Can an OB or Midwife tell if a baby is posterior...

[Hope44]

Just by an exterior exam?  How is that possible?  I had two posterior babies, but none of my doctors predicted the face up presentation until the last stages of labor.  I have a friend whose midwife has told her that her baby is anterior and she can tell just bey feeling around on her stomach.  Is there such an exam that doctors and nurses use to determine this?  

[EmseB]

I could generally tell, based on where the bottom was in relation to the kicks, and if baby is anterior you can feel the curve of the baby's back.

[beaners]

The spinning babies website talks about figuring out how a baby is sitting and things you can do to make it easier to get the baby in a good position for labor.

[Soror]

I could usually tell with my own babies and my midwives were much more adept at it than me. Feeling around enough you can tell what part is where. My oldschool ob did some external palpitation as well but most OBs are so used to using the ultrasound they don't bother. Now, you cannot always clearly tell and sometimes an ultrasound is required, I've heard about some midwives referring when the babies position was ambiguous.

[happypamama]

Sure, sometimes they can tell easily, based on where kicks are and all. If you have a lot of solid masses, that indicates anterior more than a lot of little knobs and bumps, which can indicate posterior. They could tell my DD was posterior and tried to get her to turn. She never did and was born sunny side up. They were also able to tell that she was breech at 34 weeks, and I could tell that something had changed a week later; they confirmed that she had indeed turned head down, where she stayed. I could generally tell pretty decently where my babies were -- all five tended to hang out a lot in the same spot, curled up on my left, with their feet out to my right, little butts under my left ribs -- although they moved around a lot too.

[momacacia]

Midwives yes, OBs I'm not so sure. I think they rely more on u/s than the "old-fashioned" skills.

[fruitofthewomb]

My OB was close to retirement age & very experienced & he could tell the exact position of thee baby. I have seen it confirmed numerous times by u/s over the course of 5 pregnancies.

[SproutMamaK]

My midwives could always tell. One of my OBs could tell as well, but in early pregnancies I did have some less than stellar OBs who wouldn't even try and would order ultrasounds to determine baby's position. Not sure if that was due to lack of knowledge/training in that regard, lack of confidence, or CYA legal reasons.

[TechWife]

My OB could tell from an exterior exam by the way the baby moved his head. 

[Hope44]

Well, I appreciate the info.  I think what I meant is that my doctors did not say anything about the presentation until I was pushing.  I will say though, all of my labors were exactly the same and I felt no differently with the face up babies than I did the face down.  All were long labors but no back labor.  

 

Please, let's not slam OB's. I think they're quite capable and were very necessary part of my delivery.   Perhaps they did know early on about the facial presentation of my babies, but I didn't ask.  I didn't know there was a way to know this without an ultrasound.  I did ask about breech and head down though and that information was given to me.   

 

Also, no...I don't think unless you're high risk OB's ask for ultrasounds in the last weeks of pregnancies.  

[redsquirrel]

They can tell by feeling.  And I think sometimes baby turn during labor and end up posterior when they didn't start that way.  I remember a midwife talking about a birth and saying "and then the baby turned so it now it was posterior' 

 

 

[happypamama]

Well, I appreciate the info. I think what I meant is that my doctors did not say anything about the presentation until I was pushing. I will say though, all of my labors were exactly the same and I felt no differently with the face up babies than I did the face down. All were long labors but no back labor.

 

 

My posterior babe was my longest labor, but it was also my first baby, and at 11.5 hours, that really wasn't terribly long. In a lot of ways, it was my easiest labor. I was able to rest and even doze a bit. I had a bit of back pressure that probably was back labor, but it wasn't excruciating. My second labor was harder, even though it was only seven hours. He was anterior, but he was also really far forward on my pubic bone, and getting his head off of it and under was hard. Needless to say, I stopped worrying about posterior vs. anterior after that!

 

Otoh, I've had friends who had terrible back labor with their posterior babies, and their babies really needed to turn before being born. Everyone's bodies are just shaped a little differently, and those little differences can mean big differences in labor!

[xixstar]

I found this pretty helpful for how position is determined via palpitation:

 

[Hope44]

Wow very helpful video!  It all makes sense too!  Thank you!

[Kerileanne99]

Such a fun video xixstar:)

 

Hubby and I just watched and played a bit on my 33 week belly...

