As I sit with my children at the park, I hear it all too often from the other Moms.... "my labor stalled... so my baby had to be born by cesarean section. He was just too big to be born vaginally". I would, of course, always follow up with.. "Well, how big was your baby?" The answer to this question almost always led to a normal birth weight ranging from 7 lbs to 8 1/2 lbs. Since the average woman's pelvis is designed to birth a 10 lb baby, I find it hard to believe that all of these average sized babies are truly "just too big".
In reality, true cephalopelvic disproportion, or CPD, is quite rare (1 in 250 births). This occurs when the baby's head is truly too big to mold through Mom's pelvis. Unfortunately, since a stalled labor or "failure to progress" is the #1 reason for having an unplanned cesarean today, a high number of these births are incorrectly classified as CPD. The danger in this broad diagnosis is that it leaves Mom with the misunderstanding that her body is unable to birth vaginally. She may feel that scheduled cesarean births are necessary for any future pregnancies when in fact she may have a very good chance (over 80%) of having a successful VBAC (vaginal birth after cesarean) and be able to avoid another surgery completely.
What is causing this high rate of "misdiagnosed" CPD? There seems to be an epidemic of malpositioned babies going into labor [today]. Maybe as many as 50%. If the baby is unable to rotate through the pelvis during labor, labor will stall and a cesarean is performed. And yes indeed, if the baby's head enters the pelvis at the wrong angle it could easily and correctly be diagnosed as being "too big to birth vaginally". A malpositioned baby may have a head circumference of 11.5 cm as opposed to a baby coming through the pelvis correctly which would easily mold to 9.5 cm. This 2 cm difference is a huge deal when it comes to the baby passing through the pelvis. Babies used to make there way into the world vaginally nearly 95% of the time (as late as the 1970's)... today, hospital delivered vaginal births are down to about 67%.
On a more personal note... I pushed for nearly 3 hours to birth my 2nd child who was malpositioned. During my third pregnancy I practiced OFP and was very strict about going to my chiropractor once a week the last four weeks of my pregnancy. To my delight, my 9.7 lb son was born in less than 3 hours (total labor time) and after only 15 minutes of pushing.
~ Michelle McClafferty
Your baby's position can have a major influence on the kind of labor you will experience and the way that your baby is born (no/low intervention vs vacuum, forceps, or cesarean). Encouraging your baby to lie in the most effective position for his passage through your pelvis significantly increases your chance of a spontaneous and straightforward childbirth. Your unborn baby also plays a very important role, as he instinctively wants to move into the most effective position for birth too!
Head down--but the other way around..... "Babies are not being born the way they used to be, or were meant to be." ~ midwife, Jean Sutton
The problem lies within our modern lifestyle. If you take a look back in history, women were on their hands and knees doing daily chores such as gardening or cleaning the floor, sitting in straight backed chairs, or leaning forward over the sink while hand washing the dishes. This forward positioning of the pelvis allowed gravity to rotate the heaviest parts of the baby (the back of the head and the spine) forward to align with the curve of Mom's belly and into the best position for a normal birth. It seems that [today] babies are "encouraged" to lie in the woman's pelvis in the posterior position (the back of the baby's head lies against Mom's spine) during pregnancy because of maternal posture and our lax lifestyle. What this means is that the modern pregnant woman tends to use postures in her every day life that do not assist in aligning her baby into the most effective position for the labor and birth of her baby. Any position that tilts Mom's pelvis back... such as a couch, computer chair, recliner, or bucket seat, may persuade her unborn baby to position himself to the back or posterior part of her pelvis.
Practicing optimal fetal positioning during the last six weeks of pregnancy is non-invasive and includes the use of appropriate maternal postures and exercises that encourage your unborn baby to move into a position where his head can move through your pelvis without restriction. Nothing in life is a guarantee, but at least you will have a good head start at having a more natural, less medicalized birth.
What position is your baby in?
