Back to back babies during labour - Is enough to being done to detect and support

[NurseryRhymesStuckInMyHead]

Just wondering whether others who had back to back (OP) or ROT or LOT babies found that their local maternity services had the skills to detect and support labour in a way that would give mothers the best chance of avoiding interventions during labour in these cases?

My experience was that even though the labour played out as a textbook OP (anterior placenta, start stop extremely long early labour, very slow active labour) OP was not detected until very late (8cm dilated) and then no one told me and no one even suggested trying some different positions that might help the baby turn... Such a shame really as these births seem to have a much higher rate of intervention so really I could have done with all the help I could get! Did anyone else have the same experience?

I know some babies turn easily on their own so I'm not suggesting interfering if things are going well anyway, but if they are not progressing wouldn't it be good to have someone skilled to suggest some different positions, not do ARM, do anything else that might help before interventions?

I am currently 40 + 5 with my 1st baby and was told yesterday that baby was OP, after being told consistently he was in perfect position since 34 weeks.
I was sent off to lie on a ball, told to expect a long/hard birth, consider an epidural and wait for an induction next week.
I left the appointment feeling pretty disappointed, unsupported and feeling like I wouldn't go into labour myself before next week.

I will check out spinning babies, squats and scrub some floors in the meantime but does anyone have any tricks that worked for them to encourage baby to move?

NurseryRhymes - I think it is luck of the draw with the skills of the midwives involved irrespective of where you give birth. Luckily for me DD never dropped her heart rate so I was allowed to carry on and progress at my own pace without intervention. Some of the things I have read on this thread really ring true for my experience, namely vomiting, no let up of pain between contractions, severe back pain and how awful contractions were sitting down (the journey to hospital was the worst part).

I'm due in April and as I have moved to a city with no midwife led unit (pretty crap service provision given it's the third largest city in the UK) I am planning a home birth. I have met the midwives who will look after me and they seem very knowledgeable and experienced, so fingers crossed for a good birth.

This thread is really bringing back memories for me and explaining a lot of what I went through. I came away from first labour feeling completely traumatised and although I was told baby was OP, no one told me what this meant or told me to get in any different positions. I also couldn't sit or lie down and the hospital transfer was awful.

Reading that first link on this thread has explained it all to me and now I can make some sense of the agony I went through. I had 12 hours of agonising labour at home before hospital transfer. Thankfully then an epidural, but had to have the drip to speed up contractions. Epidural wore off after 8 top ups, agonising pushing stage, rushed to theatre for spinal in prep for C Section but they managed to get him out with episiotomy and forceps. I remember telling DP that he could break both my arms and it wouldn't come close to the pain I'd just been through.

I'm now 34 weeks with DC2 and starting to panic about labouring again. At least this time I'm more informed and can hopefully ask the right questions.

NurseryRhymesStuckInMyHead I knew she had turned back to back because I could feel loads of kicks and stuff on the front of my belly - I can't remember if I mentioned it to the home midwives but I assumed they knew I thought it was obvious. I remember at the hospital feeling a bit better because they mentioned she was OP straight away and said that I was coping very well(haha)

I'd heard about the ARM thing before, it makes sense. I imagine a lot of typical OP labours end up being augamented with the drip which you have to have ARM if your waters haven't gone already.

Out of my antenatel class 4/5 of us had OP labours. 3/4 where c-section/forceps and could be described as bad labours. 1 had a lovely sounding waterbirth. I don't think an OP baby is a sentence to a shit labour but it deffo increases the odds. And I thought about 1/10 labours the baby was OP for most of the labour, so they're not exactly rare. Someone on here mentioned the other day that 75% of OP labours ended in C-section. If that's the case why don't they offer you one after you've been struggling for a few days. You wouldn't have to have it. But I would have jumped at the opportunity and a section after 2 days of labour would be shit loads better that one after 4 days for me.

I am very pro natural birth but I got to a point where I was like - this just isn't working.

I think mine could have been loads better if I had some slightly more sympathetic care, and maybe some pethidine or something so maybe I could of got some sleep earleir on? I don't know, but surely more can be done.

Another OP here. I had no idea till the midwife said it during labour.

Nobody suggested any different positions to move it. This was a midwife-led birth.

I soon asked for an epidural and after that I was hooked up to a drip and had to be on my back anyway.

