Is baby's being in the Left Occiput Transverse (LOT) position and only 4/5 at 40+ weeks a 'bad thing'?

[plasticspoon]

I'm currently 40+2 - had my 40 week check a couple of days ago and the first thing the midwife said was 'ooh, I think the baby's a bit back to back'. She then qualified this, saying that he is lying sideways, head down, looking towards my right hip.

He is only 4/5 engaged and she said that this was because of his position - and that I need to be doing everything I can to shift him.

I felt a bit annoyed and disappointed :( Annoyed because I've been checking his position regularly myself and and as far as I can tell he has been like this for several weeks but other midwives have all said (at 34, 36 and 38 weeks) that he was fine and in a good position. 40 weeks is surely too late to try and shift him from where he obviously so comfy?

I feel disappointed because the conversation seems to have bizarrely (and illogically) started to sap my belief that I will go into labour naturally - like I'm not very competent or something :(

I think the feeling was compounded when she then went immediately on to say that she would book me in next week for a stretch and sweep, another 3 days after that and at that appointment I will be booked in for an induction. It felt like they expect me to fail - and also that there wasn't any choice in what interventions I have when.*

*Of course I know that I do have choices and that I need to consent, but I'm just losing my confidence...

Sorry, all a bit ramble-y!

It's perfectly possible to have a baby move from ot to oa during labour. In fact many do. Some move from op, through ot to oa.

My dd was lot. Nothing I did or could have done moved her from that position.

The sweep/induction chat is just normal isn't it? Once you're 40+ weeks. Not a comment on you or your dc's position.

You have nothing wrong. You are not incompetent. Pregnancy, foetal positioning, childbirth etc, it's mainly down to luck.

Thank you Show - I guess the chat is perfectly standard but this is dc1 so it's the first time for me!

Gah , I'm aware that I'm being totally irrational but you have no idea how reassuring it is to have someone else say it back to me, in nice simple phrases :o very reassuring!

plasticspoon, it has taken 3 years after the birth of my wonderful dd to accept that childbirth is not dependent upon what I did. I didn't get dd into any position, I didn't determine the way I would experience labour, I didn't choose the type of newborn I would have. None of it.

The best thing to do is to go into labour thinking about how you'd like things to be, how you might maximise the chances of that happening, being aware that labour is an unknown quantity and acknowledging what you will do should certain situations arise. And accepting completely that you cannot get this wrong. I promise you that. You don't win or lose, fail or succeed at labour.

You have choices. You don't have to have a sweep. You don't have to be induced. You can ask them to monitor you and discuss reasons why you might opt for induction. But you do have a say over what happens to your body.

It's so normal to feel how you do at the moment. It's because you don't know what will happen. But I promise you, absolutely promise you, that this is just the beginning. It's seems monumental (and yes it is) but the bit that comes afterwards is the truly mind-blowing bit. This is just the journey there.

Hi plastic, just wanted to add my experience in case it's any help...

I was told DS2 was ROA position throughout pregnancy and then in labour was told he was ROT. The thing was I kind of knew he was in a funny position in the last few weeks of pregnancy as his head 'grated' against my pelvis. (!)

Anyway, I'll be very honest with you that the labour for DS2 was painful (more so that DS1) and long... but I managed to push him out myself.

Best advice I can give you is to not be afraid of accepting pain relief. A midwife friend of mine actually texted me in labour and advised me to have an epidural with a head in that position as labour COULD be long and I should be careful not to get worn out. It was the best decision I made as it too the edge off the pain (by no means took it away) and allowed him to turn throughout the labour. I actually felt the turn - it was probably the most painful bit, but it was manageable.

The actual birth was actually easy - pushing for only 10 mins. Having had the epidural I's been able to resist pushing during the labour meaning his head had no swelling etc and literally just popped out. (I say this as a woman who had an epis and forceps first time round.)

A hugely positive experience for me - so please don't think the T position is a marker that things will go 'wrong'.

Good luck!x

Thank you both for your responses. Am I being a total fool hoping to go to a stand alone MLU for the birth? I would prefer to keep pain relief to a minimum but it's impossible to make that kind of call when you have no concept of what pain you might be in!

I have said in my birth plan that if I am in too much pain in the early stages I will go to the hospital instead...an attempt to be realistic. I know I will be disappointed with myself if I do though. Ridiculous!

I guess I'm just used to being able to control/influence what happens in my life through force of will.

I found the hardest thing about labour was the lack of control. I like to be in control of everything in my life. And I wanted to know that I was capable of going into birth and having it the way I had decided. I knew I'd feel I'd failed somehow if I didn't manage the home waterbirth with no drugs that I'd planned.

I know now that I was an idiot. That I had no control over a lot of it and I'd got it wrong. Because while you can't choose the position of your baby or the way you experience contractions or how labour will go, you can choose what you want to do in each given scenario. So you might not want an emcs, but you can acknowledge in your mind that if that's what you need then you can ask for the screens to be lowered, or your partner to have skin to skin or for them not to tell you the sex etc. Disappointment lies in the gap between your expectations and reality when your expectations are things you aren't in control of.

There are people who have babies in perfect positions who go into labour on their due dates with average sized babies. And their labours are difficult and long and intervention-heavy. And babies in odd positions, or bigger than normal, or 2 weeks 'late' and labour is quick and relatively easy.

All you can do is go into it with a plan of what you'd ideally like, and contingency plans for what you'd like if the ideal isn't possible.

