anterior position (facing my back). Her posteriority (I think I just invented a word!) brought with it some surprises. I had fully expected my second birth to happen very quickly. My sister's labors were each roughly half as long as the previous. My first daughter's birth lasted less than six hours, so I was expecting my second to come in less than three! I suspected she might be posterior, however, when that supposed-to-be-fast labor turned into an on-again-off-again roughly 28-hour labor.

Fortunately, for me and my baby, the planets aligned to make our birth experience smooth and uncomplicated. My labor started and stopped every few hours, eventually kicking into full gear after about 26 hours. I arrived at the hospital nearly 6 centimeters dilated and delivered my baby about two hours later. There was no need for forceps or vacuum to get her out, I pushed for less than 20 minutes (it wasn't until then that my midwife said the p-word and confirmed my suspicions about my baby's position), and I suffered only a minor tear. My recovery was terrific compared to my previous birth. My first baby was not born posterior, but I suffered extensive tearing followed by a very painful recovery. Ultimately, I succeeded in having a very satisfying unmedicated labor and delivery despite having a posterior baby.

I feel fortunate, because, for many women, a posterior position is a recipe for disaster. A 2005 article, "Digital/manual rotation reduces need for C-section," in OB/GYN News explains: "Previous epidemiologic studies have estimated the prevalence of the occipitoposterior position to be about 5%. Among such pregnancies, there is a high incidence of cesarean section, instrumental delivery, third- and fourth-degree perineal tear, postpartum hemorrhage, and puerperal infection" (source).

I shudder to think what my experience could have been like. If I had gone to the hospital earlier when my labor was periodically stalling, it is likely I would have been given Pitocin. The contractions produced by the Pitocin would likely have been too painful for me to handle without medication, so I would have likely asked for an epidural. Epidurals make the pushing stage more challenging for many mothers, particularly those with posterior babies, so it's highly likely I would have ended up with an instrumental or cesarean delivery. I feel so fortunate to have evaded those outcomes!

I will be forever grateful that I trusted my baby and my body enough to wait things out and let labor kick into full gear on its own. I spent most of my labor upright, moving, walking, rocking my pelvis, getting on my hands and knees--outdoors and in my own and family members' homes until the last couple of hours. Sometimes these measures will help a baby to turn. Sometimes babies just stay put. And that's okay. Don't let the "p-word" scare you. Having a posterior baby doesn't have to mean a horrible birth experience. For me it was smooth and satisfying. I believe it can be smooth and satisfying for most women when labor is allowed to progress without interference.

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