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Labor sunny-side up babes!

Shieva Ghofrany: [00:00:00] Okay. Hi. I'm on labor and delivery. I'm going into a closet because we have a baby model with a pelvis and I'm gonna show you guys some things that can happen when you're in labor with the baby's position. So look at our baby model. Okay? And I'm gonna take off my mask cuz I'm in here alone in like literally a side closet just so you don't think I'm gone rogue. 

Okay? So, The baby tries to come out. The ideal position for labor and pushing is when the head is down, Notre breach means the butt is down. So when the head is down and when the face is looking towards your spine. So we define the position of the head by what's called the oxy putt. So vertex is head down, and then the oxy put is the back of the head. 

My hair looks very gray in this light, by the way. So when the oxy. Is towards the front. That means the face is [00:01:00] looking towards the spine that is what we call oxy putt anterior, and that's an ideal position for easier delivery. Oxy putt posterior, where the back of the head is towards mom's spine. So the face is looking up, or what we call sunnyside up less optimal. 

Doesn't mean the baby won't come out vaginally, it just means it can be harder because the diameter that's trying to come out of mom's pelvis is bigger. , even when a seven pound baby is trying to come out, or in my case, a six pound baby is trying to come out the diameter of the head. If the baby's looking on his side up is bigger than if the baby was looking towards mom's spine. 

So let's see if I can do this with one hand. This, can you see this baby? There's the face. Okay, that's the face. Very creepy baby. Imagine. This is sunny side up, meaning the face is looking up towards mom's spine. The oxy putt is posterior anatomically. This is anterior cuz this is [00:02:00] mom's front and that's posterior, that's mom's back. 

So when the oxy putt is posterior, now most babies are not directly op, meaning directly sunnyside up. They're tilted kind of like this. So what we call left oxy putt. Posterior, meaning the oxy putt is to mom's left or right, oxy posterior, right? So again, it's a bigger diameter. Can I flip this baby around than if the baby was coming? 

Tucked like that. Okay, so this would be oxy putt anterior. Now sometimes it'll be sideways, which is transverse. See that line? That is what we call the suture line of the baby's skull. Let me get this baby out. And that suture line is the part that's not fused in infants. This is the soft spot, the fontanel, and these will all fuse later, but the baby, when it's trying to come, We'll tr we will actually [00:03:00] squeeze its bones and the bones will slide over each other to allow that head to mold into a shape that it can come out. 

So for example, my first baby, six pounds, sunny side up, that meant back labor because the back of the head, the oxy pot, was grinding against my sacrum. , it makes labor longer and sometimes more dysfunctional, meaning the contraction pattern won't look like a nice sign wave. It'll sometimes look like what we call a buffalo hump or a camel hump. 

You'll have back labor. You'll sometimes have really prolonged labor and pushing can be harder. So my six pound baby took me three hours to push him out, and when he came out, he was like a little garden nome. He had a very big cone head because there was so much what we call molding, which is where the. 

Mold into the shape to come out. Now again, as you can imagine, if the baby is six pounds and had trouble coming out, a bigger baby can have even more trouble because some people estimate that when a baby is sunnyside up, it is as if you can add two pounds to the baby's weight. Meaning me pushing out a six pound baby was as if I was [00:04:00] pushing out an eight pound baby. 

Some women can do it cuz their pelvis is amazing. Some women can do it cause they're in better. I was not in amazing shape and my pelvis is apparently not amazing. So it was a very challenging delivery for me. But other women are able to, another position that a baby can be in that is not necessarily sunny side up or regular oa, we call it oxen anterior, that a fancy word called A and clinic. 

So Asynclitic means that I'm gonna try to get this baby back in with one hand. Asynclitic means that the suture line get this plastic outta the way, the suture line, this is not coming down symmetric, but instead the baby's head is kind of tilted. So you see what I mean? Either tilted, where that suture line is tilted towards the back or tilted towards the front. 

So it's not the whole head is turned, it's the head is tilted, and again, you get kind of a [00:05:00] wonky pattern of the head trying to come out, which can make it harder. Again, none of these mean babies can't come out that way. It means they can either be more challenging or some of them don't come out vaginal. 

Which is okay, or paradoxically I've seen where someone has a baby coming out in a funky position and they oddly come out strangely fast for the first, for the first labor. Um, now when a baby is in that position, why would that be? You know, we joke like, oh, that's stubborn baby. That kid is so stubborn in reality, it's because something about the shape of mom's. 

Or her uterus made the baby more comfortable in that position. Babies do not choose to be in that position. So a common theme, like in my case, my first baby, like I said, came out in a very challenging delivery and then I chose a C-section. And when my partners pulled my second baby out, my uterus, which looked technically speaking normal shape, but just had a d. 

Presence about it that after years of experience, my partners could tell. They [00:06:00] kind of said, yeah, it's just a strange uterus, which we joked still groomy, happy, healthy baby. So that's all I cared about. So, and then my third baby was breach. The reason she was breach, and by the way, it's breech, not breech, duh breach. 

The reason she was in the breach position, meaning her butt down, was whatever caused my first baby to be sunnyside up. My weird. Probably allowed my third to be breach because she just was more comfortable in that position. And interestingly, my second, the in between one, he came out with kind of a funny shaped head. 

Um, we were considering a helmet, but he had had a club foot, so we had. Boots and braces on, and I just felt like I couldn't do too much paraphernalia. So to this day, he has a beautiful head that is a little funny shaped on the side, and that may may have been from after the delivery, how he was kind of resting in his crib or in his car seat, but probably it was due to his position in my funny shaped uterus. 

Again, all common, none of these things [00:07:00] are bad as long as we look at the end result. Either way, everything is okay if the baby comes out vaginally or C-section. They're both good. So you can see my common theme is these are all ways for me to help educate you guys on things that might happen. But I don't wanna be sad and apologetic, like I'm so sorry your baby was semi side up, because I don't think that C-sections are bad. 

I think that in an ideal world, if every baby could come out vaginally and easily, that would be wonderful. But when babies can't, we need to to. Um, maligning C-sections. We need to stop making the cult of vaginal delivery so strong that when women ultimately need a C-section or choose a C-section, they end up having a lot of emotional and psychological distress over it, and that's not healthy. 

Um, so I hope that little tutorial about the baby and how the baby comes out is helpful. I will maybe post more tomorrow about some other things that can happen in labor and delivery, and actually I'll just throw those out right now that, again, and I mentioned this yesterday, sometimes you're in. All of a sudden the heart rate goes [00:08:00] down, people might run in, flip you into different positions. 

Um, try to break the water if your water isn't broken, cuz that can sometimes help them evaluate the baby better. Sometimes put different kinds of monitors instead of external monitors. They'll put internal monitors on the baby's head and within the uterus to monitor the contractions in the heartbeat to you. 

It will feel really. Right, and I hate that word, but I get it. Like you're lying there and all of a sudden 50 people come running in to us. It gives us a rush of adrenaline. It is definitely nerve-wracking sometimes, but you have to remember that your team has done this a lot. We're trained for this. We do this as drills. 

We do this live all the time. . So to a degree, you have to have faith that we are there and we're gonna do the right thing and take care of things. Sometimes we forget to discuss things with you, and that's where I would say, Hey, can we just talk about what just happened? So I understand it because the more you understand it, the better you're gonna feel about the process. 

And the more faith we can each have in each other as doctors and patients, okay, I'm gonna go deliver another baby. Bye.