Tag Archives: Malposition

Malpositioned babies


Imagine planning and practicing for your gentle birth, and being told your baby is breech.  Such a thing happens to 3 to 4 percent of all pregnant women in the United States every year.  While most hospitals consider a breech baby an immediate surgical birth, there are ways to help turn a baby, through natural and non-invasive ways.

The same is true for many other positions the baby may assume before birth.  As pregnancy progresses, between 32 and 37 weeks, babies naturally turn head down in the uterus, into the vertex position.  Vertex position is the ideal way for a baby to be born, and more specifically, with the baby facing his/her mother’s back (anterior position, with his/her occiput (back of head) facing the front of mother’s body).  Sometimes, however, babies do not make this turn that nature intended, and malpositioning occurs.  The term malpositioned refers to a baby that is not in vertex anterior position (head down, occiput facing forward).

The most widely heard of malposition is breech, which means the baby presents butt first.   There are four types of breech presentation, to include:  complete breech,  footling breech, knee breech, and frank breech.  Complete breech occurs when a baby is sitting cross-legged, presenting butt first, footling breech is similar to complete breech, but one or both feet present, knee breech is similar to footling breech, but a knee instead of the foot or feet present first (knee breech is the rarest form of breech presentation), and finally, frank breech is a position in which the baby’s feet are near his/her face, and his/her legs are straight, with his/her butt presenting first.  I am sure that many people think that breech presentation occurs often, but breech only accounts for 3 to 4 percent of all births.

Malpositioning of the baby also includes OP (Occiput Posterior) or “Sunny Side Up”, this means the baby’s occiput is facing the back of the mother.  Such a position may cause tremendous discomfort, exhaustion, and cause difficulty with relaxation for a gentle birth.  (Sydney was OP, and her birth story follows.)  Another sort of malposition is transverse, which means the baby is lying horizontally or semi-horizontally with no particular body part presenting for birth.  Asynclitic position is another malposition, in which the baby’s head is tilted.  This may cause the cervix to not open evenly, and may make birthing more difficult.

While all of the causes of malpositioning may not be known, some of the causes may include:

  • Stress or Fear
  • Upsetting situation
  • Tense uterus
  • Poor posture

It is important to know, however, that if your baby is breech, there are things that can be done to help turn the baby, without resorting to pain causing medical procedures.  Here are some things you can do to help your baby turn:

  • Breech turn script with HypnoBirthing Childbirth Educator
  • Webster Method (Chiropractor)
  • Seek help from a doula, who can help with exercises to help turn baby
  • Acupuncture
  • Acupressure
  • Pelvic tilts
  • Positive attitude, coupled with visualizing baby head down
  • Shining flashlight toward vagina while playing music at vagina

It is so important to remember that nature, your baby, and your body do not make mistakes, and if your baby does not turn, keep a positive attitude.  You may still have a gentle birth, because your mind dictates how your body will follow through.  If you only allow positive words and actions to happen, your body will follow suit, and you will have a gentle birth, as one of my HypnoBirthing Moms did.  I taught Ashley and Dan in the fall of 2009, with the anticipated birth in March of 2010.  They were really the model couple for HypnoBirthing, and I held every confidence they would approach their birth with such positivity, I had no idea exactly how much.  I am still amazed and overjoyed at their journey, though it did not go as they would have planned.  Here is Ashley’s story:

“When I first found out that Ava was breech I was crushed to say the least because of the road that I knew this was going to take us down. My doctor told us when we were about 34 weeks along and generally you’re told that babies have a significantly smaller chance of flipping after 32 weeks. I was told that having a vaginal birth was basically out of the question but that we could consider doing an external version or just plan to have a c-section. Both of the options they gave me were out the question in my mind at the time and in my opinion I felt even worse about having an external version than a c-section.

