Not every child is born in a kind of "storybook birth". Some have to struggle through the birth canal, and some need medical assistance. There can be many reasons for this. One of them is a cranial position of the child at the beginning of labour that is not quite optimal: the "posterior occipital position" (HHL). These "stargazer" babies are the subject of this article.
How Tim came into the world
Karolin (names have been changed, of course) is 40 weeks pregnant when her waters break at 9.17am on a Monday morning. So off to the maternity clinic! In the afternoon of the same day, her Opening labour pains already well under way. Karolin hopes that she will be able to hold her first child in her arms before midnight. This also motivates her later on to endure the labour, which is usually experienced as particularly strenuous by women giving birth. Transitional labour to breathe well until the cervix is fully open and not to go into a "tailspin". Sometime after 10 pm, Karolin was finally allowed to push: The Exit phase (formerly expulsion phase)has started, the contractions are very strong.
It is already around 11pm when Karolin hears from the midwife during the next contraction: "Don't push. It's important that you breathe out the contractions. Come on, I'll help you into the quadruped position. At that moment, Karolin didn't understand why she shouldn't put all her energy into pushing. She had the feeling that this would make this long labour even slower.
When Tim was finally born, not only Karolin was happy, but obviously so was the midwife. Because this time, little "stargazer" Tim was born without any aids or complications. He is healthy and lying on his mum's chest.
Only now does Karolin realise that her baby had even less space in the birth canal in this position.
There aren't very many children who are labelled "stargazers", but they are still around. An estimated 0.5 to 2% of babies are born facing upwards rather than "as planned". Based on a vaginal birth in the mother's supine position, these children look up at the sky - at the stars, so to speak - and are therefore called that. On the winter's day when Tim was born, the term was particularly apt, because shortly before midnight, countless stars were twinkling in the cloudless winter sky.
As people have always tended to associate unusual phenomena with all sorts of things, and not just around the time of birth. Myths the "stargazer" children are also considered to be something special. For example, they are said to have good luck in life and a special relationship with the stars, and are perhaps also particularly close to nature. But of course, none of this can be scientifically proven.
What is certain, however, is that the birth of a "stargazer" baby is usually more stressful for mother and child, often takes longer and more complications can occur.
The anterior occipital position: ideal starting position for vaginal birth
As long as the baby still has enough space during pregnancy, it keeps changing its position in the womb. It stretches, stretches, turns and twists and can literally do somersaults, sometimes upside down, sometimes upside down. As the baby progresses, it usually lies with its back to the right or left of the mother's stomach. Some still have their heads up, but usually turn in time before birth. Many, however, already position themselves upside down in the "correct" position, the so-called cephalic position (abbreviated SL).
Around the 36th week of pregnancy Lowering labour This causes the baby's head to slide lower onto the entrance to the mother's pelvis, gradually moving into the starting position for the birth. It is still able to turn on its own axis. This is why its back can sometimes be felt on the left (SLI) and sometimes on the right (SLII) through mum's abdominal wall.
As soon as labour pains begin, which push the baby deeper, it automatically begins to bend its head. This reduces the circumference of the head and saves space.
In this position, the baby can enter the birth canal with the back of its head and then pass through it in an ideal position. In technical jargon, this is referred to as the "anterior occipital position" (VHL).
On its way through the birth canal, the baby rotates on its axis. This is the best way for it to pass through the deformity of the mother's pelvis. The so-called pelvic inlet area has a transverse oval shape. This is why the baby pushes itself into this plane facing the mother's pelvic side.
Continue to the area called the centre of the pool. This is round. The baby can use this level to turn its head by 90°. At the bottom, in the pelvic outlet area, the baby's head should ideally be strongly flexed and its back turned towards the mother's abdominal wall. This allows it to squirm out of the birth canal.
It is then decided in the centre of the pelvis whether the baby will be born in the anterior occipital position or whether it will turn its back towards the mother's spine and be born in the posterior occipital position, i.e. as a stargazer. The "posterior occipital position" (HHL) is also known as the dorsoposterior cephalic position. In this position, the baby turns its face upwards at birth when the mother delivers it lying on its back. Like Tim, the baby is born as a "stargazer".
