HOW WILL I BE BORN?
 
What babies wish their mothers
knew.
 
Optimal Foetal Positioning Explained
 
 
 

 
 By Jean Sutton
 
 Midwife, Mother and
International Birth Educator
Co-authored and edited by Julie
Sutton
 
 
ISBN 978-0-9541631-1-2
Copyright  @ 2007 Birth Concepts UK
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system or
transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise,
without the prior written permission of the copyright
holder.
 
 
For my husband Bill, who for so many years
encouraged and supported my attempts to really
understand how the process of birth is designed.
 

For all those babies whose first reaction to being

born has been so educational.
Disclaimer.
“How will I be Born” has been written to enable
those involved with birth to look at it from a different
angle. It is to be used as a source of information only.
All birthing families should have the care of
professionals with whom these and any other ideas
can be discussed. The author takes no responsibility
for any injury or damage suffered by any woman or
baby, whether occurring during pregnancy, delivery
or otherwise.
 CONTENTS
 

Babies Thankyou Baby says Hi!

Introduction Introduction to the book
Chapter 1 A General Look at the Normal Birth Process
Chapter 2 The Anatomy Involved in Giving Birth
Chapter 3 Lifestyle Changes and Ante-natal Education
Chapter 4 Birthday
Chapter 5 Minor Mistakes
Chapter 6 Babies Who Get It Wrong
 
Dear Mummy and Daddy,

I can’t actually talk to you at the moment, but if you

read this book it will be the next best thing – because
all the important stuff that I’d like you to know right
now can be found in these pages.
 
I really want us both to have a good birth experience,
so please pay special attention to all the fact and
fiction notes, as well as the useful tips and pointers
in the boxes that you’ll be glad you know about when
my birthday arrives!
 
We’re in this together. I will be doing my bit all the
way. Just listen out for my signals.
I reckon that once you’ve read this little book, you
and me will at least try our best to get the best start
in life ever – a successful birth.
 
Thanks mum and dad.
Soon I’ll give you a special hug to say “Well Done!”
for all your efforts on my behalf.
Lots of love from,
Your active little Bundle of Joy xx
 
 INTRODUCTION
 

FICTION: The baby is only

a passive passenger
throughout the birth process.
FACT: The baby plays a
vitally important role and is an
active participant in his own
birth.

How we are born influences our lives forever. Babies know

how they should be born, and try very hard to teach those
helping them. Of course, they can’t tell us in words, so we
must learn to understand their sign language.
Mothers already know that no two babies are alike, even
before they are born. They all have many things in common,
but each one has it’s own special needs. Some babies get
everything correct from the beginning, and some get
organised quite late in the process. A few get the process
right at the last minute, and a very few never manage it.
This book contains the knowledge gained from observing
and assisting hundreds of mothers during pregnancy and
birth. The way they behave when feeling safe, as well as the
effects their actions have on the physical birth process.
Much of this conflicted with what is in the textbooks, but in
the end it became clear that birth functions in the automatic
nervous system and that we should not try to control it.
Mostly, birth is a self regulating process.
It goes without saying that when things are not progressing
steadily, the situation must be re-evaluated, and if it cannot
be corrected, then intervention will be life-saving.
This book has been written to help expectant parents and
professional care-givers to look at the birth process from
the baby’s angle, and if possible help him to have the
safest, simplest entry into the world.
“Being Born” is a major action, and the baby who does it in
this way has accomplished the greatest achievement of his
life. He has “got himself born” by his own efforts, along with
his mother’s assistance. This baby brings with him a sense
of victory, that will help him for the rest of his life. When we
admire him, a few minutes old, lying in his mother’s arms he
has a very relaxed, satisfied look on his face. He gazes
around, flexes his limbs, and begins to nuzzle about to find
food. The change from a 24 hour constant support system
must be a puzzle.
Today, less babies are born in this triumphant state, and in
this book we will try to make it a reality for more of them.
When once again the World Health Organisation’s
recommended 85% of babies begin the process of birth,
settled into their mother’s pelvis in the best position, birth
rooms will be places of joy and celebration. Labours will be
much less traumatic, as mothers learn how to respond to
the baby’s signals.
Pain, other than from the mother’s cervix stretching should
not be the problem that it is today. Just as a broken arm
hurts, so does a labour where the baby is unable to use all
the space in his mother’s pelvis.
We will discuss how each baby makes his way from womb to
world, and ways to give him the available space he needs.
Very small changes in lifestyle can make dramatic
differences to the process.
To understand how the birth process is meant to work, we
must consider the mother—her bony pelvis and the soft
tissues within and around it; her uterus or womb, in which
the baby grows, - and the baby himself.
These are commonly known as “The passage, the powers,
and the passenger”. The word “passenger” has led to the
belief that the baby has no part to play in being born, but as
we shall see, he is the key to a good or tiresome event.
Safe, simple birth takes place when all three pieces work
together.
We shall look first at the way things should happen, then at
each part separately. Finally we will look at what happens
when a baby doesn’t get himself properly organised (the
posterior position) and how to help him.
 
 
 
FICTION:      Any “head  
down” position will be okay at
the outset of labour.
 
FACT:         A posterior
positioned baby will usually
result in a much harder birth
than an anterior positioned
baby.

 
 CHAPTER 1
A General Look at the Normal Birth
Process
Until he is completely born, the baby is usually known as the
foetus. However in this book he will be called baby---a boy,
because there are often two females in the picture already—
Mother and midwife.
To make the journey easily the baby must; · Be head down.
· Have his back to his mother’s front between her left hip
and umbilicus.
· Be able to move his head and tuck it in as he descends.
· Have his bottom pushing forward.
The books call this Vertex LOA or “the first vertex.”
 
A Baby in the
Optimal Foetal
Position L.O.A.
(Left Occipito
Anterior)
 

A Good Posture To Encourage

Baby Into L.O.A Position
  
The mother must during the last few weeks of pregnancy
(from 36 weeks for first babies, and 38 weeks for any
more) -
 
· Do everything she can to encourage her baby to settle in
this position, sometimes known as “The Optimal
Foetal Position”.
· Keep her knees as far away from her spine as possible---
the way they are when walking. This leaves plenty of
moving room for the baby.
· Rest and sleep on her side, preferably the left.
· When sitting, place a cushion under her bottom, to tilt
herself forward.
· Watch TV while sitting backwards on a dining chair, or lie
over a beanbag.
· Walk to the shops when possible---borrow a friend’s baby
and pushchair.
· When driving, put a firm, preferably wedge-shaped
cushion on the seat.
 
 
 
Now the process -
 
As birthday approaches, the baby in the right position gives
his mother’s body very clear signals to start getting ready.
 
· Her pelvic joints start to soften, and her back begins to
sag. This gives a swayback, or lordosis. If backache is a
problem, then a girdle or support should be worn.
· The tissues of the birth canal soften and become quite
swollen.
· The cervix, or neck of the uterus also softens and starts to
shorten.
· The uterus has sessions of “practice” contractions, as the
baby moves about trying to get his head into the pelvis.
These can be very tiresome, but mean that the baby is
doing his best to get ready. These are not labour
contractions, no matter how regular or painful they may
be.( the tummy stays the same rounded shape, and
the contraction is felt towards its top.)
 
 
 
 
 
 
 
 
 
 
Wear A Maternity Girdle
For Added Support and Comfort
 
 
 
 
Birthday
At some time during the day or night, the mother will feel
the tightening of her uterus has changed. The discomfort is
now at the bottom. It feels different from the way the baby’s
head felt. A short tight cramp, and it’s gone.
To begin with, these cramps may come at quite long
intervals, but they get closer, and last longer. When the
mother notices that with each one, the shape of her
abdomen (tummy) changes, from a round to a shoe box she
knows that this is the “real thing”. These contractions are
proper labour ones, and will open her cervix, and then push
her baby out.
 
 The Changing Shape of the Abdomen between
Contractions
 
 
 
Full line between
contractions
 
Dotted line during contractions
 
 
These changes only occur when
real labour begins.
 