Having taken Hypnobirthing classes early on in our pregnancy and practicing Hypnobirthing during the months leading up to this it felt like everything was being turned on its head and there wasn’t much I could do about it at this point. I felt very helpless, sad and guilty (for being so upset about the situation despite that we still had a perfectly healthy baby girl) in the beginning. After a couple of days though the line from the Hypnobirthing CD about meeting any problems that may arise during the pregnancy or birth with calm and confidence started running through my head. The CD also mentions being an educated parent and making informed decisions, these thoughts also started running through my head. I knew that I was fully capable of giving birth naturally but now it came down to making the best choices I could with the opportunities and information  that I had in front of me. At this point I figured I had a few options 1.) Be upset and worried about the whole thing, 2.) Accept the situation and move on, 3.) Accept the situation at the moment but try my best to provide an environment for Ava to flip if that’s what she wanted to do.

I chose option #3 and I am so glad that I did. I educated myself on ways to help a breech baby to flip without using any force at all. I tried many different positions, headstands, I had a chiropractor perform the Webster Maneuver 4 times and tried to maintain as much of a relaxed frame of mind as I could. All of this was going on while my husband was deployed to Haiti which made everything a lot more difficult but praying a lot, having faith in God’s plan for our family and staying relaxed using my HypnoBirthing CDs helped me to maintain a positive attitude during this stressful time. After trying many different things to help Ava flip we were told at 39 weeks that she was still in the breech position which I was actually pretty surprised about but my husband and I were able to take the news very well because we knew that we had done everything that we felt comfortable with doing to help her flip.

If she hadn’t flipped at this point we felt pretty confident that she would not flip at all and we were ready to look into the other options. Since the 39 week appointment was my last appointment before Ava’s due date we needed to move things along quickly. Generally at this hospital breech c-sections are scheduled sometime between 38 and 39 weeks, rarely do they schedule them for 40 weeks or later. Ever since we found out Ava was breech I thought that as long as I could give Ava the longest amount of time possible to flip on her own that I would feel much better about any decisions regarding c-sections that we would have to make. I was very hopeful that we would be able to push any possible c-section out to her due date. Thankfully since I had declined scheduling the c-section at my 34 week appointment as they had wanted me to we were able to have the c-section scheduled exactly on her due date (March 5th) due to a full c-section schedule during my 39th week. I felt at ease with having a c-section in the end knowing that Ava had had a full 40 weeks in utero and we had tried as many things as we could to increase our chances of being able to have a natural birth. I am very happy with how the c-section went. Of course I would have loved to have had a natural birth but it was not in the cards for us given where we were giving birth, how far we wanted to push the medical boundaries and Ava seemed to be quite happy in the position she was in. I was alert throughout the entire procedure and I have very good memories from the day Ava was born.

I was able to begin breastfeeding her about an hour after the procedure which helped a lot with bonding and making up for the things we were unable to do due to the c-section. Her Dad was able to see and touch her right when she came out. He then was able to bring her over so I could meet her a few minutes later. We had a great moment there right in the operating room where the 3 of us were finally together as a family. At that moment when I finally knew that she was going to be ok, that Dan and I were ok and that we were all together everything came into perspective and I realized that nothing is more important than that. No matter how Ava was going to come into this world it was going to be an amazing moment and it was… one that I’ll never forget.

Here are some ideas that helped me during this experience:

1.) Do your own research and use the information you find to help make your experience what you would like it to be

2.) Be open minded

3.) Stay positive… either way the outcome is going to be great

4.) When the big plans fall through, set small achievable goals that you’ll feel good about reaching (mine were to try different exercises each day to encourage Ava to flip and to make it to her due date)

5.) Come to terms with what is happening… denying it is only going to work for so long

6.) You don’t always need to settle with what you’re told and it’s ok to say no.

I look forward to trying to have a natural birth in the future and seeing what my body is capable of… but for now I’m going to go enjoy my healthy, happy breech baby!”

Attitude is everything, and HypnoBirthing was able to help Ashley, Dan and Ava tremendously.  They clearly wanted to achieve a gentle birth they knew their daughter deserved, and they worked toward it with goals that were reachable.  I can honestly say that I have seen many babies in my life, and few are as peaceful and calm as Ava.