The posterior occipital position: much more strenuous for mother and child
At birth, children try different head positions to wriggle through the pelvis. Some children turn their heads sideways and want to come into the world with their parietal bone first, others use their forehead as the leading body part, others push their nose forward and are then in the so-called facial position. Each of these positions is rare and stressful for mum and baby and sometimes an impossible situation. Midwives and obstetricians refer to this as a birth-impossible position. These children are then helped by the Caesarean section from this awkward position.
As Karolin experienced, the posterior occipital position is possible as a birth position for the baby. Stargazers can be born normally. However, the special joy of the midwife in charge shows that this is not possible with all "stargazers".
Birth from the posterior occipital position requires time, patience and strength, not only on the part of the baby and mum, but also on the part of the specialist staff.
Birth positions that widen the pelvis help your little one on their way. This includes, for example, the quadrupedal position, but also any other upright position, such as the birthing stool.
Birth in the supine position is (almost) always less favourable. The supine position of the mum is not suitable for the success of the spontaneous vaginal birth of such a baby.
If your baby is also in HHL, your midwife or gynaecologist will be able to tell during the birth by palpating your abdomen using the so-called Leopold handgrip. This is because in HHL not only the baby's back, but also its arms and legs can be felt or during the vaginal examination.
Sometimes children also lie with their backs to their mothers during pregnancy and this is discovered as part of prenatal care when the abdomen is palpated or during the Ultrasound examination determined. However, this is a snapshot and says nothing about how the baby will move into the pelvis at birth. However, children whose preferred supine position during pregnancy is on mum's right side (SLII) are more likely to be "stargazers" at birth.
Why is HHL less favourable for the birth?
The baby can pass through the birth canal most easily with the back of the head first, i.e. in the anterior position (VHL). This is because the baby's head has the smallest possible diameter and therefore requires the least space on its way through the mother's pelvis. If, on the other hand, the baby's head is at a different angle in the HHL, it needs more space. This means that the baby has to overcome more resistance on its way through the birth canal.
In many cases, this greater resistance delays the birth process. This in turn causes many affected mothers to experience labour in HHL as particularly painful and with a longer exit phase. If the child is also larger than average or this is the woman's first birth, it is also possible that the labour may stop. This is why additional oxytocics are often given. This is intended to speed up the birth or prevent labour arrest. It is not uncommon for a suction cup (vacuum extraction) to be used during labour in HHL.
In addition, the baby's head in HHL presses on the mother's sacrum during labour, exerting pressure on her bowel. This can trigger the urge in the labouring mother to push - but often too early. If, for example, the cervix is not yet fully open, this can cause bleeding or a perineal tear.
The maternal Pelvic floor is particularly stressed during the birth of a "stargazer" baby. A Postnatal course for the mother is even more important than it already is. A Online postnatal course is particularly suitable in these cases because the pelvic floor needs more training than in a birth from the anterior occipital position.
Perhaps you are now asking yourself whether it would not be more advisable to use Caesarean section to give birth when the baby is in the posterior occipital position. The answer is no. Because the baby can change its position during labour and you can make the journey easier for your baby with the help of the birthing positions. In order for you to succeed, it is important that you invest time in practising the Birth positions invest.
If it turns out during the birth that a caesarean section is the better option for you or the baby, a secondary caesarean section, i.e. a caesarean section during the labour phase, can be performed at any time and at your leisure.
The midwife and the medical team will take a very close look at each individual case, weigh it up and give advice.
What helps when the baby is lying in the posterior occipital position?
Even in the delivery room, "stargazer" babies often turn on their own. The midwife present at the birth will show the mother ways in which she can encourage the unborn baby to lie in the optimal birth position with its back facing forwards. For example, the woman giving birth can sit on an exercise ball and let her pelvis rotate. If the woman is lying on the delivery bed, it can also help if she turns alternately onto her right and left side. Changing birthing positions can also work wonders. As already mentioned, this includes the four-footed position. Sometimes this causes the baby to turn into the correct position. In any case, it will have more space for its birth as a "stargazer". In addition, a massage of the mother's bottom may also have an effect. This colloquially known as "shaking apples" can be performed by the person present. Father in the delivery roomor another Accompanying persontake over.
In any case, you can be sure that the team of obstetricians will be at your side to do the best they can for you and your baby.
Can HHL be averted during pregnancy?
Karolin with her "stargazer" baby once asked me after the birth of Tim whether there was anything she could have done to influence her baby's position during pregnancy. My answer was: Basically, no. After all, nobody knows exactly why a baby doesn't settle into the best birth position. In Karolin's case, several factors came together that could have favoured HHL: Little Tim had a large head circumference as well as a very long umbilical cord that had wrapped around his chest.
