What do we know about the OP baby?

Penny Simkin gave us a great talk yesterday at the MAWS conference about what the research says about OP (posterior) babies. I was chasing my toddler around so didn't get to write any of the statistics but a few things she said stuck out:

* There's no reliable way to know the position of a baby except for ultrasound (at this time). She didn't love saying this to a group of midwives and I doubt anyone was happy to hear that. ;)

* Palpation, back pain, digital examination, etc. - none of it was really reliable in determining the babe's position

* Lots of women have malpositioned babies and no back pain! It's just not a good indicator of whether a baby is malpositioned.

A question I have is whether in these studies it was one type of provider being studied or a cross of several. If we're asking doctors (who aren't necessarily invested in finding out fetal positioned by palpation/digital exam) to stand up against midwives who are, and who are therefore going to (likely) be more successful at it, is it skewing results? Could it be that midwives are better in some ways at determining fetal position than say, labor and delivery nurses?

I've been to many births where I suspected malposition (I have 'OP-dar) and during a vaginal exam would ask the nurse or doc if they could tell, and most often the answer is now. They say that there's a caput in the way, too much swelling. That's the only tool they have and they don't know what to do with information when the baby's head is swelling in the way. Somewhere along the way I learned (and I may be wrong but so far it's been right on) that if there's swelling in the way to feel the sutures, baby's head is in a wonky position, it's not OA. Now I'm not putting my hands in women, I can only go off of what is happening with the labor, what is happening in the woman's body and how she wants to move/doesn't want to move, where she's feeling sensation, and what the provider can say about the position- but so far I've been pretty consistently on about baby's position.

When I'm working with a client and I hear these things, it tells me there's something up with a baby:

* Water broke first
* Water broke and no contractions follow for many hours or even days
* Contractions are coming regularly but are short in duration
* Contractions are coming consistently (not going away) but are irregular in time between or in duration
* Mom has back pain, hip pain
* Belly button area is flat when she lays down or standing straight up
* Mom has a feeling about the baby in a funny position

I don't have to touch a client to see these things (and I don't, because I have no clue how to palpate). I don't have to inquire or interrupt her for the most part, it just is a matter of watching for it.

One thing Penny said was that just because a baby starts out the labor OP doesn't mean it will be born OP, and same goes for OA. Babies move in labor! We don't have to stress mothers out in their last weeks about fetal positioning and avoiding sleeping in certain positions, etc. I think this is a great starting point for dialogue about this. I definitely talk about fetal positioning because I want my clients to understand why it's important, but I don't tell my clients that they 'can' do something. I say they can 'encourage', but that the baby is a part of the deal too and they won't put themselves into danger or a stinky situation. Trust your body, trust your baby - it will be what it's supposed to be and we'll work with it. I have not seen it lead to a stress in my clients about their positions or the baby's positions.

Sometimes I wish I kept detailed information on every birth so I could go back and see how often babies are starting labor OP or asynclitic and then come out just fine, or otherwise - I just don't have that data in my own practice.