Occiput posterior position is when a baby is in vertex position (head-down) with their head facing to the front side of the mother in the womb. Babies can also be in various positions, such as head up, down, or facing back. Although it is safe to deliver vaginally in the occiput posterior position, it can be harder for babies to pass through the birth canal. In addition, some babies may turn to other positions before delivery. Read on to learn more about the occiput posterior position, causes, and what complications may arise during labor.
What Does Occiput Posterior Position Mean?
A head-down position of the baby facing your abdomen (and not the back) is called an occiput posterior (OP) position. The vertex presentation wherein the occiput (back of the baby’s head) is anteriorly (to the front) positioned is called occiput anterior and is considered the optimal position for birthing (1). There are two OP positions: Right occiput posterior: ROP has the baby’s back facing towards the right side of the mother and the back of the head facing towards the mother’s back.
Left occiput posterior: LOP has the baby’s back facing the left side of the mother and back of the head towards the mother’s back (1).
The baby could also be in a straight OP position:
OP occurs due to certain physical and lifestyle reasons.
Can An OP Position Affect Labor?
Here is what could happen in the case of posterior labor:
Most babies, who are in the occiput posterior position before labor, tend to rotate to the occiput anterior (OA) position after the labor sets in.
Some posterior babies may get delivered without any slowdown in labor, while some may take time but require no obstetric interventions.
When the posterior baby might not turn, or the possibility of vaginal delivery is low, then the mother may have to undergo a C-section.
Deliveries with babies in the OP position usually need assisted methods such as a C-section or use of vacuum and forceps.
In some cases, the babies may not turn and could make the labor difficult (2).
What Could Be The Complications Of A Posterior Labor?
Here are the possible complications for the mother and the baby in the case of posterior labor (3) (4):
Possible risk of postpartum hemorrhage (more than 500ml of blood loss), and infections
Delivery done using forceps and vacuum may cause third and fourth-degree perineal tears
A longer lasting pre-labor (first and second stage), with a backache
Needs frequent induction to start the labor, and its failure may necessitate a C section.
Chorioamnionitis, also called intra-amniotic infection (IAI), is the inflammation of the fetal membrane due to bacterial infection
A baby delivered in the OP position might have chances of a low APGAR score (less than 7), meconium-stained amniotic fluid, meconium aspiration birth trauma, NICU admissions, and longer neonatal stay (5)
These complications could make labor difficult in OP cases. Some women are likely to have a tougher time than others. Posterior labor is likely to be less difficult if:
The baby is smaller or average in size
The posterior baby engages during labor.
Your OB/GYN would do everything possible to manage the OP position and avoid any complications.
What Causes A Baby To Get Into Occiput Position?
Some factors that could lead to an occiput posterior baby are (6): A pelvis with an oval-shaped inlet, with a large anterior-posterior diameter (anthropoid) and a narrow pelvic cavity, may also lead to OP.
The Risk Factors That Might Increase The Chances Of OP
Here are the factors that may influence your chances of having an OP position during the delivery (7).
Your age is more than 35 years
Nulliparity – you haven’t given birth before
Previous OP delivery
Obesity
Decreased pelvic outlet capacity
African-American ethnicity
Birth weight of more than 4,000g
Gestational age of more than 41 weeks
An OP position might complicate the labor by prolonging it. Timely diagnosis and management could help minimize the implications.
Diagnosis And Management Of Occiput Posterior Position
The OP position could be diagnosed through an ultrasound scanning, and its management is done only if the fetal heart rate is reassuring. An OP may be managed through:
Operative vaginal delivery C-section
Operative vaginal delivery from the OP position: It could be done if there is sufficient room between the occiput and the sacrum, allowing the baby to turn. Forceps or a vacuum extractor may be used to bring the baby out (8). C-section: This is done when the above methods do not help you deliver the baby through the vagina. Occiput posterior may not be as serious as a breech position, but it is not as easy as the occiput anterior either. Therefore, you may try preventing OP and get the baby to the easier OA position.
How To Prevent An Occiput Posterior Position?
Following the below postures and exercises might help keep the fetus in an appropriate position and facilitate delivery (9). i. During pre-labor: Pelvic rocking for ten times for 2-5 times a day is likely to help in rotating the hips in a circular motion. Get down on your hands and knees, and lean forward as much as you can comfortably. Repeat this during the early stages of labor. ii. Towards the end of the first stage of labor: If the baby is moving towards an OA position, then squatting could help relax the pelvic floor muscles, creating more room for the baby to rotate. iii. During the pushing stage: Doing double hip squeeze during the contractions may help the pelvis spread, providing more room for the baby to move back to the right position. Note: Ensure that the exercises and therapies that you consider are approved by your doctor.
You may also try breathing techniques.
Try to lean forward during the labor as it helps in relieving the back pain to some extent.
Use a hot or cold compress.
Get your lower back massaged.