 
  

Initially, the mother will have feelings of excitement and

anticipation---just as when any new event is starting. As the
contractions get stronger, and the cervix opening can be
felt, most mothers drift into a detached inward focusing
state. They need to know that they are safe, and supported,
but should be left to sink into themselves. Too much fussing
and hands on care brings them to the surface, and slows
down progress.
This first stage of labour
takes several hours with
first babies, but the mother
can shorten it if she
· Stays mobile and upright---there is no
point in lying down at this stage. There
is also no point in moving for the sake
of moving. If somewhere other than the
cervix hurts, it means that the baby
needs more room. Later in this book,
we will look at why different places
hurt, and how to help relieve them.
· Potters about getting baby things
ready until the contractions make her
catch her breath, and find something
to lean on as they come.
· Allows herself to drift into a state
where her hormones take over and do
most of the work.
· Realises that going to bed and
reclining makes contractions much less
effective. The uterus contains the
baby, the placenta and the liquor.
These add up to around 5 kg. If lying
down on the back, before the uterus
can exert any pressure on the cervix, it
must lift all this weight forward and up.
What a waste of energy! This is one of
the main reasons that labour is shorter
when mothers are up and mobile.
As the first stage nears its end, the contractions are much
longer and closer together, and most mothers feel the need
for someone special to hold them. Again, the need to feel
safe and protected.
The last few contractions, as the cervix comes over the
widest part of the baby’s head, will really take the mother’s
breath away. Still, she knows that if she stays upright it
doesn’t take long.
Usually, at this point, the membranes holding the liquor
rupture - the “Waters Break”.
Suddenly, everything stops. The cervix is wide open, and
the baby’s head is in the birth canal. The mother relaxes,
and finds somewhere to lie down. Some mothers have a
short nap now. This stage is sometimes called “The Rest
and Be Thankful” stage. During this pause, which is very
important, the uterus recovers from the loss of much of its
contents, as its muscles regain their tone.
The baby finishes turning his head, to be facing his mother’s
spine, with his nose up against the inside top of her sacrum.
His shoulders should follow, and be straight across the
inside of her pelvis at the top.
Second stage labour begins once the uterus has
recovered from its efforts in first stage, and some
interesting things happen.
The mother, whether lying on her side, standing or kneeling
will raise her hands, and throw her head back. She will arch
her back, and begin to move her pelvis as her knees bend
down and open.
The back of her pelvis (the rhombus of Michaelis) will move
outwards and the coccyx will straighten. This means much
more space at the outlet for the baby to pass through.
The uterus begins to contract again, but this time it is
pushing the baby down and out. The mother has no need to
push if the baby is lined up properly, and she keeps her
knees well away from her body.
The baby begins to emerge, facing mother’s back. Once his
head is out, he makes a 90 degree anti - clockwise turn to
face mother’s right leg. Now his shoulders will fit easily. The
back (left) one comes first, and he lies peacefully on his
stomach. If his front shoulder comes first, he lies on his
back, which is not as good for fluids to drain from his nose.
Second stage labour will have been short and there should
be no need for anyone to help the baby out. Touching his
head confuses him and stops the automatic process of
descent and birth so it is best not to do this.
Tears or episiotomies don’t happen when the tissues are soft
and pliable, and the mother always keeps her weight
forward. Leaning backwards tightens the pelvic floor,
creates a need to push and hinders the baby's progress.
This mother and baby can feel satisfied that they did it
themselves. They will both be ready to move on to the next
stage of life, - getting to know one another.
Now it is time to look at the individual parts involved in the
process, and how they work together.
 
FICTION: When contractions
are 5 minutes apart, the baby is
about to be born.
FACT: True and effective
labour has only begun when the
tummy is changing shape. This
does not always occur even
when contractions are close
together in an OP positioned
baby. Tummy changes from a
round to a “shoe box”.
 CHAPTER 2
 
The Anatomy Involved in Giving Birth
 
 
The Pelvis
 

 
Because humans walk upright on two legs, their
pelvis must be able to support their body. This means
that it is not a simple ring attached to the spine, but
a much more complicated structure.
The spine is flexible as low as the sacrum, which is
made up of five vertebrae fused into one large
curved bone. At the bottom, four tiny bones form the
coccyx, or tailbone. This is able to move backward
during childbirth.
The top of the sacrum is formed by a bone that is much
larger than the others, and protrudes into the body. It is
called the sacral promontory, and forms a difficult
obstacle if the baby is not in the best position.
The sides of the pelvis are called ilia or wings. They are
attached to the sides of the sacrum at the back by strong
ligaments that soften during pregnancy and allow the back
of the pelvis to “open” during second stage labour. This
action was recorded by Sheila Kitzenger when she was
researching in Jamaica, and has been seen by many
midwives and support people when mothers give birth in
upright positions. The wings join at the front at the
symphasis or pubic joint.
The pelvis is much shorter at the front than the back. On
either side of the pelvis near the outlet are two bony lumps
known as the ischial spines. These form the narrowest
part of the pelvis, and are an obstacle if the baby is facing
the wrong way.
At the lowest part of the pelvis, on the sides, are the ischial
tuberosities, or sit bones. When standing or sitting, our
weight should be carried through them. Dancers, gymnasts
and horse riders will be familiar with this idea.
 
Female Pelvis
 
Male Pelvis
 

A female pelvis is different from the male, but just as strong.

 

The inlet or top is widest from side to side and their front is
much rounder than the male. They are more shallow, and
the curve at the back, known as the sacrum is much deeper.
The outlet is wider than the male, and the coccyx, or
tailbone is higher in relation to the pubic bone at the front.
They are all wider from side to side at the top, (heart
shaped), have a round cavity, and are wider from front to
back at the outlet (diamond shaped). Tricky to negotiate, but
we shall soon see how it’s done.
The commonest pelvic type is called gynaecoid----around
50% of us have this type, and it is the best for birthing.
These women can be recognised by their figures. They tend
to have bottoms wider than their shoulders, and round
buttocks. They also look quite awkward when they run, as
their Ischial tuberosities—the technical term for seat bones--
- are wide apart. Their babies can curl up into the back of
the pelvis very easily as long as they are facing their
mother’s back.
The next is the anthropoid type, which is the one that
causes a lot of confusion, because babies can get through it
easily even when facing forward. They find it easy to turn to
face backward at the outlet. It is an oval shape at the top,
and has straight sides. These women tend to have shoulder
wider than their hips, and very attractive legs. They are the
athletes and gymnasts.
Around 23-24% of women are like this.
Next, come the android type. This is more like the male,
with a narrower outlet. They are also narrow at the front, so
the baby’s position is very important. He must be facing
backward but will need to move further back in the pelvis.
These women often have solid, straight down legs. Their
problems start in second stage labour, as the baby needs
his mother to move frequently to give him more space.
There are around 23-24% of women like this.
Last, come the platypelloids. A long word for a very few
women. About 3-4% have this. These are the women who
are very wide from side to side at the top, but very, very
narrow from front to back. They also often have a thick
pubic bone that takes up too much space. Their babies have
a difficult time getting into the pelvis, but once in almost fall
out.
 
Different Female Shapes
 Gynaecoid Anthropoid Android
 

Very few of us have the extreme pelvis, but are more or less
one type or the other. It helps to know, because then special
help and advice can be given at the right time.
We have seen that the pelvis is much shorter at the front
than the back, so it makes sense to encourage the baby to
follow the short path. This is why upright, forward leaning
positions with the knees well away from the body shorten
labour, and allow the second stage to be simpler.
The baby who is facing his mother’s spine, has only to
uncurl and straighten his neck. This is why all the textbooks
describe Vertex LOA—head down, back on mothers left as
the first vertex.
Any other position is a compromise, and needs extra
thought.
 
 

 
 
In O.A Babies the foetal heart is heard at x during an
antenatal check
 
  

The Uterus The uterus or womb is a fascinating

organ. It grows enormously during pregnancy to hold
the baby, his placenta and membranes, and the
liquor or waters in which he swims.
Before pregnancy, it consists of the parts known as : · The
body, made of special criss-crossed muscle fibres.
· The isthmus, or a band of cells that will start to change
about the thirtieth week to form the lower segment. If the
placenta is very low on the wall of the uterus, this is when
it appears to move, or if it is across the top of the cervix,
there may be painless bleeding. The placenta does not
move, it is the lower segment which grows. The fibres go
round the lower segment in circular fashion. This is the
place where a caesarian section incision is made.
· The cervix, which alters its size and shape as the
pregnancy grows. By the end of pregnancy, it should feel
very like the end of a nose. It will be pointing toward the
junction between sacrum and coccyx, and quite high up in
the pelvis.
Until around week thirty-six of the forty weeks of most
pregnancies, the top of the uterus rises steadily up the
middle of the mother’s abdomen. Now it begins to lean
toward her right side, making the left side rather longer. The
books call this right obliquity and dextro-rotation.
This is part of the plan to ensure the baby is comfortable
only in the proper place.
If this is a first baby, the lower part of the uterus will be pear
shaped, which also helps the baby decide where to lie. A
second or later baby is in an apple shaped uterus, so he
may choose to position himself on the right side, (ROA) but
will still find the left more suitable.
 
