Chances are if you are pregnant, someone has talked to you about back labor (whether you asked them to or not). They may have also mentioned that their baby was “facing the wrong way” or “sunny side up” in labor. What they are referring to is when a baby is in the occiput posterior position. We’ll cover what that means here.

Occiput posterior (commonly referred to as OP) is when your baby is in the birth canal and the back of her head is facing the floor, with her face looking up at the ceiling. This is why it is often called sunny side up—basically, the face is looking up. This position is often associated with increased back pain in labor, hence the stories of bad back labor with OP babies.

Why does this matter? The short answer is that babies in the OP position are somewhat harder to give birth to vaginally. However, don’t give up hope yet! Many can and will be born via the vaginal route, though sometimes with a little more effort.

The opposite of occiput posterior is occiput anterior (OA). Basically, the baby is face down in the birth canal, or the opposite of an OP baby. This is an easier way to fit through the birth canal because in this position, the diameter of the baby’s head is smaller than that of an OP baby.

If you want to prove this to yourself, try the sweater trick. Grab a sweater and put it on as most people do—flexing their chin to their neck, with the sweater passing over the back part of your head. Easy, right? Now try to put on that same sweater with your chin extended up toward the ceiling. It’s harder trying to get the sweater on when more of the front part of your head is trying to get through—and this is exactly what it is like when a baby in the OP position is making her way down the birth canal.

The good news is that many babies who start out in the OP position in labor rotate to the OA position by the time the pushing and delivery phase comes. Persistent occiput posterior is when this doesn’t happen, and the baby stays in the OP position and is in that position when she is born. This affects about 2 to 13 percent of all labors.

Studies have shown that for women whose babies remain in the OP position, the risks are higher for a longer labor, delivery by a vacuum, forceps, or cesarean section, postpartum hemorrhage, and worse vaginal tearing.

None of that is appealing, which is why many women ask how they can prevent their baby from ending up in the OP position. We do know that certain factors are associated with OP babies: the shape of the mother’s pelvis, having had a baby before, and the use of an epidural, among others. However, the studies linking epidural usage to OP presentation do not agree, so the verdict is still out.

Your doctor or midwife can tell the position of your baby when you are labor, either by vaginal exam or by ultrasound. Don’t forget that if your baby is OP at the start of labor does not mean he will definitely remain that way! And there is no data to support doing anything before labor starts to affect the position of your baby (despite what your friends insist).

Once in labor, many women will be encouraged to keep moving or to frequently change positions to help get baby in a “good” position for birth. However, there is again no data to support this practice, but it certainly can’t hurt.

If you have begun to start pushing and your baby is OP, nothing necessarily needs to be done other than to monitor your progress, because many babies will still rotate on their own to the OA position. If this isn’t the case, your doctor can try a manual rotation. This is when she uses her hand to try and gently maneuver your baby into the OA position. Forceps can also be used to do this rotation, but they are not as commonly used for this as they once were.

If your baby is OP and is not coming down in the birth canal despite pushing for a long enough time, a C-section may be needed for delivery. This is something your doctor or midwife can discuss with you if the need arises.

Takeaways

  • Occiput posterior is when your baby is in the birth canal and the back of her head is facing the floor, with her face looking up at the ceiling.
  • Babies in the OP position can be harder to give birth to vaginally.
  • Most times, babies will eventually rotate to a better position as labor progresses.

References

  1. YQ Cheng, et al. The Association between persistent occiput posterior position and neonatal outcomes. Obstet Gynecol 2006; 107: 837-844.
  2. WH Barth, Jr. Clinical expert series: Persistent occiput posterior. Obstet Gynecol 2015; 128: 695-709.

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