By Misha Safranski
With the cesarean rate now over 30% and climbing in the United States, many of those unnecessary according to the World Heath Organization, it is vital for women to be informed about ways to reduce their risk of cesarean section as well as difficult and/or instrumental vaginal delivery. There are many aspects to this complex issue, one of the major ones being the position of baby at delivery.
When a mother is delivered by cesarean, often it is blamed on "CPD" - cephalopelvic disproportion or dystocia. What is more often the case is that the baby is misaligned in a number of possible ways; asynclitic - baby's head is tilted slightly to one side, posterior - the baby is facing forward in the womb with his/her back to the mother's spine, occipital transverse - baby facing to the side while trying to enter the pelvis, and rarely face-presentation - baby's head is flexed with the face pointing down toward the vaginal opening.
Obstetricians have lost the art of palpation, which allows the care provider to assess the baby's position during late pregnancy and labor. Mothers can, and should, learn to do this themselves by studying books like Optimal Foetal Positioning by Jean Sutton and Pauline Scott, and websites such as Spinningbabies.
This will help the mother identify a malposition and attempt to correct it by specific positioning exercises. Chiropractic care can also be very useful, both for malpositioning and general pregnancy aches. If you seek out chiropractic care, try to find a practitioner who knows how to perform the Webster Technique - a maneuver that can help open the pelvis so that the baby can align properly. A Webster chiropractor can be found by searching the ICPA website.
There are also steps a mother can take to prevent a well-positioned baby from getting into a bad position during labor, or to maximize baby's chances of turning if she or he is still badly positioned when labor starts.
Avoid epidural anesthesia. Being flat on the back encourages a baby to stay, or turn, posterior, as well as keeps mom's pelvis in a restricted position which doesn't allow it to open as fully as possible. It also numbs the mother's sensations which can prevent her from being able to tell if she needs to adjust her own position to help baby along.
Stay mobile. Mobility allows mom to do things such as lunges, knee-chest, hands and knees and squatting, all of which can assist in getting a baby well aligned.
Do not allow AROM (artificial rupture of membranes). This is perhaps the most important thing a mother can do. AROM robs the baby of the cushion of water, which can be a great help in allowing baby to get into position for birth. If baby is already malpositioned, AROM can jam him or her into the pelvis in a way that prevents any further adjustment. AROM is not necessary; research shows it does not significantly shorten the length of labor and in fact increases the risk of cesarean delivery. AROM also puts mom on the clock, most hospitals "require" that she deliver within 24 hrs. due to the perceived risk of infection (which is raised, for the most part, because of excessive vaginal exams).
Knowledge is power. Most obstetricians and even some midwives do not tell mothers about the importance of baby's position in the womb. Be informed, and you will greatly increase your chance for a safe, satisfying birth experience.
References: Amniotomy for shortening spontaneous labour. Obstet Gynecol. 2008 Jan;111(1):204-5.
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