Pear Shaped Uterus

 
Back View Side View
Throughout the pregnancy the uterus is practising
contractions. These usually go unnoticed by the mother in
the early days.
As the birth date draws near these become much more
noticeable and may occur in sets at regular intervals.
These are called Braxton Hicks Contractions.
The mother may believe she is in labour, but as long as the
uterus stays the same shape they will stop. They are often
started by the baby trying to get himself settled in the
proper place. He will make very strong efforts to do this, and
if he is lying with his back on his mother’s right, between
her spine and hip, it will be painful. His head will rub on the
top of her pubic bone and her bladder.
Unfortunately, this moving can go on for several minutes at
a time, and make his mother very unhappy. This is when his
mother can take action to help him as we shall see shortly.
 
 The Baby
 

The baby is the person who should control the entire

process of pregnancy and birth.
 

Today, we try to tell him what to do, instead of listening to

him tell us what he needs. Dr Michel Odent says that “Birth
is an involuntary process, and as such cannot be managed.”
If we give this some thought, we know it’s true.
Human babies are a funny shape, being wider from front to
back at the head, and side to side at the shoulders.
When we look at a baby and a pelvis, the journey seems
impossible. Not so, it is really very easy, if the baby is able
to follow the basic plan.
The baby changes his mother’s body to suit his growth. He
causes her uterus to grow and her body to produce the
materials he needs to form himself.
By thirty-six weeks he takes up more room than the liquor,
and is no longer weightless. However, he is still buoyant,
and able to move freely but deliberately. No more flips.
As the time for his birth approaches he will send signals that
stimulate the hormones needed by both of them for a
successful entry to the world. He needs to be ready to begin
independent life. His mother’s body will prepare for his
leaving.
If she adapts her posture she will develop a swayback, that
tips her uterus and the baby forward. This helps him lie into
the hammock formed by her abdominal muscles. Nobody
can lie comfortably on his or her face in a hammock.
Many babies at this stage are lying on their mother’s right,
and facing forward. That is, they have their back between
the mother’s spine and hip bone. These mothers are often
told “you are carrying so well”. Babies like this, known as
ROP, or right occipito posterior are the ones who have
problems. They have trouble getting into the pelvis, because
their backs are too upright, and they can’t bend their necks
enough.
They are the babies whose movements are painful as they
try to turn onto their backs. When this happens many
mothers feel things are too painful, and lift their whole
uterus up off their pelvis. This stops the hurt, but prevents
the baby getting into the right place.
They are the babies who are induced for post maturity or
late arrival, and known as high head at term. Once labour
starts they still have problems, as they are unable to use all
the space in the pelvis. They get into the back, and come
face first. They try to bend forward and bump into the
pubes. Imagine trying to get through a cervix dilated to
10cm when your head is 11cm from front to back! It’s
obvious that something has to give.
 
 

 
FICTION:    A mother can do
nothing to affect the kind of
birth experience she will have.
All she can do is “hope for the
best!”
 
FACT:      Amother’s antenatal
actions can have a huge effect
on her labour outcome. Minor
changes in lifestyle can have a
positive effect.
 
 
 
 
 
 CHAPTER 3
Lifestyle Changes and Ante-natal
Education
 

Until fairly recently, most babies managed to get

themselves into the best position for birth in plenty of time.
Women worked around home or farm, and spent most of
their time in forward leaning postures.
Work surfaces and stoves were much lower, and laundry
was done over tubs. Floors were scrubbed while on hands
and knees, so most babies found plenty of chances to settle
into the best position. Abdominal muscles tended to be
looser too, so the hammock was already there.
Today the situation of women has changed. Women
nowadays are likely to work almost until their expected date
of delivery. Often women in offices are sitting on chairs not
conducive to the correct posture for encouraging the
optimal foetal position prior to the onset of labour.
Classes may be attended to learn about birth and babies,
and exercise classes to try and keep fit. Breathing
techniques will be taught, though in a spontaneous labour,
the mother’s breathing will be involuntary, and varied with
each contraction.
Birth plans are good and full of ideas but it must be
remembered that they may not be possible. Most babies will
be born in hospital, where care is decided by those in
charge of the often very busy unit.
Helping Yourself and Your Baby Antenatally
 

Minor changes in lifestyle will have positive effects for you

both. Around 36 weeks of pregnancy it is time to begin.
Before we consider them we need to understand what is
meant by an open or closed pelvis. All we need is a
carpeted space and a kitchen chair.
Stand beside the chair and take note of the way your pelvis
is attached to your spine. The front or pubic bone is level
with the bottom of your tailbone, and much lower than the
top of your sacrum.
If you lean forward you will find that your spine is like a roof,
and your pelvis like a hoop. In this position your pelvis is
wide open, and your baby will have no obstacles to pass.
Now sit on the chair.
What has happened to your pubic bone?
Yes, it has come level with your sacrum, especially if you are
sitting back in the chair.
Where are your seat bones or tuberosities? No longer lower
than your coccyx. Your pelvis has become a basin, and will
be hard for a baby to pass through.
The next step is to squat as deeply as you can while holding
onto the chair for support. Westerners can rarely squat with
thighs parallel to the floor and back straight. We bring our
knees up, our bottoms down and to keep our balance, bring
our backs forward. How can a baby manoeuvre through this
closed space? If he manages to get his head into the pelvic
basin, what happens to his shoulders? They are unable to
descend.
Now try kneeling on the floor. First, in an upright posture
with your back and thighs straight. and hands on the chair
seat.
Again, an open pelvis.
Now sit back on your heels. Feel your pelvis close?
Finally, push the chair forward (or move backwards) with
your forearms on the seat. Feel your pelvis open. This is a
very helpful posture for helping baby turn at any stage, or
for second stage labour, as the pelvis is wide open, and
easy to pass through.

Arms or knees under your body close your pelvis.

 
 
The Effects of Changing Postures
 
 

 
Standing
 
Good Lordosis.
Mother upright & forward.
Plenty of space between spine
& symphasis.
Baby supported by mother’s
abdominals.
 

 
Squatting
 
Western women bring spine forward & bottom down,
closing the inlet & tightening the pelvic floor.
This is not advisable.
 
 
 
 
Sitting
 
 
Little or no lordosis with baby in O.P position.
Inlet level, preventing baby bringing his back forward
to allow head under the sacrum.
 
 
 
Increasing the Available Space
 
If there are stairs or steps in your area, try walking up and
down them and feel how the sides of your pelvis change at
each step. If,during labour, your baby is not coming down
well, these movements will be useful.
 
 How Tilting the Pelvis Changes the Available Space
 
 

Below a floating ball in a bottle of liquid

represents the baby and pelvis. Notice
how the available space can be altered
to give the baby more room to
manoeuvre.

Raise Right leg Upright Raise Left leg

 
When you go to bed, try to feel the difference in your pelvis
when you;
· Lie on your side with legs straight.
· Lie on your back with legs straight and knees turned out.
· Lie on your back propped up with pillows and legs bent.
 
In the second two, you will have all your weight on your
spine, and your baby will want to lie with his back toward
the mattress. If you try these at home before labour, you
will feel more able to stay out of bed once you get to
hospital. Bed is bad for birth!!!
 
 
 
Positive Things to do
 
 
· If still working, place a firm cushion on your chair, to keep
your bottom higher than your knees.
· Do not cross your legs---this steals most of the space in
the front of your pelvis, and keeps the baby up and
probably facing forward. He can’t get comfortable the
right way round.
· A good rule when sitting is - if you can comfortably cross
your legs, your bottom is too low.
· Think about getting to work—if you travel by car, put a
cushion on the seat and stay upright, no slouching.
· During the day can you take a walk? This helps the
circulation in your legs, and gives your back some relief.
Sitting properly is hard work when pregnant.
· If your back aches, wear a maternity girdle. They may not
be glamorous, but they do feel good. The swayback or
lordosis makes your pelvic inlet more open, and helps the
baby fit into it. Believe me it is a good thing!
· If your job keeps you standing or walking most of the time,
you will need to rest when you get home and if possible at
lunch time. Try to find somewhere to lie down on your
side. Reclining in a chair with feet up may feel fine, but
baby will be encouraged to lie facing forward with his
spine against yours. The idea is to avoid this happening.
· Puffy feet are a problem, and must be raised, but elastic
stockings are comfortable and do help.
· Remember that unborn babies sleep a lot, so if you are
trying to help him change his position, wait until he is
active.
· Why not throw away the mop and take up floor scrubbing?
The position and actions involved are very useful if the
baby is slow to shift.
· Cat stretches and crawling type exercises, swimming face
down and many yoga postures are useful. Find a group or
 class to join; pregnant women benefit greatly from
contact with other pregnant women---another stimulus to
your hormone system.
· The best exercise of all is to borrow a friend’s baby,
complete with pram or pushchair and take a walk. It helps
the body, and the hormones.
· Spend some time daydreaming about your baby. Not the
decoration of his nursery, but how he will have his
father’s chin, and your eyes, or whatever special points
that you hope he will have till he feels like a real person.
This is great for the hormones—pregnancy and birth are
all about hormones, and if they are flowing well, the
process is much more enjoyable.
· From 36 weeks of pregnancy, sleep on your left side as
much as possible. Baby doesn’t like it? Of course not, if
his back is on your right. He’s used to resting on the bed,
and does not like the support removed. Try putting a
flattish pillow under your bulge for a few nights. Once
he’s turned over, he’ll be much happier. No-one likes lying
on their face in a hammock.
 