[KungFuPanda]

Mine could tell. My last baby was breech near the end, then flipped to posterior just a day past his due date. About 3 days past my due date the midwives got him facing the right direction. They tried physically turning him, but it was too uncomfortable for me because he was huge. In the end I did some exercises and he managed to get flipped around. Back labor disappeared after that.

[SproutMamaK]

Please, let's not slam OB's. I think they're quite capable and were very necessary part of my delivery.  

 

Oh, not slamming OBs - I LOVED my last OB, she was amazing. I had two before then that were horrible, lol, but that wasn't a general problem with OBs, I just had back luck of the draw with OBs in my area (one was fired, then replaced with the other who was also later fired, lol). A good OB can be a miracle worker, sometimes literally.

[dirty ethel rackham]

I don't think it is very common for OBs to be concerned about presentation unless the baby is breech or transverse.  Their rationale is that if labor doesn't progress, they use Pitocin.  If it goes on too long, they do a c-section.  They typically don't learn the skills that can help a baby get into a better position to make labor go faster, better (many of which require the mom to be out of bed or more ambulatory.)  It is within a midwife's skill set to know how to help a baby get into a better position to help labor move a long/ be more effective. 

[Hope44]

My OB's ALL had me walking at the hospital and doing everything I could on my own to help labor along on it's own.  None of them EVER just "popped" pitocin to get things to move "faster."  Their concern for my well being and my infants' was superb.  Not once was I ever just treated like a number.   I'm glad they had the education and skills set to handle the emergencies that presented themselves all during labor with ALL of my normal, low risk pregnancies.  I'm sure there are great midwives with proper medical education who work hand-in-hand with OB's.  I respect their hard work and their skills.  Two of the practices I used had CNM's on staff.  

[Tsuga]

I don't know about in general.

 

It is certainly possible to get a very good idea if you are trained to do so. Nothing is 100% but sometimes it is very obvious.

[Heather in OK]

Answering as a midwife, absolutely you can tell by palpation!!!  Usually it's very, VERY obvious.  All you feel are "parts".  :)  No smooth back along either side or anterior.  Just a squishy belly with lots of little bumps (limbs).  

You can also see it just by looking at her belly when she's laying on her back.  If you are listening to the heart tones carefully enough you can tell that way.  An OP baby's heart tones sound further away b/c you don't have the doppler right up against baby's back.  And of course asking the woman where she is feeling fetal movement will tell you quite a bit about the position.

However, palpation is a lost art with many medical doctors.  They rely quite heavily on ultrasound to tell baby's position.  Many times (and I know b/c I've watched OBs do it) when they listen to heart tones, they are picking up the cord sound, not against baby's back over the heart.  There is quite a distinct sound difference between the two.  So even if the OB picks up heart tones that may seem like baby is anterior, you can have an OP baby.  

By palpation I can also estimate a baby's birth weight.  I usually get within a few ounces if not the exact weight.  Yes, really.  ;)  

 

[simplemom]

I don't think it is very common for OBs to be concerned about presentation unless the baby is breech or transverse. Their rationale is that if labor doesn't progress, they use Pitocin. If it goes on too long, they do a c-section. They typically don't learn the skills that can help a baby get into a better position to make labor go faster, better (many of which require the mom to be out of bed or more ambulatory.) It is within a midwife's skill set to know how to help a baby get into a better position to help labor move a long/ be more effective.

My OB doctor suspected posterior position during my 1st induced labor (didn't check by US or palpating, just thought so from my back labor, the length of labor, and maybe feeling the fontanels on the baby's head when the baby's head moved down some late in labor). The OB had me lay in a position called pretzel position. I layed partially on my stomach with a pillow toward the side and bent one leg up (I guess I was supposed to resemble a pretzel in some way?????). After about an hour in that position, I heard a huge amount of static on the baby monitor machine like tHe earth was moving inside me <<<exaggeration>>>. I couldn't feel much because they had given me extra epidural medicine. When the baby was born, he was born facing down. I suspect he flipped while when I heard all the movement on the monitor. But we don't know that for sure. I do think if the baby was posterior prior to doing the pretzel position, the OB saved me from a C-section from having me try that position. I had very low amniotic fluid and a stressful labor. I am convinced my baby couldn't had handled the extra long pushing stage that usually happens with a 1st pregnancy posterior birth.

[Heather in OK]

Ellen said OB's TYPICALLY don't learn the skills.  She didn't say they never do and it doesn't mean there aren't OBs out there who don't [edited that from "do" to "don't" as I mistyped] have those skills.  

