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OBGYN.net Women and Patients - Book Review |
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"Understanding and Teaching OPTIMAL FOETAL POSITIONING" As a lay midwife trained through the apprenticeship model with many different midwives, I was lucky to be taught a few tricks for turning a posterior baby; well known to make birth arduous and make the most arduous midwife cry! I presumed that all midwives knew these tricks, and was surprised to meet a UK trained midwife in 1994 who had not been taught any tricks. I have since deduced that those taught in the medical model who are able to use pitocin and forceps and of course the epidural find that often these work and are less likely to have been in home situations where this would mean a hospital transport Unfortunately, they don't always work and the incidence of primips ending up with FTP and cesareans is high in the OP group. Upon returning to the UK last month, I was delighted to be given a small booklet by a fellow midwife. Apparently, many midwives are using the techniques described in detail with comprehensive diagrams to prevent OP babies, to turn them BEFORE labor and if needed ,what to do in labor. Sutton and Scott, claim that our grandmothers had a lower incidence of OP because they were on their hands and knees a lot and did not recline in sofas or car bucket seats with their knees higher than the pelic outlet. Leg crossing also is accused of restricting the anterior pelvis. The physiology of why any ROA/T baby is more likely to turn OP was the biggest insight as I was able to go over my records and confirm how many of these ROA babies ended up being OP with engagement/ labor. The book describes the anatomy of the pelvis in a way that makes the whole picture come together nicely and is one of the most thorough instructions I've ever gleamed from midwife or OB texts. The section on "how to turn an OP baby in late pregnancy " includes many tips such as encouraging upright sitting, leaning forward and obvious when you think of it, discouraging deep squats until the baby is in OA and engaged! Modified squats with support are recommended instead. In labor, hands and knees or modified squats are useful .There are several different simple exercises that can also be done. Any lying or semi reclining positions are to be discouraged. Why OP babies are accompanied by prodromal labor which exhausts a mother is explained in anatomical detail as well as and why first stage takes longer with the often diagnosed "FTP" round about 7cms. The phenomenum that many of us have seen when a woman is in a reclined position during second stage is that she tries to lift her pelvis off the bed. This increases the pelvic outlet and is what women will do naturally if in an unfavorable position. In old midwifery texts, placing two pillows under the woman's bottom was recommended to encourage this arching of the back in lithotomy and dorsal positions and encourages rotation or facilitates an OP birth. The booklet goes on to suggest ways of changing asynclitism, preventing deep transverse arrest and diagnosing/ changing nucal arms/hands which is the first mention of such techniques I have read and would certainly help prevent some of the tears I see with this common "problem". Unfortunately, I do not know who retails this booklet although I will post As soon as I know. Meanwhile if anyone has questions they can E mail me for specifics at Onebornjoy@aol.com. Jean Sutton has toured Europe giving very comprehensive presentations and will undoubtedly do the same for our American friends. if only I could contact her! Published by Birth Concepts Pat Sonnenstuhl, ARNP,CNM |
