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A new perspective on an old problem.

Article Excerpt
For as long as I have been involved in birth, the link between back pain in labor and a baby in an occiput posterior (OP) position has been assumed. We have talked with our students and clients about the challenges of laboring with a baby in this position: dysfunctional labor patterns, failure to progress beyond a certain point, and back pain that can occur with contractions or persist continuously until the baby rotates. However, the majority of us who attend women in labor have likely witnessed those labors that defy this logic. We've seen women exhibit signs that the baby is OP with no significant discomfort in their back. Perhaps the labor was very slow and irregular, or the contraction pattern had the tell-tale sign of coupling (a repeating pattern of two contractions close together, sometimes the first being stronger than the second, followed by a longer break), or the baby failing to descend beyond a certain station regardless of all of the mother's efforts. We have also seen women go through what seemed to be a completely normal labor with effectively progressing contractions and not a single sign of labor dysfunction, but the mother struggled with excruciating pain in her back for some or all of her labor experience.

I have seen both of those scenarios play out many times over the years. And I have been most struck by those occasions where my client's labor was progressing normally but with a lot of back pain, and a nurse (or doctor, or midwife) would enter the room, notice the back pain, and make a statement about the baby being OP even though there was no other evidence to suggest that that was the case. This got me thinking.... does every OP baby cause back pain and a more difficult labor, and does every labor where the mother experiences back pain have a baby in an OP position. That connection has been assumed for as long as I can recall, but time and experience have shown me that that connection cannot always be assumed.

In May of 2005, Dr. Ellice Lieberman, et al, published their study "Changes in Fetal Position During Labor and Their Association With Epidural Analgesia" in Obstetrics and Gynecology, the journal of the American College of Obstetrics and Gynecology (ACOG). While the intent of this study was to identify the relationship between fetal position and the use of epidural analgesia, contained within this study is interesting and thought-provoking information about the relationship between fetal position and labor outcome as well as the connection between fetal position and the woman's experience of labor.

The study included 1,562 women experiencing their first birth with either spontaneous or induced labor with a single fetus at term (37 to 42 weeks gestation). Each woman received an ultrasound exam to determine...

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