And typically OBs do not take the time with women during labor like a couple of you have mentioned about your OBs.  You had gems!!   :)  OBs like that are very, VERY rare.  

 

[simplemom]

Ellen said OB's TYPICALLY don't learn the skills. She didn't say they never do and it doesn't mean there aren't OBs out there who do have those skills.

 

And typically OBs do not take the time with women during labor like a couple of you have mentioned about your OBs. You had gems!! :) OBs like that are very, VERY rare.

 

 

I agree with this, I was actually an OB nurse at a different hospital a few years prior to this delivery. I had never heard of the pretzel position prior to my own labor experience. I had the best L&D nurse in the world who said she thought it helps in some cases. But typically what was described as the standard "labor didn't progress after Pitocin which max rate so off to the C-section suite is sadly the more common scenario. The OB that delivered my son also did high forceps instead of letting me push much at all....ONLY because he was very skilled in forceps delivery and he suspected the baby's heart rate would drop with too much pushing. He didn't want me to end up with an emergency C-section. He knew I wanted the lowest intervention birth possible and that unfortunately wasn't happening. A different doctor in the practice told me she wouldn't have tried the high forceps delivery, but would have likely suggested a C section vs. me pushing if she was on call, but she agreed that my particular OB had the best skills in forceps delivery within the hospital. I am thankful that the C section was saved as a last resort in my case, but agree elsewhere a doctor may not have tried repositioning for optimal labor and a risky forceps delivery. Also, they gave me a day and half for the Pitocin to get me from 1 to 10 cm as long as the baby tolerated the labor, and a more typical OB would have declared a C section necessary after 8-12 hours of trial induction.

[wendyroo]

My OB was very good at knowing baby's position and size by palpation.  She estimated each of my babies' birth weights to within a few ounces.  However, if one of them had flipped sunny side up between my last prenatal and labor she would not have had a clue because she certainly wasn't hanging out palpating during labor.  By the time she came on the scene, anterior or posterior was fairly obvious because the baby's head was half way out and you were either staring at eyes or hair.  

 

(Okay, that is a bit of an exaggeration, but with each of my deliveries, the OB did not enter the room at all until 3-5 minutes before crowning.)

 

Wendy

[Hwin]

Regarding your original post, I have only ever palpated my own belly, and my anterior babies were a lot easier to figure out than my posterior baby. The baby's bottom is relatively easy to find and then you can kind of feel down the back. With a posterior baby, there are more body parts (knees, hands, feet, elbows) that could be mistaken for something else.

 

I remember asking a friend (when I had only carried anterior babies) how a woman could NOT know the position of her baby. Then I had one of those fun sunny side up newborns and, boy, was he a puzzle.

[Hope44]

All of my OB's were consistently in and out of my LDR caring for me and delivering others. I had five babies at three different hospitals in different states.   My first delivery I was scared out of my mind, thanks to the instructor of the childbirth classes about even an IV or having my blood drawn and was quite sure if I had an epidural I would be paralyzed, or my labor would be extended, or my baby would be unresponsive.  I was also told on no uncertain terms by this same coach all I needed to do would be the proper relaxation and breathing techniques, and I would have an event free delivery.  

 

Back to my original question, that video really helped!  I also am now reading babies can definitely turn anterior or posterior during labor.  So, even though baby can be face up at one appointment late in the pregnancy, he/she could turn during labor.  Interesting!  

[BrittanyM]

My midwife could tell by palpating. My OB never bothered to touch my stomach without the US wand, so I doubt he can.

[sbgrace]

Well, I appreciate the info.  I think what I meant is that my doctors did not say anything about the presentation until I was pushing.  I will say though, all of my labors were exactly the same and I felt no differently with the face up babies than I did the face down.  All were long labors but no back labor.  

 

Please, let's not slam OB's. I think they're quite capable and were very necessary part of my delivery.   Perhaps they did know early on about the facial presentation of my babies, but I didn't ask.  I didn't know there was a way to know this without an ultrasound.  I did ask about breech and head down though and that information was given to me.   

 

Also, no...I don't think unless you're high risk OB's ask for ultrasounds in the last weeks of pregnancies.  

 

I am sure my OB new my baby A (twins) was posterior, because we had to have so many ultrasounds toward the end, and he had dropped into the birth canal around 24 weeks. She never said anything to me, though, until he got caught during the pushing phase (persistent occiput posterior in the notes).