If the baby is really determined not to turn, ask your midwife
where the placenta is attached to the wall of your uterus. If
it is at the front, then the lower segment of the uterus must
grow long enough for him to fit between it and the cervix to
have moving room. This may not be until 38 weeks.
 
If there is no obvious reason, try resting on your front with
pillows under your head, between bosoms and bulge, and
above your knees. See if you can relax your abdomen
toward the bed or floor, so that you create a deep
hammock.
 
 
Creating a hammock for baby to lie in OA Position

Waterbeds are absolutely wonderful at this stage. You can

lie on your stomach, and baby will snuggle down into the
warm space with his back forward.
If this fails, then there is a reason why baby won’t turn and
you will both need professional help.
 
How Will I Know He’s Turned?
Many mothers ask this question, but when encouraged can
tell just where the baby is.
When he’s in the right place, his back makes a long firm
lump on your left. When he moves it is a large heaving
motion, as his whole body moves. There will be a small foot
or knee poking out way round on your right side.
His head may rub across your bladder neck and the inside of
your pubic bone, but is usually uncomfortable, not painful.
Your abdomen will curve forward, right down to your pubes,
and you will almost always have a walk like a duck. Most of
us don’t like this, but it means that as long as you stay
mobile and responsive to your baby, things will go well.
 
A Posterior Positioned Baby
When your baby is the wrong way round, head down but
facing forward things are different.
You will have a high, tidy look and walk almost normally.
Sometimes, when seen from behind mothers don’t look
pregnant at all.
You will have a dip around your umbilicus, between the
baby’s legs and arms.
When he moves there are lots of small parts poking out.
If he tries to turn across your front, he really hurts as he
can’t curl up properly. The longer top of his head takes up
too much room.
Baby should have got himself into the best position by 38
weeks, especially if he is a first baby. Because he is in a
uterus whose lower segment hasn’t been stretched, his
home is pear shaped as well as shorter on the right side.
A later baby is in an apple shaped uterus, so has more
freedom to move as he settles closer to the pelvic inlet.
Many later babies wait until labour starts before they enter.
Remember, your cervix is still pointing toward your tail
bone. If it is to get the right signals to start softening and
shortening, the pressure of practice ( Braxton Hicks )
contractions must be in the right place.
 

If baby is facing forward, and not in the best position, the

pressure from contractions will be strongest about 3cm in
front of the cervix in the lower segment. This is one of the
reasons why these babies are usually late in coming (post
mature). Their heads are too high and too straight to
produce the best result. (See Diagram over page)
 Direction of Contractional Force in
O.A & O.P. baby

(a)          O.A  - curls

up and presses on
cervix with each
contraction

(b)      O.P - stays erect and

pressure is on lower
segment 2-3 cm in front of
the cervix (wrong)

 
 
 
 
FICTION:      Lying down on a
bed is the best position in which
to give birth.
 
FACT:                Exactly the
opposite! Forget all those
television births! Upright
postures keep the baby towards
the short front of the pelvis and
make full use of the contraction
energy.
 

 
 
 
 
CHAPTER 4
 Birthday
How will Labour start? When will I
need help?
 

These questions bother most women during the last few

weeks. Mothers are fed up with being pregnant, and just
want it over. This isn’t the best idea, as when the baby
starts the process, it goes much more smoothly.
We will look at the baby in the best position first, and in a
later chapter, talk about what to do when things aren’t
ideal.
Once the baby has settled into the optimal foetal position,
he will often become much quieter. He hasn’t a lot of room
to move anyway, but seems to need a rest before tackling
the big action of getting himself born. Maybe he wants to
give mother a rest too!
When he begins the process, the uterus responds by
contracting and changing its shape.
To begin with, contractions are very short and far apart.
They tend to feel a lot like period pains, and in the same
place. If these are usually felt inside the tops of the legs,
then expect to feel labour pains there. Usually, they are at
the bottom of the uterus, and as they get stronger and
closer, appear to start at the back and move through
between the legs to the front. Many women feel them only
at the front when they have an O A baby.
Soon you will notice that with each contraction your uterus
changes its shape, as its sides close around the baby and its
top flattens down. At the same time, it leans forward so that
your abdomen looks as if it has a shoe box inside it. All this
helps to tip the baby’s bottom forward so that he can move
down into the pelvis.
People round you will notice that you are unable to focus
your eyes now. This is when you will feel happier with your
midwife around.
As the membranes, (that should be still intact) bulge into
the cervix they help it stretch or dilate. They also protect
the baby’s head.
Baby keeps curling himself up until the top of his head is
against the back of his mother’s pelvis, and his nose is
touching the inside top of the sacrum.
This will only happen properly, if his mother keeps herself
upright, and leans forward during contractions. Being in bed,
or leaning backwards causes gravity to force the baby too
far back and down into the pelvis, which makes the second
stage of labour very hard work. Ideally we need the baby at
the front of the pelvis to give the best signals.
As first stage progresses and the cervix is around 8cm
dilated, the contractions become long and quite difficult to
handle. This is when breathing exercises are useful. Better
still, a spa bath where mother can lean forward and hold the
far side of the pool. A partner who will hold you while you
wrap your arms round his neck is a great help. This stage
rarely lasts long, if you are mobile. Lying on your back in
bed it’s a different story.
The end of first stage happens when the cervix has opened
as far as possible -10cm is normal.
 
The “ Rest and be thankful stage.”
Just because the cervix is open doesn’t automatically mean
that things are ready for second stage.
The baby may not have finished turning his shoulders across
the top of the pelvic brim. If you are asked to push now, he
won’t be able to come down any further, and you will
become exhausted.
Baby should be leaning against the front of the pelvis,
where he will be pressing on the tissue surrounding the
urethra, or tube from the bladder. This is commonly called
the G-spot, and pressure on it causes many interesting
things to happen.
The Moment of Birth
As he starts to raise his head, his mother will -
· Lift her arms, to find something strong to hold. Even when
lying in bed, or with feet in stirrups women do this---try to
grasp the top of the bed and lift their bottoms off the bed
so that their back is arched · Throw her head back
· Open her knees
While this is happening the rhombus of Michaelis (the whole
sacrum plus the 3 lower lumber vertebrae) moves
backwards. As it is wider in front than at the back it pushes
the side walls of the pelvis (the ilia) outwards. The internal
measurements are now 2cm bigger, and make plenty of
space for even a large baby to emerge without effort.
The uterus changes its action, and begins to squeeze the
baby out. He shouldn’t need any maternal effort if he’s lined
up properly.
As long as the mother keeps her body away from her legs,
and her pelvis open, the tube from the top of the uterus to
the outside is straight. If the weight goes back behind the sit
bones, the tube is curved, and the baby will need to be
pushed out.
The baby’s head emerges with him facing towards his
mother’s back. He must now bring his shoulders between
the narrow ischial spines, so turns to face his mother’s right
leg. Now his posterior shoulder slides through followed by
his anterior and he slides out face down.
No one should touch him as he emerges, or his instinctive
movements will be confused. If his mother keeps herself
upright and her weight forward, there will be no tears or
episiotomies.
 
Helping Yourself During Spontaneous Birthing
When thing are going according to the “master plan” for
birth, most mothers manage very well. It doesn’t take too
long, and shouldn’t be too painful. The cervix stretching is
decidedly uncomfortable, but contractions are quite short
and the pain goes away in between.
If everyone involved understands that true labour has not
begun until the uterus changes its shape during
contractions, mothers will have no need to focus on timing
them. By the time they are serious, you will have no doubts.
Your support people will notice also that you are focusing
inwards and your eyes do not make contact. From now on, it
is important that you concentrate on what your baby is
doing, so that you can change your position whenever you
feel him asking for more space.
Cold drinks and flannels, hot towels, ice cubes to quench
thirst and other comfort articles should be put where you
can reach them yourself. It is not good for helpers to try to
get a response from you, even between contractions. Every
time you surface, the hormone balance must be re-
established and this makes progress slower.
If a water tub is used, then the temperature must be kept at
37° or less. There should be a stool or something similar for
you to stand on while getting in and out. Remember to keep
leaning forward in the pool. This is the problem with
domestic baths---if you kneel in them, your knees are sore,
and if you sit in them your pelvis changes to a basin.
Showers are much better as the water can be directed onto
your lower back, which feels good.
Remember to keep your bladder empty, as if it is full it takes
up quite a lot of space, and also acts as a spring to bounce
baby up between contractions.
During the first stage of labour, you should stay out of
bed, so that you can change position whenever you
wish.
 

