Chapter 3
Jade’s Labour Progress—Midwife’s Check
Tummy Check for Baby’s Position—A Midwife Skill of Palpation
After initial greetings and with verbal permission I began an assessment of Jade’s labour. First I checked her basic observations of temperature, pulse, and blood pressure. A palm resting lightly on the top of her tummy during surges let me feel how Jade’s womb muscles were working.
Emily changed Jade’s sanitary pad and what I saw was normal.
Spending those first few minutes attending to Jade’s basic observations let us relax into each other’s presence and I learned that Jade knew her baby was a girl.
The next thing was to determine baby’s position in the womb via a tummy check or palpation. This would let me assess externally what position her baby was resting in and how far down into the pelvis she had moved toward arrival.
Palpation is a midwife touch technique using careful fingers and palms on the pregnant tummy to ascertain where baby’s head and back are positioned. The usual position for a baby to take in readying for birth is head down with the back predominantly on one side of mother’s tummy and slightly towards the front.
Jade’s baby responded nicely to the touch of my hands by moving. This movement helped to confirm she was head down.
Next I listened to an easy to find baby heartbeat. The heart beat rhythm held a re-assuring sound. In that home setting—or any other for that matter—listening to a foetal heartbeat with a good rhythm is always pleasing.
A Variation of Normal—Posterior Position
Through Jade’s tummy my sensitive palms and finger tips discovered a variation of normal that could have slowed or held up the progress of labour. Baby was lying in a ‘posterior position’ with its own back toward Jade’s back. This is a normal version of the head down position.
Although a posterior position of babies in labour is a common variation of the normal, it may be associated with more backache and slower progress in labour due to the less direct focus of surge pressure to open the cervix and move baby downward.
The majority of posterior babies, the ones that look up toward their Mum’s tummy at the start of labour, do become well flexed throughout labour descent and during the later phases of labour will actually roll over or rotate to look down toward their mother’s tail bone by the time they are ready for birth. Looking toward the mother’s backbone is also the commonest position babies take for emerging into the world.
Instead of Jade’s baby being curled into a ‘well flexed’ attitude with her head forward and the ‘chin tucked’ down toward her tiny chest she held an attitude of ‘de-flexion’. Her chin was what I have come to call ‘untucked’. This meant baby was not presenting the smallest diameter of her head to come through. Potentially this could make the curves of the inner pelvis more difficult for baby to negotiate.
A baby’s position in the womb and degree of flexion in readying for birth or during labour can be influenced by the inner shape of a woman’s pelvic structure, the tone of her body, and activity and postures throughout the day.
During labour a chin tucked head down baby will descend through the pelvis and readily move downward and out to birth regardless of whether labour began with them in the anterior or posterior position. Midwife reflection on details around Jade’s labour and birth are unique to this situation and are shared for your interest…
Other Chapter 3 Subtitles: Benefits of a Flexed or ‘Chin Tucked’ Baby; Engagement and Descent of a Term Baby; Vaginal Examination—When Will My Baby Be Born?; Some Babies Wait to Engage Much Later in Pregnancy; The Inner Pelvic Floor Affects Engagement and Descent; Can a Woman Wait to Let Her Baby Engage?; Statistically Driven Forward Planning; Benefits of a Flexed or ‘Chin Tucked’ Baby; Chin Tucking Tips Available; Use of All Fours Position and Torso Over Pelvis During Labour; A Version of Normal— Posterior Position of Babies in Labour and Birth; Face to Pubes—a Baby Born in the Posterior Position; Posterior Position of Babies in Labour and Birth—A Version of Normal.
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