What is a posterior baby?
Posterior baby refers to the position of the baby in the mother's pelvis at the time of labor and delivery. In a normal presentation, the front part of the baby's head is presenting facing the mothers back. This is ideal because the smallest dimension of baby's head leads the way through the birth canal. The technical terminology is OA, ROA or LOA. This refers to occipital anterior, right occipital anterior or left occipital anterior. Occipital is the part of the scull that is presenting. If the baby is posterior, the front part of the head is facing the front of the mother's pelvis. This causes pressure on the sacrum resulting in severe back pain during labor, and slow progression of labor as the wider diameter of the baby's head has to navigate the way through the birth canal. The technical terminology for this is OP, ROP or LOP. This refers to occipital posterior, right occipital posterior or left occipital posterior. Most babies will turn at some point during labor, however it is possible and more difficult to push out a posterior baby.

What is the incidence?
The official numbers are that 15-30% of babies are posterior at the start of labor. However some people will say that the incidence is much greater.

How do I know if my baby is posterior?
Sometimes it is hard to know before labor starts, but typically if you feel lots of hands and feet on your belly, this is an indicator.

What can I do to prevent a posterior position?
There are some things you can do to prevent your baby from getting comfy in a posterior position. Starting about 6 weeks before your due date, lessen the amount of time you sit reclined on your comfy couch. (Easier said than done, right?) It is better to sit on a firmer surface, leaning slightly forward. Spend some time each day on your hands and knees, doing pelvic rocks or tilts (arching and rounding your back). Get a birth ball or exercise ball and spend some time leaning over it. You can also pile up pillows, make sure to have some for your knees!

It is important to note here that you may not be able to prevent this completely!!!!!!! So do not think that you have done something wrong, or have not done enough. Some babies will be posterior and that is that.

What if my baby is posterior at the start of labor?
Well, in early labor you can spend lots of time on hands and knees, doing pelvic rocks or tilts. This will alleviate some of the pressure on your back and help the baby to turn. Try the open knee chest position, with your head on the floor/bed (on a pillow please) and with your bum up high in the air. Between contractions, you can try abdominal stroking in the direction the baby should turn. You need to know the exact position of the baby, your midwife or doctor can help with this, and if the baby is ROP (right occipital posterior) stroke right to left. If baby is LOP (left occipital posterior) stroke left to right. You can also try abdominal lifting between contractions.

In active labor try a warm bath, on hands and knees, with a cold pack on your back. This will help with discomfort and also encourage the baby to turn (away from the cold, towards the warmth). Try side lying; again lying in the direction the baby needs to rotate. Kneeling and leaning forward, some firm pressure on the sacral area is helpful for some women for pain relief. Or slow dancing with your partner, arms around their neck, knees bent slightly swaying from side to side.

At some point the baby will hit a point of resistance and turn. Some women do push out posterior babies. This makes for a long second stage (pushing) and good support is vital.

I would like to note that there was a study done that showed that 19% of women with epidurals had a posterior baby persisting in 2nd stage (pushing) compared with 4% of the non-epidural group.