Uber Doulas, what would you do?

[joandchris18]

I have a gal at 39 wks with baby laying ROA. Baby is still high and not engaged. I would like to try to do something to help baby turn so that she doesn't end up with a post. labor. What would you do?

[DoulaCBE]

Quote:

Originally Posted by joandchris18 I have a gal at 39 wks with baby laying ROA. Baby is still high and not engaged. I would like to try to do something to help baby turn so that she doesn't end up with a post. labor. What would you do?

It would depend on if baby is always ROA or if it's a mobile baby who likes to move around.

If it's a baby who favors ROA I might have her do all the wrong things, recliner etc and see if we can get baby direct OP then work on getting baby to LOA before the onset of labor.

Is it her first baby?

[joandchris18]

Yes, it is her first. And I think baby has been on the right for a couple of weeks, but not sure because I have just met her recently. She went to the Chiro yesterday, so I hope that will help encourage baby to start moving.

[Lindsay]

A slightly different perspective here. Definitely have her continue chiro care, but it's possible to birth and birth easily with an ROA baby.

I have scoliosis, and one of the results of that in pregnancy is persistent ROA babies. All 3 have been birthed from that position with no complications, and they weren't small babies either, weighing 8lbs, 9oz, 9lbs, 4oz, and 10lbs, 2oz. Her body might birth best with baby ROA.

[Ceci]

Swimming? With her belly down. Sorry I am half asleep here so that may not make much sense

[Jenmcfar]

I was going to suggest chiropractic and swimming also. And of course, the old, "Talk to your baby" and visualize routine.

[HotRodMama]

ROA at 39 weeks is viewed as favorable in our practice. When labor initiates as such, the whole spiral of descent and restitution flow smoothly. In my experience, as long as the baby's head is not presenting asynclytic or brow-first, everything "works out." I see no issue, personally.

[DoulaCBE]

Quote:

Originally Posted by HotRodMama ROA at 39 weeks is viewed as favorable in our practice. When labor initiates as such, the whole spiral of descent and restitution flow smoothly. In my experience, as long as the baby's head is not presenting asynclytic or brow-first, everything "works out." I see no issue, personally.

In my experience babies who are ROA usually have to rotate to OP to LOT to LOA. I've seen ROA babies with multips that usually aren't a problem, but IME babies like to rotate clockwise. So if the pubic bone is 12 the sacrum 6, they like to rotate from ROA to ROT, ROP, OP, LOP, LOT, LOA.

To explain a bit more for those who may not have a good "visual". When a baby (especially in a primip) is ROA before the onset of labor I see them enter the pelvis at ROT, and then maneuver through the variations of OP and then they make it to LOT (with mom usually complaining of intense bladder pain if unmedicated) and then to LOA and end up LOA or direct OA on the perineum at birth.

When I have a mom with a baby who is LOA during pregnancy or even LOP I see them tend to have more straight forward labors. Baby enters the pelvis from LOT and rotates to LOA or AO for birth. Shorter and more direct route=more straight forward labors.

Those with ROA babies I see a lot more of the characteristic "posterior labor" issues. Back pain, baby not applied well to the cervix, etc. If we ask position of baby during labor we often see what I've outlined above with the baby moving through OP presentations to get to LOA or OA. More drawn out, head not well applied to the cervix, slow dilation, slower descent=longer labors, babies born with a lot of caput usually.

Nikki from CBI has shared similar experiences, if she sees this thread she might be convinced to pipe in. She wrote of her experience many years ago and it's largely what the Rotational Positioning module that CBI has is based on. I started noting what was going on after she introduced me to the concept and for the most part it seems to be spot on. If I recall correctly Sutton and Scott also have the LOA being noted as most favorable in their Understanding and Teaching Optimal Feotal Positioning book.

I don't freak out over position for the most part, but I do teach OFP to all my clients and we do basic positioning to encourage a non-op baby starting at 34-36 weeks for first time moms.

[HotRodMama]

Thanks for the rundown.

I've heard before that - just like water down a drain - babies in the Southern hemisphere rotate counterclockwise. Fascinating . . .

[BirthBuddy]

Quote:

Originally Posted by HotRodMama Thanks for the rundown. I've heard before that - just like water down a drain - babies in the Southern hemisphere rotate counterclockwise. Fascinating . . .

I am not sure about the babies... but as far as the water down a drain thing, it's scientifically not true

Quote:

Which direction does the water flow down a drain? That depends on which way the water spills into the bathtub, and how the bathtub is built. Contrary to popular opinion, it doesn't depend on the bathtub's latitude. The inertial force with which the rotating Earth affects air and water masses is known as the Coriolis effect or Coriolis force. It's the reason why cyclones rotate clockwise in the southern hemisphere, and counter clockwise in the northern. However, you need huge amounts of moving air and water for it to take effect. In the case of a bathtub, the water drain is primarily affected by the shape of the drain and residual currents in the plumbing.

[abuela]

I have also observed that labors that start with an ROA baby are not as easy as labors that start LOA. Often they do fine in the beginning and then stall around 5-6 cm or develop back pain late in labor.
I had a client who was clearly ROA, and I told her that some people think that LOA may make birth easier and would she like to try some positions and exercises that might encourage the baby to switch. She then asked her midwife about that - the midwife said it makes no difference whether the baby is LOA or ROA, and the woman was put in an insecure position as to whom to believe. I backed right off, but I kept giving her OFP exercises with the general goal of optimizing fetal position (no more reference to ROA). (Baby changed to LOA a few days before the due date and she had a great labor.)
The lesson I learned: there have been no studies on this issue, and there is no consensus. There is a lot of anecdotal observation, some from very respected and inspired midwives, so don't discount it, and keep observing carefully... but tread carefully when advising someone...

[ctowndoula]

Nothing new to add, just agreeing with others; chiro and rotational positioning (but I don't usually worry until early labor-babies move so much).