Useful Positions For Labour

 
 
 
 
 
 
  

If monitoring of baby is needed, ask if it can be intermittent

rather than continuous. It is possible to use a monitor while
adopting forward leaning postures, or draped over a bean
bag for support. A scalp clip (ask your midwife) allows
mobility, but baby’s membranes must be ruptured to apply
it, and this is better avoided when labour is progressing
well. For most spontaneous O A labours, using a portable
sonicaid is fine.
Toward the end of first stage, contractions last longer, and
are closer together. This is when you wonder why you got
into this situation!
Don’t ask for an epidural now. Putting one in means going to
bed, and staying absolutely still. By the time that’s done you
would have passed through this painful stage known as
“transition” and not needed it. Epidurals take the pain away,
but also stop you feeling what your baby is trying to tell you,
and being able to keep your pelvis open. They also stop the
back of your pelvis opening---their job is to stop your body
feeling the pain, so the nerves are out of action.
Once your cervix is wide open, the pain disappears and you
should have a rest. Lie down if you wish, or kneel on the
floor or bed with your knees well away from your body. Baby
must finish turning his shoulders now, and needs as much
space as possible.
People around you may start to think that your labour has
“gone off” and needs managing, but once baby gets his
head and shoulders sorted out, it will start again. You may
need to lie on your right side, or even flat on your back for a
couple of contractions if he’s slow,(especially if you have an
android pelvis) but he will turn.
If your midwife or doctor is planning to help with the actual
birth of your baby, it is important that they stand behind
you. If they are in front, you will lean back, and turn the nice
straight tube from the top of your uterus to the outside into
a bent one. Then baby will get caught too low and too far
back, and you will have to push. You may even end up with
a medical intervention.
Second stage is the really exciting time, as you feel your
whole body respond. You will want to raise your arms above
your waist to find something to grasp. This is because your
pelvis is about to open and will be unstable.
If baby is far enough forward, there will be no urge to push.
You will find yourself moving your pelvis in amazing ways, as
baby straightens his head. It’s a painless, indescribable
feeling, but you will adapt to it.
As he emerges, you will probably sink towards the floor or
bed, with your knees wide apart. No-one should touch
baby’s head at his stage. If they do, he stops moving, and
his instinctive actions become muddled.
The baby will bring his head out—at this point you will feel a
burning sensation at the back of your birth passage outlet.
Slow down, and let baby slide out. It takes only a little time.
Once his head is out, you will feel his body turn as he comes
through the narrow part of the pelvis (the spines). His head
will be facing your right thigh. Now the weight of his head
will come forward and bring his posterior shoulder out. The
front one will follow, and he will lie on his face on the bed or
floor.
You will feel both exhausted and overwhelmed as you look
at him, and get your breath back. A while later you will feel
like lifting him to you, and having a first cuddle. Baby will
gaze at you with big, peaceful eyes and have a very
satisfied look on his face. After all, you’ve both achieved the
most important challenge of his life so far!
The packaging that baby was in must now come out. That is,
the placenta and membranes. Your uterus will adjust to the
loss of most of its contents after a short rest. It will contract
again---probably only once or twice, and the placenta will
slip out. As its soft and small, it isn’t painful.
If the umbilical cord hasn’t been cut, it will be now. In most
places it is cut soon after baby’s body is born, but may be
left until he has begun to breathe for himself.
He will soon be ready to latch himself onto your breast and
begin to feed. He should do this himself, as he needs to
learn to put his tongue well out, and draw your nipple into
his mouth. If he is helped too much at this time, he may
take days to work it out properly. Babies are very clever, if
we allow them to be.
5 Moves And I’m Out!
lst Stage
Move 1: Head enters inlet facing the mother's
right hip.
Move 2: Head and shoulders turn clockwise so
that the head faces mother's spine. Head
tucks in.
'Rest and be thankful stage'
Move 3: Shoulders can now pass through inlet.
This may take some time.

2nd Stage
Move 4: Head straightens and passes through outlet.
Move 5: Head and shoulders turn 90° anticlockwise and shoulders can
now emerge
 
 
 
 
 
 
 
 

FICTION:     Don’t worry.

Leave it to “nature”. Babies
always get it right.
 
FACT:          This is not the
case. Sometimes babies do
need extra help. You can ask
where/how he is positioned
and you may be able to help
him during labour. If not do
accept outside help.
 
 
 
 
 
 
 
CHAPTER 5
 Minor Mistakes
 

Some babies fail to get the tucking up right. There are only
four ways in which a baby in the O A position can get
confused.
Hand on Head

Some babies manage to get a hand up beside an ear as

they enter the pelvis. This is annoying, as it slows things
down and can hurt. When this happens, the baby’s
membranes may rupture as labour starts. The contractions
stop, and you are confused. Once they start again you may
have normal progress until baby’s head is well into your
pelvis. Now we run out of space, and you feel pain on one
side or the other of your pelvis where the hand is pressing.
Your baby needs more room to allow him to either pull his
hand back, or slide his head past it. You should raise the leg
on the painful side. This makes more room across your
pelvis, and he will soon turn.
This movement can be done by:
· Walking sideways up some stairs, painful side first. Come
down free side first.
· Stepping on and off a low stool about stair height or
8inches.
· Getting into or out of a water pool, lifting the sore side first.
· Walking to the toilet, and lifting your leg as you turn to sit
(labouring women seem always to do this).
If all fails, it is often possible for your midwife to do a vaginal
exam with you standing and leaning on the bed. If the head
and hand are in the cavity, she will touch the baby’s hand,
and he will pull it away.
 
Elbow Under Chin

You will definitely know if your baby has done this. He puts
one hand on the opposite shoulder, and thus his elbow
under his chin. This means that he can’t come down, so his
arm must move. You will feel his elbow pushing into your
sacrum with each contraction. In between, things are fine.
This is quite different from the O P backache, which never
goes away and gets worse with a contraction. When it’s an
elbow, there is pain only when he’s being pressed down.
What can be done?
This takes a lot of thought, and you must focus on just
where he is. Like the baby with a hand up, he needs space
across the pelvis, but in this case a lot more. Sometimes it
works if you lie flat on your back with a pillow under your
bottom. He slides back towards your body, and may move.
Active pelvic rocking and circling –as in “belly dancing” may
be successful. Usually, it’s a matter of trial and error.In a
water pool you can bend right forward, and that may give
enough space.
Asynclinitism
 

This is a trick that second or later babies play. They bend

their heads toward their shoulder as they try to enter the
pelvis. This means that the bone at the side of the skull is
leading, and it is unable to fold or change its shape. Also,
baby is unable to straighten his head. Labour starts off fine,
and progresses but soon slows right down. The mother feels
a nasty ache deep in the back left section of her pelvis----
behind the “spines”.
Here the mother needs to make more space across her
pelvis, and from top to bottom on an angle. She needs to
keep the leg on the same side as baby’s back raised during
several contractions, so that he can find room to straighten
his head.
Going to the toilet is often a very successful move. If it’s not
an ensuite, see that your midwife is behind you with a
wheelchair.
A baby born in this position needs to be seen by a physical
therapist or osteopath as soon as possible after birth. Most
of them have had their necks bent for some time before
birth. This means that the muscles on one side are shorter
than on the other, so when put to bed on their back, they tip
their head toward the shorter side. These babies need to
sleep on their side, with a firm support under their head to
keep their neck straight until the muscles are the same
length. Without early help, the baby tends to grow up with
his bent neck, and when he starts to walk, bends his spine
to compensate. This gives an unnecessary spinal curve.
 

Cord Round Neck More Than Once

Some bright babies, while flipping about in their capsule,
manage to wrap the umbilical cord round their neck, or neck
and body, more than once. This means that it is too short to
allow them to descend in the proper way. If your baby is in
the best position, and contractions are going well, his heart
should be heard steadily moving toward the middle and
bottom of your abdomen. If he’s not doing this, then your
midwife will be watching to see when he will need help. First
stage should be fine, but descent in second stage may be
very slow. At this time, the professionals will need to deliver
him. You may be asked to push him out, or they may need
to use forceps, or ventouse. On rare occasions a caesarian
section may be the only answer. Recognised, it isn’t usually
a problem, and in most cases, once he’s out he just needs a
cuddle while he gathers his wits.
 