In general, however, pregnant women are advised to make sure that they move a lot during pregnancy and always sit as upright as possible in order to optimise their child's birth position. Pregnancy yoga and gymnastics are also said to prevent this initial position, as well as standing on four feet every day and sleeping on the left side. But as I said, it is not known whether this will prevent HHL during pregnancy.
Scientists also discuss various risk factors for HHL. These include, for example, a conspicuously high or low birth weight of the child as well as its disproportionate growth or an unnatural deformation of its skull. A very short or very long umbilical cord or an umbilical cord loop can also increase the risk, it is assumed. The same applies to certain anatomical anomalies in the mother, such as a pelvic malposition, benign growths on the Uterus (fibroids) or the incorrect position of the Placenta (anterior wall placenta).
But I would like to emphasise once again: All this can may favour HHL, but this is by no means an "if-then inevitability". Therefore, try not to worry unnecessarily. Don't be afraid to speak to your midwife or doctor if you are unsure and/or have any questions. You can also contact me in my online counselling contact.
How does HHL affect the child?
Whether in the anterior or posterior occipital position - during a vaginal birth, every baby's head must first pass through the narrow birth canal and a bend in the mother's pelvis. In order to fit through better and more easily, the baby's still soft skull bones are usually deformed. This means that they shift along their still flexible sutures, making the baby's head "slimmer". This is normal and has no disadvantages for the child. However, it is conceivable that the baby has to overcome greater resistance on its way into the world in HHL, as already described. Its skull has to adjust and adapt to this more than would be the case with VHL.
However, if the child was born with the help of a suction cup due to HHL, it usually has a ring-shaped swelling on the head where the cup was applied. This "bump" (cephalhaematoma) is caused by the vacuum created underneath and then disappears. However, children born this way have an increased risk of neonatal jaundice or anaemia requiring treatment, and they are also more likely to have problems adjusting after birth. The risk of haemorrhages in the brain also increases. However, these are all side effects that result from the vaginal form of delivery (vacuum extraction or forceps delivery) and can also occur in any other birth position if the birth is terminated by vaginal surgery.
In addition, birth by suction cup as well as by forceps can cause possible blockages or tension in the newborn. Whether certain symptoms such as poor posture or developmental delays in the baby can be derived from this has not been proven. However, it is easy to imagine that a baby then feels more uncomfortable, is possibly in pain and cries more.
Tip: I therefore recommend that you and your "stargazer" baby visit a physiotherapy practice that specialises in osteopathy for children after the birth. They will know how to gently help and harmonise your child.
But it is also important to know: Children born in HHL overcome the stressful birth. Some just need a little more time. Even in the puerperium, you can help your little stargazer with Baby massage help to overcome the stresses and strains of childbirth more quickly.
How does the birth of a "stargazer" affect the mother?
A more complicated birth process can also lead to major birth injuries for the mother, for example through the use of a suction cup and the associated possible perineal incision or tear. Vacuum extraction can be the method of choice if the baby's head is already in the centre of the pelvis or on the pelvic floor and the baby's vital condition requires the birth to end more quickly. For some mothers with children in HHL, a caesarean section is also performed after weighing up all the factors, provided the baby's head is still in the pelvic inlet.
In all such cases, the woman needs more time to heal from the birth injuries. Many mums also experience feelings of failure or guilt after such births and need longer to come to terms with the sometimes unexpected, sometimes challenging events. It is important to know that no mum can fail during childbirth! No mum should feel guilty! Especially not if the baby has not adjusted optimally.
Ultimately, a mum can prepare herself perfectly, but if the baby doesn't rotate through the pelvis in the way it can fit through this narrow passage, the influence of the woman giving birth is very limited.
However, the postpartum period should be a time of rest and relaxation, especially in the case of difficult births. This also leaves room to recognise what is special about this baby.
My baby was also born as a Stenengucker. As the son of a midwife, he learnt early on how children should actually be born. And he said to me when he was of primary school age: "Mum, I'm sorry that you had so much trouble with me during the birth. But you know, I wanted to see you first and not the papers under the birthing stool!
I loved this child for this sentence and told it to Karolin when we talked about her "exhausting" birth.
Perhaps you can imagine how Karolin gazed at and admired little Tim, her stargazer, during this story.