During the last few weeks of your pregnancy, your doctor or midwife will want to know if your baby has moved himself into the "head-down" position. Even if your baby is head down, he may be lying in any number of positions. The two most common positions are:
The World Health Organization has stated that a cesarean rate over 15% is harmful, increasing the maternal death rate and infant morbidity. The US cesarean rate is 33+% and climbing every year!
"The living room couch is the #1 cause of cesarean sections!"
Some tips to use to determine your baby's position in the 3rd trimester:
Where is your baby's back? Take a moment before bed to lay down (put a pillow under one hip) and give yourself a belly massage. Your baby's back will feel long and curved. Not only is this helpful in finding your baby's back but it is also a great bonding technique for you, your partner and your baby. For an OA position, your baby's back with be towards the left/front of your belly (36+ weeks).
Where is your baby kicking? When your baby is in the OA position, you may feel most of the kicks on your right side. If you feel a lot of kicking towards your belly button or on your left side, it may indicate that your baby is in the OP position.
Where are the hiccups? On the left (OA), right (possible OP), or around your back (OP)
What shape is your belly? Look at the shape of your belly either standing or lying down. Is your navel area rounded out (OA) or flat/sunken in (OP)?
Please be aware that some babies can move all over during the third trimester until the last month or couple of weeks. If you notice you have an active baby, follow a good OFP lifestyle and trust that your baby will settle in a good position just before labor begins. If you notice your baby likes a certain position early in the third trimester, work actively to move the baby into a better position prior to 36 weeks.
Exercises: Encourage your baby into the OFP
Think of your belly as a hammock to cradle your baby. Any time you are sitting up straight or leaning forward, gravity will naturally pull your baby's head and spine down and forward into the OFP.
Late-Pregnancy Postures:
Sit up straight or lean forward over the back of a chair to watch TV.
Sit on a birthing ball as opposed to sitting back on a couch.
Use pillows in bucket seats to ensure your knees are always lower than your hip bones.
Sleep or rest on your side (preferably the left) with a pillow between your knees
Avoid recliners and soft chairs
Avoid sleeping on your back
Avoid crossing your legs
Avoid deep squatting the last few weeks (it may engage your baby in the OP position)
Exercises to move your baby from OP to OA:
The chiropractor is a pregnant woman's best friend: The Webster Technique
Another powerful tool in helping your baby settle into the OFP is going to a chiropractor who is trained in the Webster Technique. This technique is known for it's ability to allow breech babies to move into the vertex or "head-down" position. The Webster technique also alleviates pelvic and uterine restriction so your baby can safely move on his own into the OFP.
"I give part of the credit for my smooth, fast labors to my monthly chiropractic visits during my pregnancies to Dr. Auturo Presas who uses the Webster technique."
~ Sheryl
The anterior position (OA): your baby's back will be lying towards your front. The occiput (back of baby's head) will be towards your anterior (your front). This is the most effective position for your baby's passage through your pelvis. This position is the optimal fetal position, aka OFP.
The posterior position (OP): Your baby's back will be lying towards your spine. The occiput will be towards your posterior (your back). In this position, your baby will most likely need to rotate into the anterior position in order to be born. This can directly affect your labor, possibly causing it to be longer and more painful labor, which increases the likelihood that you will need or want medical intervention.
A round belly is indicative of an OA presentation.
A flat belly is indicative of an OP presentation.
Pelvic Rock: This exercise should be done following the knee chest position to aid in rotating your baby into the OA position. This is also a great exercise to relieve back pressure and to keep your baby in the OA position.
Knee Chest Position: 3x per day for 15 minutes: This gently brings your baby slightly out of your pelvis so he can rotate into a more favorable position.
I have notice that many of my pregnant clients are working full time and sitting in computer chairs all day. In addition to the history of the couch increasing the risk for fetal mal- positioning... I am now finding that the computer chair has significantly increased the rate of OP babies in the last few years.
