Direct OP position

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Specializes in L&D/Antepartum, Neuro.

Anyone else finding this position more and more common for a reason as for a primary c/section due to failure to progress/descend? I do my best to flip my patients from side to side once the epi's in place but being a night nurse I sometimes find my laboring patients fast asleep so I leave them alone. My question is: Is there anyone magic formula to get these babies out of the "sunny side up" position?

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Specializes in L&D.

Definitely I see lots of pts with this probably because of early epidurals. I haven't found one position that works all the time. In fact I have less luck with hands and knees position than anything. One nurse on our unit swears that if you can find out wear the back is mostly you can lay them on that side and stick a towel roll under their belly and it flips them. I haven't tried it enough to be a nay sayer or a believer but maybe its worth trying.

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Specializes in Obs.

Not only have I seen this a ton in ten years of obs nursing, I also had a primary section for this reason! I rocked myself on hands and knees from 7-10 cm to no avail, then pushed for 2 1/2 hours...no go.

What I have seen work in the past is lying in Sims position on the bed, and if the patient is able to get out of bed and stand, one leg up on a stool in a sort of lunge position while leaning over the bed. I've also noted that a lot of suprapubic pain is indicative of an OP position...I lovingly call it "bladder pain".

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Specializes in Rural Health.

Why is on the rise? Just curious.

Is it because of early epidurals? Does it have to do with early inductions, starting Pit when the mom is thick, closed and high and nowhere near ready for Pit? Does it have to do with early AROM.

We have a 50% C-section rate where I work and a 90% induction rate. I am obviously new to the world of OB but even I know that's incredibly high. :confused:

Long of the short, the day time politics drove me to nights and it's almost refreshing to work nights - we actually get patients in actual labor. It's great!!!!

Anyway, if anyone has links or ideas where I can start my search on this I would love it. It's something of great interest to me (as a future CNM).

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In our facility, we use a "peanut ball" for positioning to assist in rotation and decent of the fetus during labor. I know that one of my co-workers has been compiling research regarding use of the peanut ball. I have been amazed at how much this has aided in successful lady partsl delivery. It also has been a method of pain relief for the patients. It doesn't seem to be successful 100% of the time but any time it is successful, it is great!

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Specializes in Midwifery.
We have a 50% C-section rate where I work and a 90% induction rate. I am obviously new to the world of OB but even I know that's incredibly high. :confused:

quote]

WOW Thats appalling! Why?????:icon_roll:bugeyes::madface::lol2:

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Specializes in Midwifery.
In our facility, we use a "peanut ball" for positioning to assist in rotation and decent of the fetus during labor. I know that one of my co-workers has been compiling research regarding use of the peanut ball. I have been amazed at how much this has aided in successful lady partsl delivery. It also has been a method of pain relief for the patients. It doesn't seem to be successful 100% of the time but any time it is successful, it is great!

Whats a peanut ball? Tell us more!!

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A peanut ball is an excercise ball that is shaped like a peanut. When the patient is lying on her side, the ball is placed between her legs. The upper leg is positioned towards her front, the bottom leg is bent at the knee. We use blankets to support each end of the blanket. This helps the pelvis open up because the ball holds the legs open. I always warn the patient that it may feel like she is falling forward (depends on the patient) but with a couple of blankets to help support the ball, it is stable. It can be a little more difficult for our petite patients because of their shorter legs but it can be done.

One of the nice things is that it is perfect for the patient with an epidural because it doesn't require standing or for them to position in any uncomfortable way.

When I go to work later this week, I will see if I can find some of our information that we use in orientation and post it.

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Specializes in Obs.

I would love to hear more about this peanut ball! Looking forward to your post with more info.

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Specializes in L&D.

We use a partially deflated birthing ball with almost all of our patients when they have an epidural. We place it between their legs to help open the pelvis. Sounds very similar to the peanut ball. We still have a C/S rate of 35-40% though. I think the reason epidurals are associated with the OP position is something to do with the epidural inhibiting the bodies natural muscle movements that get babies into the correct position for delivery.

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Specializes in Community, OB, Nursery.

I had to google 'peanut ball' and this is what I found:

http://www.ballsnbands.com/fitball_peanut_balls.html

Very interesting. Learned my new thing for the day! :)

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Sadly unless "walking" epidurals are encouraged and women get over the idea they will experience nothing during childbirth its going to keep happening. Laboring on our back is one of the worst things for OP babies. As well as not being able to push because of epidural being up too high.

Habits while pregnant also help lead to malposition of the baby. www.spinningbabies.org has great info on how to turn a baby in active labor as well as prevent an OP baby in the first place.

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