  

 
FICTION: It doesn’t matter
if the baby is not in the
optimal foetal position; it can
be sorted out.
FACT: An O.P. baby takes
longer to be born and the
birth is generally more painful
because contractional
pressure is not opening the
cervix effectively. O.P. babies
can be helped, but there may
be long-term consequences
for mother and baby
thereafter.
CHAPTER 6
 Babies Who Get It Wrong- Posterior
Position
 

These days there are plenty of them. They are the babies
who need to be induced, who need help all the way, who
just can’t get into your pelvis because until their bottom
comes forward they can’t bend their neck round the sacrum,
who end up being born by ventouse, forceps or caesarian
section.
If they finally do get in, they can use only the space down
the middle of your pelvis. If they try to use the back then
their face comes first---not a good idea. If they try to curl up
and bring the smallest diameter of their head first, they
bump into your pubic bone-again, not wise.
Approximately 40-50% of babies are like this today, when it
should be around 10%.
 

Why Don’t They Fit?

We will look at the most common measurements of
mother’s pelvis and baby’s head. Then you will see that if he
tucks his head right into his chest, there is plenty of room. In
this position, he is also able to fold the bones of his head
over one another along the sutures and fontanelles (the soft
spots at the top and towards the back of his head.) The
bones of his head are joined together by membranes when
he is born, so that his head is able to grow as he does.
The books talk of his head moulding, but if he is able to
bend it, he can fold the bones into a smaller size. Moulding
really means changing the shape of some of the bones, and
this is a long, awkward process. Folding is preferable.
 MEASUREMENTS OF THE PELVIS
 
Normally
 
               Transverse        Oblique       Ant / Post
 
Brim             13                     12                 11
Cavity          12                     12                 12
Outlet          11                     12                 13
 
Second stage - after rhombus of Michaelis opens
 
Brim             15                     14                 13
Cavity          14                     14                 14
Outlet          13                     14                 15
 
 
MEASUREMENTS OF THE FOETAL
HEAD
Diameters Circumference OA 9.5 x 9.5 cm 27.5 cm (head tucked up)
OP 11.5 x 9.5 cm 35.5 cm (head straight and erect)
As you see, the baby needs to have the smallest
measurement leading the way. If his head is straight, there
is very little room round it especially if he isn’t lying across
the inlet facing his mother’s leg. If he is unable to bring his
bottom well forward, he will probably not be able to get past
the sacral promontory----the large bone at the top of the
sacrum.
If by some chance he does get into the pelvis with his head
straight, he’s got a major problem trying to turn round. His
head takes up almost all the space, and he’s got to try and
get his shoulder across the big sacral bone. His head doesn’t
change shape before labour starts.
All in all, it is worth making an effort
to persuade him to turn while he’s
still in the abdomen. There’s plenty
of room there.
Helping Him Turn
We’ve already looked at some of the things to do, but we’ll
have another look at them now. There is no need to worry
before 36 weeks of pregnancy, as before then he takes up
less space than the liquor or bath water in his capsule. After
that, his back is quite long, and he can’t just flip about.
Once he’s settled, he tends to stay put. If he is really
comfortable where he is, you will need to be determined to
coax him to move.
Wait till he is awake and try any of the following leaning
forward, tummy down postures.
Once again : Things to try are; · Keep a cushion
under your bottom when sitting---this keeps the
knees below the seat.
· Take the dog, or a friend’s baby for a walk.
· Join a swimming class, and try floating tummy down even
if you can’t swim.
· Wash the dishes in the sink instead of the dishwasher---
babies love that.
· Lie on your left side on the couch when your feet are puffy
and you need a rest.
· Do you know someone with a waterbed? They are
wonderful for pregnant women. You can sleep on your
front, and baby will love to snuggle down on his back into
the warmth.
· Sleep on your left side. If he’s in the wrong position, he will
get very cross, and try to make you turn over. This is
because you have removed his support, and he doesn’t
like it. You may need to put a flattish pillow under your
bulge till he gets used to it, and is willing to turn.
· Lie over a bean bag.
As babies are supposed to lie facing their placenta, most of
them are quite happy to turn. Placentas are usually on the
back wall or the top of the uterus. ( If they are in front, there
is not enough room to turn till around 38 weeks.)
 The OP Baby has his head erect as in
the
“Military” Position
 

 
 
 
Foetal Heart heard at ‘x’ on mother’s
right flank
 
  
 
 
Contractional Pressure is
2-3cm in front of the cervix therefore
the cervix does not dilate as
effectively
 
 
Entering Pains and False Labour
Not understanding these causes expectant mothers far too
much anxiety. This is especially true if it is your first baby
and you have no real idea what to expect. The books aren’t
as much help as they could be. No one wants to frighten
you, but by not explaining properly what is happening,
mothers are left to wonder and worry. Partners try to help,
but seldom know enough to do so.
Entering pains begin if the baby is not lined up in the
optimal way. He knows how he should be getting ready, and
makes great efforts to achieve the easiest birth. The
problem is that he is now low in your abdomen, and as he
tries to turn he feels awful. He rubs across the inside of your
pubic bone and upsets your bladder. He may keep trying for
several minutes each time, and you will find this painful.
Your uterus won’t like it either, and begin to contract
strongly. However, it doesn’t change shape, and the
contractions are long---around 60 seconds. Thus you know it
isn’t labour.
Unfortunately this may occur several times over 3 or 4
weeks, till you are totally confused.
False labour is just that. It causes too many mothers to feel
unable to give birth without lots of drugs, or to ask for a
caesarian section. If you and your support people
understand entering pains, and what proper contractions
look like, you will be less fearful.
False labour contractions may be as regular as clockwork.
They are often 5 minutes apart, but 60 seconds long from
the time they start. Some mothers feel them in their back,
as a strong ache, and others feel them across their front. It
depends just how baby is lying. If you wait, they will stop, or
change to the shoe box type. Most likely, they will stop after
3 or 4 hours. You see how things get out of hand, and you
get too tired to care?
It is unfortunate that timing contractions is taught at ante-
natal classes, and most units ask you to come in when
contractions are regular and 5 minutes apart. You get there,
all excited and are told that your cervix has not dilated at
all, or is about 1cm dilated. The feeling of disappointment, if
these pains have been going strong for hours is too much.
Some-one suggests a drip, and epidural, and you agree. Not
a good idea. You will have to go to bed, on your back, and
your baby, who needs to turn over, must then try to climb
uphill.
A better idea is to stay home, have a warm bath, and a
milky drink, and pop into bed on your side. Try your
relaxation techniques, and breathing slowly and gently.
What you need now is sleep and rest, so if these don’t work
you may need something prescribed by your doctor. If you
can relax enough baby may turn over, and when you wake
proper labour start. You will know it’s the real thing if your
abdomen changes shape, and the contraction is short.
Remember, the practice contractions have no effect on your
baby. No matter how many there are, how long they last, or
for how long they go on, baby is okay. However labour
contractions do affect him, and enough is enough. There are
no medals for heroics in the birth process!
 
  

Labour With an Occipito-Posterior Baby

 

This is an endurance test for everyone involved.

-You, because it is more painful, usually lasts a lot longer
and the backache is present all the time.
-Your baby, because he must change the shape of his
parietal bones to make his head smaller. He also has the
contraction pressure coming through his head and neck,
because he can’t get his head out of the way.
-Your support people, because this will be a long session.
-Your care-givers, because there is little apart from drugs
that they can do for you
Unfortunately many of these babies are overdue, or post
mature, so their head bones have started to harden, and
don’t mould easily.
 