Yes absolutely - all the reading I've been doing has felt like I'm preparing for a big exam, or a role in a play. I've had a couple of classic anxiety dreams over the past weeks where I'm on stage but don't know any of the lines.

Your point about childbirth not actually being the point of pregnancy made me smile. I think that many women (certainly in my peer group) have a sort of 'hurdle' mentality to life - we make the effort, put in a lot of preparation, leap the hurdle (get that degree, land that job, get the promotion) - and then move onto the next one. The concept of a child, a new permanent part of your life, is incomprehensible from this side of childbirth whereas birth itself is a nice discrete hurdle to jump. And so it becomes the focus of your energy.

That said, birth is still where a lot of my mental energy is! I have checked over the bit of my birth plan that deals with an emcs and while it's fairly close to the suggestions you've made it was definitely written with an 'I have to put it in but it surely won't actually happen' ostrich-type mentality.

I had that mentality. I was so prepared, so knowledgeable, so well-read, so up to speed on how to have a 'good' labour and delivery that when I ended up with an emcs, I felt I'd totally and utterly failed. And what that meant was that the really important bit, the bit where I should have been enjoying the marvellous experience of raising a wonderful little person, was deeply tainted by my feelings of failure. I ended up with ptsd. Because I thought I'd done something wrong. Because I couldn't do it naturally. Well naturally, I'd be dead. And so would dd.

I know where you are now and tbh having been there, I don't think anybody could have convinced me otherwise. I read through all the cs info the midwife gave me with an air of 'I won't need this but I'll read it anyway'. I wish to God I'd listened.

If I have another, I'll go about it the same way. I'll want the same things. I'll want a home waterbirth. But I will NOT be beating myself up if luck/fate/whatever decides that it's not possible.

My DS was LOT - although noone realised it, but he never really engaged and was bobbing around in OP for a while. I tried bloody everything to shift him from OP, didn't sit on a sofa for three weeks for Christ's sake, but now realise I should have just gone with the flow. I too had that awful pelvic grating feeling and couldn't understand why I didn't want to pace during labour at all, when I was sure it would help.
I never used drugs til 7cm when I found the bliss that is gas and air and was quite comfy (to say I was in labour) mooing in a birthing pool but probably should have used harder drugs as another poster suggested. I used six cannisters of gas and air - and after 19 hours and being utterly exhausted - had to have an emergency c section. They never realised DS who was 98 centile for height and 9 lb 6 was LOT, bloody midwife just thought I wasn't trying hard enough pushing despite me, a first timer saying um I don't want to push something doesn't feel right. Then she burst my waters and he started getting swelling on his head. Not good. Anyway he was just fine, but I felt bloody awful after ending up with a big bleed post section - quite common after extended pointless pushing! But I would do it all again. I'd just spend my final three childless weeks sitting on the sofa eating icecream rather than yoga, swimming and being far too bloody earnest about it all! At least your midwife is aware of the position. Good luck OP.

Poppet, I think we've chatted before. My midwife hadn't noticed dd was lot and I said that pushing felt 'wrong'. I just knew something wasn't right, no urge, odd pain, no feeling of her moving down. 6hrs of pushing and she didn't descend a jot. DD's poor head.

Yes, if I ever, ever, ever have another, I'm not buggering about with all fours and swimming. I'm eating gingerbread and watching Pride and Prejudice on dvd.

Poppet, thanks for sharing your experience, it sounds as though you had a horrendous time and I'm sorry that your feeling that something wasn't right wasn't listened to. Yes, I'm glad to be going in knowing that his position may not be great. 40+5 now and he hasn't moved a jot despite having exhausted myself over the last few days because I felt the implication at my appointment was that I haven't made sufficient effort to shift him!

I've been getting excrutiating rib pain that comes on each afternoon because of the way he's lying and the fact that he's still so high up. When I mentioned it the mw just said that when I get him into the right position the pain will go. Unfortunatley all the forwards positions (and esp bouncing on the bloody ball) make the pain worse and then it affects my sleep. You know what feels really good though - lying down!!

It does seem counterprodutive to exhaust myself just before one of the most intense and physically demanding challenges of my life! I think I'm going to head upstairs for a nap in a minute. :)

Oh just sleep.

I was really surprised in labour that all of the upright, active, forward positions felt totally wrong. I just wanted to lie down. I'd expected the opposite. I knew lying down was 'bad'.

Just to reassure you, dd's difficult position and emergency delivery wasn't because she was LOT. She was also asynclitic!

The obstetric consultant I saw recently for counselling said that he never assumes LOT is a bar to vaginal delivery and that the problems I had weren't due to the LOT position (though she did end up in something called deep transverse arrest).

Plastic spoon it really wasn't horrendous. Honest, really, really. And as it was my only shot at labour so far I don't have much to compare it to. But I'm hoping for another baby at some point and would pick a VBAC over a c section. Stumps we have indeed bumped into each other before on the LOT threads, six hours of pushing. Christ. I've had the deep transverse arrest thingie mentioned too by one of my midwifes after the event, but can't for the life of me find out what it was? Do you know?
And yes plastic sleep, eat lots of junk food to build up some energy stores for labour, and enjoy some quiet moments on the sofa.

I was told the same thing, having been told the baby was in perfect position before. Went into labour naturally and midwife on ward said...baby in perfect position as far as she could tell. And that's the point, they don't know for sure.

You are where you are. Don't panic, listen to the midwife on the day and listen to your body.

I lay down on my left during the last couple of hours of labour - just fancied it. Then when things really got going I was up on my knees leaning against the back of the bed breathing on that wonderful gas and air.