They made me push a lot to encourage him to turn around. I reckon I was pushing for an hour and a half on and off. But because of the epidural it wasnt painful, just knackering. He turned halfway around with the pushing, but it had to be ventouse to get him out.

I really hope this next one isnt back to back. I'll be hyperaware of it this time.

I think DS1 must have been back to back as all my contractions felt like someone was ramming a red hit poker right into the base of my spine and the monitor didn't pick up the contractions very well. It was horrendous and I ended up with an epidural then episiotomy and ventouse. DS1 got distressed, ingested Grade 3 meconium and ended up in NICU for a bit. No-one ever mentioned him being B2B though so I don't know for certain. My contractions with DS2 and DS3 weren't like that at all just like really bad period cramps. TOTALLY different.

Murkhan Try all the spinning babies stuff but don't be disheartened if it doesn't work. It's not a guarantee of a shit labour, and they might turn as soon as you go into labour - it's very unpredictable.

When I did antenatel classes they implied that if the baby was back to back it was because you'd been sloughing too much the shape of your uterus and the position of the placenta play a big role I was told, by an Ob, afterwards.

slouching not sloughing ffs

Ironically, the pain relief from epidurals tends to be less effective with an OP baby. There is often a need for frequent re-dosing of the epidural, and pain relief can be spotty, with "windows" of sensation. No one is quite sure why this happens, but it probably results from a lack of uniform distribution of epidural meds because of the pressure from the baby's head against the mother's spinal column.

OMG, this happened to me! My epidural was all spotty and had to be topped up 3 times!

Still though - couldnt have done it without it tbh.

I knew for a few weeks beforehand (overseas where they do scans at every appointment) and no one seemed that bothered by it. I had read up a lot so was desperately trying all of the exercises to get him to turn but no luck.
Labour was constant pain once it got going. Too much lower back and bum pain between contractions toget myself ready for the next contraction. The midwife only got interested when I said that the pain in my bum was making me strain like pooing. Then she made me get out of the water and walk two and a half thousand miles to the bed for an exam. At that stage was 7cm so screamed for an epidural. Resulted in hours of upping and downing pitocon before they finally decided he wasn't coming out alone so emergency csection.
If I had been given support and advice in getting him to turn in the prior few weeks it could have been a totally different experience.

Having said all that, it was still the most amazing experience in the world to have my little man in the world with me and that's still the strongest memory from that time, lying in bed all night staring in wonder at the little gem in my arms

In answer to the OP, my experience with my DS1 was, no, they did not. After contracting for a day and a half and into my second night with no sleep I was admitted to the MLU within hospital in the early hours of Sunday morning. On examination I was 4cms and they did mention he was OP, maybe LOT but 'should' turn. I don't believe it was mentioned again. About 6 hours later I was still around 4cms so they did AROM. I wasn't having a classic 'back' labour as I didn't have pain in my back. Labour still progressed slowly, I was upright and mobile and spent some time in the pool. Got stuck in transition with anterior lip for 2 hours, wanted to push but not allowed. Finally 48 hours after contractions began I was fully dilated. After 2 hours of pushing with intense pain in my hips and pelvis and DS1 going nowhere midwife examined me, said baby was now OA, and told me, not terribly nicely, that I was exhausted and would need to be admitted to labour ward for ventouse. Upon arrival in labour ward registrar examined me, immediately identified DS1 was stuck LOT and also asynclitic (head tilted to one side). Signed consent for spinal block, high rotational forceps and EMCS if forceps unsuccessful. Further 2 hours of delay and faff in theatre as registrar called away to deliver another baby, DH in tears in another room thinking DS1 and I were dead, DH called in, DS1 rotated with keillands forceps and yanked out, 52 hours after first contraction. We were both ok but he had a massive bruise on his head, presumably where my pushing had driven him against my pelvis. Horrid experience and I still feel bitter that I was made to think I was too crap to push him out by midwife and my notes had 'failed to progress' all over them. I really couldn't believe that the midwives were so blasé about something as vital to delivery as the baby actually being in the correct position.

I gave birth to DS2 less than 2 years later, which was very different. He was also LOT on arrival at hospital, but I had only taken 6 hours to get to 5cms this time, he arrived OA 2 hours later, my waters stayed intact until just before 10cms.

Now 27 weeks with DC3. I know I have anterior placenta this time so feeling a bit (DS1 was anterior placenta, DS2 was posterior). I'm under a different PCT now as we've moved house so we shall see how things go this time.