Labour may take one of many different paths, so although

they have most things in common, we need to look at them
individually.
1. First, it may start after a long false labour session;
2. Second, pressure in the wrong place may cause baby to
rupture the membranes holding the liquor and most of it
may drain away. Contractions rarely start until the
muscles of the uterus regain their tone.
3. Third, he may not get organised, and have to be induced.
In the first type of birth, a session of practice contractions
just keeps going. This is probably because baby has decided
that it is high time he got born. Most mothers think that
labour has begun, but there is no change to the shape of the
abdomen.
Comfort is what is needed. In some places, this is when
pethidine is used. It takes away most of the pain---yes, this
is painful and wearing. Pethidine and morphine, cause deep
relaxation as well as sleep, so if it is offered, it may be a
good idea to accept. While you sleep, on your left side,
baby may well turn over, and you will have a normal O A
birth. If he doesn’t, at least you will be rested, and can get
up and help him as real labour starts.
If you are unable to have chemical pain relief then every
effort should be made to help you sleep. Homeopathy,
hypnotism, acupuncture -- there are lots of things that you
may already be using. Just don’t stay up and about counting
contractions, and getting exhausted.
Going to hospital and having an epidural may take the pain
away, but for some reason babies don’t seem to turn with
one until they are on the pelvic floor. As they must still come
down in the wrong position, and giving poor signals, labour
progress is very slow. (These are the labours that we are
told lasted 36-40 hours. Not so, it was the getting ready part
that took the time.)
Secondly, the membranes holding him, his placenta and
liquor may rupture. This may be just a trickle from a hind
water leak. This is when the rupture is near the top of the
uterus above his head. The constant leaking every time he
moves is frustrating, as there’s enough to need a pad, but
not a real flood.
If the fore waters break, you will find a sudden gush of fluid,
with no warning. Some mothers do feel that something is
going to happen and are able to reach the toilet. It may
happen at any time or anywhere, after baby’s due date.
Contractions very rarely start at once. Babies have been
known to take 3 or 4 days before they trigger labour. Today,
this is not allowed and most places want you to come to
hospital after 12—24 hours.
If as soon as you are sure that the membranes have
ruptured, your midwife or doctor checks to see that there is
no cord in front of baby’s head, you should have a short
rest, and then get mobile. Baby will still be on your right
side, so you need to try stair walking, or one of the actions
that changes the level of your hip bones. Baby will probably
be busy trying to turn and this is extremely painful once the
waters have broken. However, it is not as tedious as a
posterior labour. Pain relief as in the first situation, and a
good sleep will be useful.
Keep your fluid intake up, and eat light food. One of the
signs that real labour has started is that food has no appeal.
Make sure you empty your bladder frequently---there’s not
much spare space in the pelvis.
Thirdly labour may need to be induced.
When babies are overdue or seem to have problems, an
induction may be advised. This needs to be thought about,
but can be helpful. Your unit will have it’s own procedures
but a common one is to insert some vaginal pessaries or gel
containing prostoglandin hormones high into the vagina
behind the cervix at night. These help the cervix to soften
and shorten. “Ripen” say the books. Alas, it has no effect on
the vaginal walls or the tissues of the outlet. Next morning
the state of the cervix will be checked, and if suitable the
membranes will be ruptured.
Now you may be asked to walk about. Walking on a flat
surface is a waste of time. The baby needs to be able to
move his head, so you need to find some way of changing
the level of your hip bones. Again, stairs are good, but not
often available. Crawling on fours would be excellent---again
where can you go in a hospital? Rocking from side to side
while leaning on a window - sill is often useful. Having a low
footstool in front of you and raising alternate legs slowly
may work. This is likely for the mother who rises onto the
toes of one foot with a contraction.
The worst thing that you can do is go to bed. You can’t
move, your pelvis becomes a fixed, awkward basin and your
baby must try to turn uphill, with no help from the liquor.
If labour fails to start in a reasonable time, a drip with the
hormone syntocinon will be started. This must be carefully
monitored, and so must baby. If a monitor transducer is
used, most units have you propped up in bed on your back,
and ask you to stay still to keep it in place. Just when you
should be moving about. Ask if you can be on your knees on
something not too firm or otherwise on your left side. Once
your cervix has dilated enough, ask if a scalp clip can be
used. This is not ideal, but does allow you reasonable
freedom of movement. If baby is coping okay with the
syntocinon in the drip, it may be possible to have him
monitored at intervals instead of all the time.
Progress of Labour
 
Once labour has actually started, things happen in much the
same way in all O P births. Baby has his head too straight
and pressing against the back of your pelvis. This causes
pain that stays all the time, and gets worse with each
contraction. Contractions are too close, too strong and too
uncomfortable from the start. It is no wonder that most
mothers ask for an epidural or caesarian section.
 
Progress is much faster if you are able to be out of bed and
responsive to the internal pressure. As we have said, this is
not on the cervix, but around 3cm in front of it on the lower
segment. This isn’t the bit that opens. Baby has several
choices now.
 
1. Press in the wrong place so that the cervix stops opening
at 5-6cm. This is often called failure to progress, and a
drip put up.
2. Move enough to press on the cervix, keep coming down
and turn at the bottom of the pelvis
3. Come out still facing forwards, a face to pubes or direct O
P birth.
4. Turn half way round and get stuck at the “spines”—the
narrowest part of the pelvis.
 
Any one of these may result in you both needing help,
especially if you go to bed.
Helping Yourselves in an O P Birth
 
There are many things that can be done to help, once you
know just what is happening. This is often the hardest part.
No-one wants to alarm you, so you go on in pain and feeling
that there is no progress. If you know just where baby is,
and how far your cervix has opened, then you can make
sensible choices. You know by now, how to help baby turn,
and how much easier things are once he has. If he won’t
turn, because for some reason he can’t turn then you will
feel happier about accepting help.
 
Dealing with the backache
 
Regardless of where you are the key point is to keep your
knees and abdomen low.
Keep those knees well away from your body.
 
Don’t believe the talk of gravity helping in any other
position. All it does is encourage baby to get too far back
and on the pelvic floor. This is bad enough in first stage
labour, but is the main reason that babies today must be
pushed out. The opening for birth is in the front of the
pelvis.
 
Obviously, going to bed makes things much harder. You end
up sitting or reclining with your sacrum on the mattress and
your pubic bone lifted upward. To stop yourself sliding down
the bed, you raise your knees. What have you created? Yes,
a hammock, but the wrong way up! Your baby will have little
chance of turning himself over. Also, you will have splinted
your pelvis into a bowl shape, so that it has no flexibility. It
is now a rigid tube with a nasty bend. No wonder it is so
painful, and progress is so slow. As soon as your weight
gets behind those sit bones, you have created a
problem.
 
 
Bringing knees close to pelvis means the baby has to
turn uphill to be born.
 
 
 

 
 
 

 
Remaining upright will ensure the baby has a nice
straight tube to move through. Birth will be easier
when upright and mobile.
  

Backache is a feature of O P births.

To relieve this the back of baby’s head must be moved into
the front of your pelvis. We saw previously that his head is
11.5cm long, and the shortest pelvic brim measurement is
11cm. Thus he must be in the oblique diameter (see page
55), or directly across the brim. From here he can begin to
descend, and stop pressing on your spine.
If real labour has begun, his bottom will come forward
during contractions, and give him room to bend his neck.
Before that, the only way he can get forward is if you are on
hands and knees with your back sagging.
With each contraction, shift your weight from one foot to the
other, to increase the diagonal space inside your pelvis. Try
“belly dancing” or moving your hips in circles as you sway
to some real or imaginary music. Hot towels applied to your
lower back are a great comfort as you try to help him.
Sitting on a birth ball beside the bed and leaning forward
brings your weight forward and may assist. Getting your
partner to sit on a chair while you kneel on a cushion and
lean on his thighs often helps. He can massage your back at
the same time. Really big beanbags are comfortable to lie
forward into. They support your abdomen without pressing
on it and the beans mould round you. Add a pillow for your
head, and sleeping is easy.
Some areas allow you to use a water pool in which you can
float and keep your abdomen down even if the membranes
have ruptured and this can be useful. It does slow down
early labour, but getting baby to turn is more important
now.
Acupuncture or pressure points may be stimulated to both
relieve the pain and help baby.
Many homeopathic remedies will also help. If you plan to
use these, consult an expert well before your due date.
Once his head is in the pelvis and his neck is in the brim the
worst is over. The most useful thing you can do is stay out of
bed after your short rest.
When you are able to eat or drink during labour, you should
do so. Not large meals, but little snacks. Some of the new
sports drinks with electrolytes are very useful. Concentrated
fruit juice, especially peach juice made into ice blocks is
tasty.
Muscles that are working hard in labour benefit just as much
as athletes’ muscles. A shortage of glucose or calcium
makes pain worse. In an O A labour the muscles rarely need
any special care.
Too much help from other people is again non-productive.
You are having the baby, and you must concentrate on the
process. Support people who are obviously there for you,
and who see that you have the things you need are a
blessing, but too much “hands on” help can get in the way.
When the backache is severe, and you have tried every
change of position that you can imagine, then chemical pain
relief from a doctor may be the only answer. Their drawback
is that they work constantly, while the pain is intermittent.
They also mean that you must be confined to bed, and
unable to do much to help yourself. (Inhalation relief;
entinox, is not much help at this stage).
 

Creating a false pelvic floor.

There is one thing that your midwife may be able to do for
you when she does a vaginal exam. If your cervix is 5cm or
more dilated, she may ask you to kneel on the bed, or stand
beside it while she does this. She will place her fingers
inside your vagina, with the nails pointing toward your
sacrum, and keep her hand perfectly still. When your next
contraction comes, baby will be pressed down against her
fingers. This will give him something firm to rotate against: (
a false pelvic floor ). Sometimes it takes up to three
contractions, but it often works. If it does work, you have a
straightforward birth. It is an uncomfortable feeling, but well
worth a try before a drip or caesarian.
Note:There is no point in trying this before 5cm, as
your midwife needs to be able to open her fingers
that much to create something to rotate against.
 
