cephalic OP position and pushing, what is the best position for mom to push?

  1. I'm back in the saddle again in OB/LDRP. Been out for seven years. Just had a delivery where the baby was OP. I tried putting mom on her right side with left leg extended up. (Held by dad). Yet she still seemed to not be able to push well. She had a good epidural working. Any suggestion for future reference?
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  2. 12 Comments

  3. by   CA CoCoRN
    I don't push epidural pt's until they've labored down to the lowest station they can. With a good epidural, the pt's not feeling much, so you can afford to let her body work, efficiently, hopefully without too much discomfort. Especially with a fetal cephalic OP lie. I would flip her back and forth, back and forth, back and forth.

    (For pt's who don't have epidural, I even get them on hands and knees or standing on the bed, squatting, to try to get that baby to turn. Hopefully she's got an adequate pelvis to get that baby a-turnin'.)
    Then, once her body's advanced the baby to the lowest possble station without her help, ONLY THEN will I start pushing with her. Otherwise, if you start pushing too early, you're risking maternal exhaustion (not to mention nurse exhaustion) :imbar
    Sometimes you get the baby to turn, sometimes you don't. But it's a beautiful thing when you're putting gentle digital pressure on the posterior wall of the vagina and you see baby finally start to rotate!!!
  4. by   BabyRN2Be
    Hands and knees might work if mom doesn't have an epidural.
  5. by   Energizer Bunny
    I always wanted to squat when pushing, but since I had an epidural each time I was kinda stuck in the prone position.
  6. by   L&D_RN_OH
    I agree with Ca CocoRN. Hands and knees is a good position, obviously w/o an epidural. And alternating rt and lt sides can aid in turning baby.
  7. by   Dayray
    Agree with the suggestions above.

    Before the patient is complete and pushing I sometimes put mom on her side and rock her hips, It's an old midwife trick. I can't say for sure it works, sometimes the baby turns. it's hard to tell if it was the rocking or just the baby on its own. Also hands and knees or sitting on the bed leaning arms over a bedside table while rocking left to right is supposed to help. The idea of all of the tricks is to make room for the baby to turn and too use gravity.

    I can't say that any of this stuff helps but I do seem to have less OP deliveries then nurses who don't use these tricks.
  8. by   USC2001
    I have even done the hands and knees position with an epidural when mom was small and didn't have too strong of an epidural. I was so excited the first time I was able to get a baby to turn by pushing in this position! I was bragging to everybody!
  9. by   at your cervix
    I have found that there is really not one good position that works all the time. I have found that the trick is to frequently change position. Try pushing on the right for 15-30 min, then go to left, then hands and knees if possible, then squatting if possible, etc (not necessarily in that order). Also, if you can tell early on that baby is OP, (before epidural) have her get up and walk around, and when in bed change position frequently, that way you can deal with the posterior problem before she is pushing.
    One other old midwives tale that I have heard is to put an ice pack under mom's lower back, near tailbone. Supposedly, baby doesn't like the cold and will turn away from it, although I personally haven't had much success with this, it may work!
  10. by   Energizer Bunny
    I'm sitting here LMBO right now...at your cervix...I LOVE your username! LOLOLOL!!!!
  11. by   at your cervix
    Quote from CNM2B
    I'm sitting here LMBO right now...at your cervix...I LOVE your username! LOLOLOL!!!!
    Thanks. I can't take full credit for it. One of the physicians that I work with used to have a licence plate frame that said Dr._______ at your cervix. She doesn't use it anymore so I kind of took over the identity!!!!!!!
  12. by   SmilingBluEyes
    when i see "at your cervix" i think of that wonderful movie with robin williams as the comedic doctor.......ugh what was the name of it???
  13. by   lynn27
    The movie was called Patch Adams...I think!
  14. by   SmilingBluEyes
    YES THAT IS IT! remember when he is hosting the obstetrician's convention while he is a resident and there at the doorway, in an ARCH, READS:

    Welcome doctors , At Your Cervix !!! (paraphrased). I thought it was hilarious.

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