In this month’s edition of Essentially MIDIRS, independent midwife Chris Warren explores the incidence of posterior positioned babies at term. Read on for a sneak preview of her article.

Helping or hindering occipito-posterior babies by Chris Warren.

“Two women in my pregnancy group had been told that if their babies were still posterior at 38 weeks, they would be offered an elective caesarean section. I am really horrified that there doesn’t seem to be the skills to help women birth posterior positioned babies and that there is a lack of knowledge on how to support these women, or the knowledge of when and which low-tech midwifery interventions might help keep things normal…”

This article was triggered by the above email, which I received from a birth educator in October 2011. Occipito-anterior (OA) is the most common position for a baby to be in at the start of labour. Seventy per cent of all babies present in the OA position at term — this is the most commonly quoted statistic, but is likely to be a ‘guesstimate’ (Johnstone 1926, Henderson & Macdonald 2004). Posterior positions are less common but are not, in my view, malpositions and are certainly not a deviation from normal.

The incidence of OP positioned babies at the start of labour is unknown and not well documented. Estimates in the midwifery literature vary from 10-30%. Just because something is less common does not make it a deviation from normal. To return to the quote at the beginning of this article, why are women being offered an elective caesarean section because their baby is in a less common position, when most will progress to a spontaneous vaginal birth?

To read more on this and other topics, make sure you have your copy of this month’s Essentially MIDIRS.

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