Other Positive Things To Try
 
We have said already that an O P baby takes up almost all
the space inside your pelvis. The pelvis is a bony object,
with limited capacity to move during first stage labour, but
its diameters can be changed. As you found while trying
stair walking, your pelvis moves with your legs. Thus, when
one leg is raised, there is more space from top to bottom
and the “spines” are uneven. This gives baby more room to
move his head. Some of the ways in which you can make
more space include;
1. Marching on the spot---this is a favourite with second time
mothers.
2. Leaning forward onto a window sill and lifting one foot
onto a low stool.
3. Kneeling on one knee with the sole of the other foot on
the floor.
 At all times, you should avoid any
posture that brings your bottom
lower than your knees.
No Western style squatting—this brings your knees up
and your bottom down. Think about the time that you tried
to go to the toilet behind a bush. Where did the urine run?
Your pelvis was closed like a book, and is now, so even if
your baby could get his head past the inlet, his shoulders
would have no chance of doing the same.
 
Coping with tiredness
If labour goes on too long, both you and baby will get tired.
This is why it is important to rest at the start.
During first stage there is very little you can do to make
things go faster. Your baby is doing his best, but until he
gets round, or is able to cause pressure on your cervix,
progress will be slow.
Trying to “manage” your labour is self defeating. If you are
able to accept that it takes place in the involuntary nervous
system which is programmed to manage it you will find
things much easier. It is not your responsibility to do the
“work”,
- just provide your baby and your body with what they need.
For example, you don’t try to control your heart, or
digestion, and they get along perfectly well. It is the same
with the birthing process. Somehow, giving birth has
become misunderstood, with the consequence that too
many mothers feel that they have “failed”. If your body has
been able to provide baby with all his needs for 40 weeks,
why should it stop now? Babies are not called “the worlds
most effective parasites” for nothing. They know exactly
what is needed and when and will tell us if we listen!
Ideally a quiet space is needed, with gentle lighting to
reduce the stimulus. Relaxation music may help you to drift
off into your own world. Purposeful activity is a good idea,
but only when you feel the signals as baby asks for space.
Although your support people want to help, their actions
and sometimes presence may be too much. If they will just
sit and “be there” that’s fine. Talking to you, and lots of eye
contact becomes wearing.
As we said above, it is important to keep your fluid intake
going, but you do not need large amounts. Whatever you
take must be easily digested. Your system slows right down
once labour establishes. This is another reason to be sure
that the contractions are not practice ones. If you stop
feeding yourself too soon, your body will be short of
nourishment and feel pain much more easily.
You need to give your hormones a chance to come into play.
There’s no doubt that tiredness makes you more fearful, and
the birth hormones don’t work very well then.
Remember, your lovely little bundle of joy will get born.
Once he starts, he will come out. Very, very few modern
women have a pelvis that will cause trouble. Always
remember that if he can get into the top he can get out the
bottom---there’s more space there.
Established labour
As first stage labour progresses, baby will be moving down
through the pelvic cavity.
Because he is facing forward, he is unable to use the space
in the sacral curve, but must come straight down. As he
does so, he must reduce the size of his head by moulding
the large bones at the sides. He changes their shape from a
square to an oblong which gives the “sugar loaf” shape we
see in the pictures. To do this takes time. This part is usually
better, because his head is in the cavity, and his smaller
neck in the inlet. Your cervix will be stretching forward with
each contraction, and will soon be fully open. Once his head
is small enough –reduced from 11.5cm to 10cm from front
to back, he will slip out and into your birth passage. This
marks the end of the first stage.
You will now have the “rest and be thankful” period, to rest
and allow your body to prepare for the next effort.
During this type of birth, you both
really need a break, so when
everything seems to have stopped,
curl up on your side or front and
make the most of it.
This stage may go on for a long time. Your body has been
working very hard, and you and baby will need a rest. Don’t
panic. Have some nourishment. Some mothers want hot
soup or something savoury. This isn’t easy to find in a
hospital. Perhaps there should be some in your goodie bag.
If you don’t eat it, your partner will. If your care-givers want
to hurry things along, ask for more time.
Baby will have another chance to get organised now. He will
need to get his shoulders sorted, or he will end up with one
of them leaning on the front of the pelvic brim, and be
unable to come down even if you push your hardest.
Second stage labour with an O P baby
When the baby is still in an O P position, he is much slower
to give good signals. He needs to have the back of his head
against your pubic bone to do so, and this isn’t going to
happen. He will be too far back in your pelvis, and have his
face, or cheek towards the front. The opening of the
rhombus of Michaelis may not happen at all, so the baby
who needs extra space doesn’t get it.
Once the uterus has regained its tone, the expulsive
contractions begin. These are quite different from the first
stage ones, as their job is to push the baby out into the
world. Once again, the uterus grasps the baby and as it
contracts squeezes him forward. If you hold a marble
between thumb and two fingers and squeeze, you will see
what happens. Maybe you have squeezed a cut lemon, and
seen the juice fly out! That’s it.
You don’t have to do the pushing. Your body will move,
sometimes very dramatically as your uterus contracts. This
is why if you are standing you must be grasping something
sturdy with both hands. Once again, the idea is to keep your
legs well away from your body.
If you are being supported from behind, whether on your
feet, or a half squat you will feel like sliding forward and
opening your knees really wide.
If you wish to kneel, keep your knees well away from your
body. If you are kneeling on the floor, against a couch or the
bed, move back, and bring your arms forward and up. This
keeps your pelvis wide open, and makes baby’s exit as
simple as possible.
If he’s slow to come down try letting your abdomen sink
down---this looks odd, but means that your spine is like a
roof, and there is only a hoop for baby to pass through.
If none of these ideas appeal, you can try lying on your left
side, but you must control your top leg. Most helpers bring it
too far up your body, and this closes one side of your pelvis,
You may turn it right out and place the sole of your foot on
the bed, while you lift your seat. Mothers make the most
interesting movements when they are able to respond to
baby’s needs during birth.
 

Four ways he may come out

Some babies never get turned round and come out facing
your front.
When mothers give birth on their backs this is often called
“sunny side up”. It is much easier for everyone if mother is
upright. Baby must bring his face almost to the outside
before he can start to bend forward and come over the
pubic bone-----when mother is lying back, he has to get
under this bone, and it’s not easy to do. It is always simpler
to topple forward than to struggle upwards, so this is what is
happening.
He will have no problems with his shoulders coming down,
as they are at the back of the pelvis, but will need to turn
sideways to bring them through the “spines”. Then he will
just slide out, back shoulder first.
 

Transverse arrest, or ‘Caught at the Spines”

Sometimes as baby comes down he turns across the pelvis
just above the spines. They are only 10.5cm apart, so he
gets stuck. Pushing doesn’t help---he gets jammed in more
tightly.
First we need to know which side his back is on, and if he
has started to turn his shoulders. Then mother must be on
her feet leaning slightly forward. Now raise one foot ( the
foot on the same side as his back) about 6-8 inches off the
floor onto a stool (or a pile of books). This makes the pelvic
spines uneven and increases the space in which baby can
move.
When the next contraction arrives, mother must move her
hips backwards and forwards and in a circular action. Belly
dancing again. During this you will feel what baby is asking
for, and may want to take your foot off the stool or lift the
other one up. Some babies have taken 3 or 4 contractions
before they get their heads turned to face backwards, but
when they do, they come out very fast. Transverse arrest is
more common with second or later babies.
 
Turn on the pelvic floor
Many babies who are coming down without turning properly,
(remember, the centre of the pelvis is a circular cavity, so
he can still descend without getting his head sorted) will get
past the spines, and then turn. This is especially so if
mother has an anthropoid type pelvis. Unless he has turned
as he enters the pelvis, he must wait until he finds
something firm to rotate against. Once again it is much
easier for all concerned if mother is out of bed. Sometimes
with a first baby things may move faster if mother is on her
right side for a few contractions, but his should only be tried
if a ventouse or forceps delivery is suggested.
Failure to descend
Sometimes, despite a mother’s best efforts, the baby just
doesn’t descend.
His head is in the cavity, quite free, the cervix is definitely
fully dilated, and the uterus is trying to push him out.
What’s gone wrong?
Almost always, he still has one shoulder above the brim. To
check that he has both shoulders inside the brim means
using a portable sonicaid. If he is in, then the microphone
must be tilted down behind the pubic bone to get a clear
sound. If the heartbeat is easily heard while the microphone
is flat on the abdomen, then he still has one shoulder up.
Now it is important to find out which one, and try changing
positions until he is straight. Once he is, he can come down
easily, and another safe birth occurs.
 A Final Note
Like the young of all other creatures, human babies have a
blueprint to follow. If we study the process and apply our
understanding, we will see how to help each other. Mother
and baby are a unit for nine months and can manage their
physical separation well if we encourage them correctly.
This book has been written, not to frighten or scare but to
inform and educate so that all involved in the birth process
are the recipients of a wonderful and enlightening
experience.
Result : A safe, simple birth with parents and baby
triumphant!