But yes, considering that a large proportion of EMCS and instrumental deliveries (certainly amongst my friends) are due to OP and other variations, it seems odd that this really doesn't seem to be taken that seriously.

Oh, and I learnt last week that there is apparently no actual solid evidence that performing AROM speeds up labour, and as I sometimes wonder if that was what stopped DS1 from turning OA himself, I feel pretty pissed off that I had what could have been such a counterproductive intervention.

I had no idea that was why I couldn't sit or lie in labour. The journey to the hospital was horrendous. I could only manage the contractions on all fours. Towards the end they had to lie me on my back for the episiotomy and it was just awful, both me and my dh were traumatised because I was screaming with pain and he couldn't do anything but hold my hand. It wasn't the episiotomy that was painful that was absolutely fine. It was being turned onto my back

My first was OP. I knew before labour that she kept moving into a sideways position. She would move round if I did the right exercises but always slid back round again. I think it was the stupid anterior placenta getting in the way.

My labour wasn't stop start but all the pain was in my back and arse and she eventually got stuck. In retrospect the midwives knew because of the positions they got me to try, and between that and an episiotomy I was able to deliver.

Nobody said anything about her position during the labour. Having just read Juju Sundins chapter on posterior births it would have really helped to have had that advice. I was at home using just a birth pool, hypnobirthing and gas and air. I was in total agony and very traumatised / felt like a failure. If someone had given me Juju's advice, that posterior births are a totally different ballgame, and not 'healthy pain' I would have felt much better about deciding to go to hospital for an epidural, which in retrospect is what I should have done.

6 months pregnant with number 2 now, thankfully have a posterior placenta this time. Still going in for an epidural though!

I had a similar labour with my DD1 to many described above and only found out that she was in OP in a birth debrief last week, 3 years later. No one mentioned it at the time and I was screaming and screaming from the very beginning. I eventually got an epidural and she was pulled out with mid cavity forceps but they let me labour on my back and never mentioned her position. Every contraction felt like my bum was exploding!

I'm due with DD2 next month and am having an ELCS. Both times I have had an anterior placenta so I'm very pleased with my choice. I agree that more needs to be done support OP labour.

No I had no advice or assistance at all. The first MW admonished me for wanting pain relief, didn't believe i was having proper contractions as they were all over the place so wouldn't examine me, didn't believe i was in constant pain not just when the contractions peaked. All fairly classic signs of back to back labour i was later told. The second one went AWOL so not only was it back to back but I had no MW assistance for the delivery, didn't know when to push etc, I panicked abit and just pushed and pushed. Ended up tearing quite badly.
Took me a long time to get over. My mum thought DD was dead when she was born. I think we were very lucky i didn't need any intervention as no one was there! DP hit the buzzer but no one came. He went out to the nurses station too but couldn't find anyone. It was all fairly horrific actually. Unsurprisingly I suffered PND and PNA after. I still feel bad it took months for me to love my daughter.
I later learnt the second MW had been 'let go' though as she really wasn't fit to have ladies placed in her care.
If I and them had known DD was back to back I'm sure it would have helped.
With my next two births I asked, constantly, how the baby was positioned from about 36 wks!

So did we all have an anterior placenta?

I knew that from early on in the pregnancy but had no idea it increases your risk of OP.

Yes I did Anna and do again for this pregnancy

I was induced with a very large OP baby, which ended in EMCS. I share many of your concerns about a seeming lack of interest in detecting this malpresentation and also have a few issues with how I was cared for in labour (I've had a few threads on here so some of this may be familiar!).

I went into labour after one pessary, but actually my contractions were quite manageable with a TENs machine. Don't get me wrong, they were sore, but milder than I'd been expecting. I couldn't lie down because it made them much worse, so I bounced away on a ball all night and in the morning was 8-9cm dilated. I had been very wary of induction, and asked if I could continue as I was making good progress, but was advised by the registrar that once down the "medical" route it was best to continue on that path, so she carried out ARM.

Until this point, no-one had mentioned baby's position, and I believe that ARM was then responsible for baby being unable to turn. I made no progress in the next two hours, so the syntocin drip was started. Very quickly the pain became unbearable. It's fuzzy now, but it was like constant agonising pain rather than contractions, and it felt like the bones of my pelvis were getting ripped apart (I saw someone else comment about pelvic pain). They realised baby was OP, but the only position they put me in was draped over the raised back of the bed. I don't think the machine was registering my agony supposed contractions properly either. Eventually it did, but baby wasn't descending. I refused Kielland's forceps and had a c-section.

