Feeling for OA or OP...

Specialties Ob/Gyn

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Specializes in OB.

I am trying really hard to learn to tell whether a baby is OA or OP (or OT) but am finding it really difficult. I can find a soft spot but then have trouble telling from there. Anyone have any good tips on what to feel? And how dilated does someone have to be usually to feel this?

Also...I know that if a baby's back is on mom's right side, they tend to have further to rotate, and will be OP at some point. My question here is...do I put them way over on their right side to help rotate the baby around? Versus the left side I mean?

I am terrible with visualization so this is why I am asking these questions. I would really like to learn to tell OP from OA so I can be more proactive in positioning my pts. during labor.

Thanks!!

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Specializes in OB, lactation.

I'm not really a good one to answer all of your questions, but a recent article in JOGNN stated "Sims’ posture on the same side as the fetal spine is recommended during labor to enhance rotation from occiput posterior to occiput anterior."

You may like the article:

Diagnosis and Intervention for Occiput Posterior Malposition

Volume 36 Issue 2 Page 135-143, March/April 2007

Journal of Obstetric, Gynecologic, & Neonatal Nursing 36 (2), 135–143.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1552-6909.2007.00130.x?journalCode=jogn

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Great post above. I can't recommend "The Labor Progress Handbook" by Penny Simkin enough here. It helps with all these things. Telling position is a matter of practice, like so many things. I have not let myself get all hung up and upset whether a kid is OA or OP UNLESS progress freezes to a standstill. Then we do the position changing and other interventions recommended in this wonderful handbook. For women w/epidural, moving them side to side, (if fetus and mom tolerate) is the key. And I mean WAY over on the side as far as she can go, and then back again. Then sitting up straight is also helpful.

For those w/o epidural, I recommend standing them and leaning them over a bed, commode or on their partner coach, rocking back and forth (another great resource, anything from Ina May Gaskin, a foremost authority on these matters).

You will learn the fontanel positions that tell you which way a kid is facing. And if you feel a face in there, way back, you know you have a problem. (had one of these the other day, darnit).

Give yourself time. Have people check with and behind you to ascertain what you feel. It will come, I promise, Shortstuff.

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When determing postion I always combine digial examination with abdominal palpation- you will gain confiedence with experience.

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easiest way to do it is. babies feel like little frogs on palpaation. lol i shoudl elaborte on that P. when you do leiopolds youll feel their littel knees drawn up like frogs .

next forget all the fansy names for the suters, it really confuses me that way too. find the big long suture and efollow it up or down until you find that soft spot, just by finding the suter you know its either AO,OP,OT ..strait up and down its either OA or OP. now when you get to the soft spot, is it shaped like a diamond or triangle? in the front babies have a diamond, you can feel 4 points (of course its not a perfect diamone due to molding but it will ahve 4 points) on the occoput they have 3 points, I always tell new nurses to look for the dianmod or triangle.

Id say about 3-5 cm depending on allot of things . but the main thing to remmebr is to wieht the value of the information agianst the pain your cuaseing mom. Its not worth torchering soemone to determin position, you can always find out later and ther are other sighns (true they arent as definative) but it you ahve a apteint with back labor or an OP contraction pattern, its not goign to hurt them to do the positions recomended for OP

Ihave had success with turnign OP babies, where i work its 96% epideral so mostly turn them on the side with 2-3 pillows between the knees and have the husband or pts mom gently rock her. It works soemtimes , but when it does you cant say for sure it was due to the rocking. however you have now included dad and have convinced both mom and dad that they have done everythign they could to get baby out lady partsly, so if the labor ends in a c/s they have a clear consious. but it tends to work most of the time P.

lol my favorit one was a native american couple to whom lady partsly delivery was very important. the OB had turned off the pit and told her she was goign to have a c/s. then she got called another delivery so the c/s was deleyed.

her husband and i started rocking her hips and the OB shook her head but let me turn the pit back on. she had been stuck at 4 all day. next tiem we cheked her she was complete, she pushed the baby out and that family get to tell the storie of how dad got the baby to turn =)

good for you ! so many nurses dotn learn this and I think it makes a huge differance in how your going to position.

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