As mentioned above, OP (occipital posterior) is another form of malposition.  This occurs when the back of the baby’s head is facing the mother’s back.  As we prepared for our HypnoBirth with Sydney, I grew more and more excited as her birthing day drew nearer.  Here is the story of Sydney’s birth:

I went into labor on July 16, 2007 at about 5:30 pm.  My husband was at work, and my mother in law was with me.  I timed my surges to establish the baseline, which at that time was 20 minutes apart.  When I felt changes, I paid attention, but for the most part, I relaxed.  I felt fine, relaxed, ready, excited.  We hung around the house, I ate, took a bath, and my husband arrived home from work.  I was upstairs in the bathtub resting, and his mother had told him I was upstairs in labor, with surges 10 minutes apart.  When he entered the bathroom, I informed him they were 3 minutes apart, and it would be time to go to the hospital soon.  Needless to say, he was shocked.

We arrived at the hospital at about 10:30, and I was given the choice of walking or being wheeled to the room.  I chose to walk.  The nurse started me on a blood pressure cuff, intermittent fetal heartrate monitors, and asked me for the birth plan.  I cheerfully handed it to her, and she exited to read it, then returned with questions.  I continued to labor comfortably, and was not asked about pain or discomfort (per my birth preferences), and was only asked how they could help me to be more comfortable.

As my labor progressed, my body continued to clean out, and I was free to move around.  I walked, sat on the toilet, sat on my birthing ball, rested in bed, and kept moving.  My labor was becoming progressively more tiring, and I was experiencing a lot of pressure in my back, and at hour 17 of having minimal intervention (no IV, only intermittent fetal heart rate monitoring, and blood pressure readings), I whispered I needed help.  Everyone in the room heard me, but further relaxation was encouraged, and I followed suit.

At hour 20, I had reached a point of physical and emotional exhaustion, and felt as if I could not continue with my labor as it was.  At this same time, I was informed that my baby was OP, and Nicole, my HypnoBirthing Childbirth Educator (she is also a chiropractor) encouraged me to assume polar bear pose to help baby to drop out of my pelvis so she could rotate.  I did this, and was impatient and exhausted, so at 10 cm opened, I chose to have an epidural.

It is useful to know that about 70% of all OP babies are born via cesarean section.  4 hours after getting the epidural, with a lot of forced pushing (which HypnoBirthing does not advocate for, but I had no choice, she was wedged), inspiration from looking in a mirror at my baby emerging, and just pure adrenaline and determination, Sydney Ava was born.  The lights were dimmed for her entrance into the world, and she was placed directly on my stomach for skin-to-skin bonding.

She remained with us for an hour or so, before they completed any assessments in which she had to be taken from us.  Considering the circumstances of Sydney’s birth, and knowing I had prepared myself for her birth, I am extremely proud of the lengths I went to to get her here, vaginally.

It is so important during pregnancy to care for your body and your baby.  It is important to eat well, exercise, and prepare mentally and physically for the birth you’d like to have.  As much as I prepared for our birth, I still needed assistance during my labor to reposition Sydney.  I later found out about the use of a rebozo for repositioning a baby in utero, during or before labor.  A rebozo is a large cloth that is used to gently reposition the baby.  These following links include pictures and video of different techniques that can be used.

Rebozo Video

Rebozo Technique in pictures

Rebozo explanation

Malpositioning happens.  And when it does, alternatives to medicine are viable and often useful options to consider.  Remember to always ask questions, if something doesn’t sit well with you, or fit in with your values or what you think is best for your baby, a wealth of information exists that may back you up.  Research what you want, and prepare yourself for any turn your birthing may take.  In the mean time, Happy Birthing.

As always, comments welcome.

*Special Thanks to Ashley, Dan, and Ava for sharing your inspiring birth story!  I love you all!