I would like a VBAC next time, but I am concerned about ending up in the same situation, as I recall reading that once you have had an OP baby, you have an increased risk of having another. To be honest, I felt like the hospital's method of dealing with it was to take no notice, as if need be they could always do forceps/cs - surely prevention is better than cure? I will be religiously carrying out all the stuff on Spinning Babies next time, that's for sure!

Oh and I didn't have an anterior placenta either.

My son and first dc was back to back but I had no idea until his head was out with the assistance of a doctor armed with ventouse suction. "Oh that'll be why you had a bit of trouble Gaston!" they said flippantly.

(I don't know the location of my placenta either, I can't remember being told.)

The 'bit of trouble' I had was actually an extremely long labour over 4 days, being turned away from the hospital twice in constant pain with really slow progress before finally being admitted because ds had passed meconium inside me. I was given an epidural and ended up with an episiotomy and ventouse because ds was distressed and his heart rate plummeted.

I put all my trust in the midwives but was told I wasn't in proper labour and that I didn't know what pain was because it was my first.

My other op baby was my last one. I knew I had an anterior placenta and I knew that she wasn't in a good position. I was booked in for a home birth. Progress was too slow and I transferred to the hospital where I was put on a drip to speed things up. The pain was excruciating in my back again but I did it with gas and air. I had to have an episiotomy right at the end but fortunately the cut was really small. It wasn't as long, I'd only been experiencing pains for a couple of days and active labour was 10 hours. At no point did anyone mention that back to backs are hard or long or particularly painful.

I don't know if it's relevant but the back to back ones were 9lb 2.5 and 10lb 5.

Burton your post really resonates with me - as do many of the others - it's not on that a woman in labour can be treated like, frankly, a fool who didn't know if she was in labour, didn't know if she was having contractions or not, and was a bit pathetic/a wuss, without someone thinking to check the position of the baby - it's shocking really. I wish I'd made more of a fuss about it afterwards. I did have a call from the hospital when DD1 was about 2 months old asking if I had any feedback, I let them have it! but I wish I'd put something in writing.

It's been quite therapeutic writing about it, it was 4.5 years ago now. I was so shocked in my second labour when the pain stopped between contractions! I do feel if it happens again at least I'd be able to recognise it.

All three of mine were OP and fairly large. I knew well before the labours and tried various positions to move them to no avail. Mine were probably OP because I have hypermobility so just had too much room at a time when they should be being pushed into position. On the other hand all that flexibility and stretchyness meant that I had no trouble giving birth even with their positions and weight (gas and air and 12, 5 and 4 hour labours)

I just saved up the pita by having to have surgery for a double prolapse after I had my last child - started prolapsing after DS1, but no point in surgery until after I'd finished having children.

WhoTheFuckIsSimon - I know it can be hard to be sure the baby is OP but that's no excuse for the stories here. In most cases they were multiple signs so they could have at least given the benefit of the doubt, listened to the woman, offered support and understanding, monitored closely, suggested trying some positions or maybe held off ARM. Would any of that hurt even if it turns out the baby is not OP? No it wouldn't. But it would make all the difference if it turns out to be OP. Might even reduce the rate of interventions & maternal trauma in these cases.

Anna I'm not actually sure what the position of my placenta was.

Slice You've hit the nail on the head there. So many similar stories here, I feel so angry.

I put all my trust in the midwives but was told I wasn't in proper labour and that I didn't know what pain was because it was my first.
This is so sad - you were let down Gaston.

My labour was 3 months ago, this thread inspired angered me enough to get in touch with the one2one midwife service I used to try and talk it through with someone. I chose One2One care over the standard NHS community midwife care because they're supposed to provide more 'woman centred care'. The Head of Midwives wants to talk to me, I'm going to put in a complaint about the midwife who laughed at me. I feel like making them read this thread. I've also got a debrief with the hospital next month so will be interesting to fill in a few gaps.

Dc3 was back to back, and the midwife said my symptoms implied that she was still bank to back, as my waters broke early, and I was having a mini contraction between the main contractions. I knew what position to aim for, and the midwife suggested the same position, and baby was born easily within an hour...