Attitude anomaly is a birth complication in which the unborn child descends into the mother’s pelvis in a way that is not conducive to birth and assumes a position that is obstructive to birth. In most cases, the birth stagnates completely with the positional anomaly. To deliver the baby, measures such as cesarean section or operative vaginal delivery are available.
What is an attitude anomaly?
Different complications during the birth process still occur today in a prevalence that should not be underestimated, despite medical advances. Some external factors increase the risk of such complications, such as advanced age of the expectant mother. Another risk factor for disturbances of the physiologically normal course of birth are so-called attitude anomalies. These are incorrect positions that the embryo assumes when descending into the mother’s pelvis. Different types of attitude anomaly exist. In addition to high degree position, the most common positional anomalies include parietal adjustment, low transverse head position, posterior occipital position, and shoulder dystocia. Positional anomalies such as transverse or oblique position should be distinguished from the attitude anomaly. Positional anomaly, unlike positional anomaly, refers to the repositioning of the parturient fetus immediately before birth. This repositioning usually results in a positional position that favors the birth process. The high transverse head position and the high transverse shoulder position are the most favorable positions for birth.
Causes
The cause of an attitude abnormality is usually an abnormality of the maternal pelvis. When the pelvic bones are malpositioned, the unborn child often cannot descend into birth-promoting positions despite efforts. However, a positional anomaly does not necessarily have to have a physical cause. In some cases, psychological factors may be the primary cause of an apparent attitude anomaly and the associated stagnation of birth. Differentiating true attitude abnormalities with physical causes from apparent but spurious attitude abnormalities with purely psychological causes is an important criterion for the proper approach during labor. Basically, midwives and gynecologists speak of a true attitude anomaly only when the unborn child does not turn in the mother’s pelvis into a position that allows spontaneous birth.
Symptoms, complaints, and signs
The leading symptom of an attitude anomaly is stagnation of the birth process. As long as the baby does not move into a position conducive to birth, the birth process cannot progress. The doctor and midwives determine which positional anomaly is present in each individual case during the birth process. Posterior occipital position is one of the most common positional anomalies. In this case, the face of the unborn child does not face the back of the expectant mother, but rather, similar to the stargazer, faces the abdomen. The child’s head must slide through the mother’s pelvis with its largest diameter first. Birth arrest does not occur in every case of positional anomalies. Unborn children in parietal setting relatively often leave the maternal pelvis in spontaneous partus. Furthermore, birth arrest in the other direction does not necessarily indicate an adjustment anomaly.
Diagnosis
An abnormality of the maternal pelvis is often detected before the birth of a child. To diagnose such an anomaly, pelvic imaging is the modality of choice. If a pelvic anomaly is known to exist prior to birth, a higher risk for an adjustment anomaly during the birth process is obvious. In this case, the midwives and physicians will be particularly meticulous about the position of the baby and carefully check whether the unborn child is moving into a position conducive to birth. In most cases, a positional anomaly that has already occurred can be diagnosed within seconds by means of palpation and ultrasound. Depending on the type of positional anomaly, the further procedure is planned.
Complications
Due to the positional anomaly, ordinary delivery of the baby is not possible. An alternative method must be used to remove the baby from the mother’s abdomen, usually using what is called a cesarean section.The setting anomaly can be diagnosed relatively well, so there are no particular complications during the birth itself. The diagnosis is made with the help of ultrasound and is not associated with pain. Depending on the position and location of the child, it is then decided what the further course of the birth will be. In some cases, a spontaneous birth also occurs, which, however, cannot be predicted. Possible pain caused to the mother is treated with the help of painkillers. If the position of the child does not change, a surgical delivery by cesarean section is performed. In most cases, the delivery proceeds without difficulties and complications. The child’s physical functions are not affected by the positional anomaly, nor does it result in a reduced life expectancy. In most cases, the mother is left with a scar on her abdomen after delivery.
When should you see a doctor?
According to current orthodox medical opinion, birthing women should always work closely with a team of doctors, nurses as well as a midwife. It is advisable to take advantage of all prenatal check-ups offered and always have irregularities as well as abnormalities clarified by a doctor. Precautionary measures should be prepared and planned in good time several weeks before the birth. If the expectant mother has a vague feeling that something is wrong despite all the examinations and arrangements, she should address this. If irregularities occur or there are spontaneous changes in the physical condition, a doctor should be informed. If labor starts unplanned and too early, a doctor and the midwife should be contacted immediately. Depending on the intensity of the pain or spacing of the contractions, consider whether an ambulance should be called. If the discomfort increases unusually, an emergency physician must be informed. If labor has already begun but then stagnates, there is reason for concern. Since the life of both mother and child can be endangered during a birth, it must be clarified with a doctor what steps must be taken if the child does not turn independently into the correct birth position. The expectant mother should refrain from a home birth in the event of a classified high-risk pregnancy and seek the care of physicians in a timely manner.
Treatment and therapy
In some setting anomalies, some time is waited, since a spontaneous birth is still conceivable despite the anomaly. This is especially true for anterior parietal setting. In the case of other anomalies, the mother is first encouraged to change her own position. In the case of a deep transverse head position of the child, for example, a change in the mother’s position can result in spontaneous delivery. If necessary and so desired, the expectant mother receives conservative medical treatment with painkillers. In addition, means for relaxation can support a spontaneous birth in some cases. If neither positional change nor relaxation allow a spontaneous delivery, the child must be delivered surgically. The use of a suction cup is preferred to cesarean section if this procedure seems reasonable. The same applies to forceps, which the obstetricians or physician may use to place the unborn child in a conducive position. Vaginal operative delivery is also conceivable after a positional anomaly. Delivery by cesarean section is performed in an absolute emergency and usually takes place only when all other means have failed. Monitoring of fetal vital signs is important in the treatment of positional anomalies. Only by means of precise monitoring will obstetricians and gynecologists be able to determine the appropriate time for an invasive birth procedure.
Outlook and prognosis
Attitude anomaly is a condition at delivery and not a disease based on a genetic defect or pathogen. The anomaly can occur exclusively during the birth process and causes labor to stop. In these cases, the use of an alternative birth process becomes necessary. Therefore, the setting anomaly is a condition that affects only one expectant mother and requires action to ensure the survival of both mother and child.In the event of early discovery of the malposition of the fetus in the womb, pelvic constriction of the pregnant woman or initial complications during the birth process, delivery by cesarean section is initiated. This is a routine surgical procedure that in most cases proceeds without further complications. The diagnosis is made before the expected date of birth by ultrasound examination. With good wound care as well as sufficient rest for the woman, recovery occurs within a short time after the cesarean section. Without medical care and intervention, there will be serious complications for both mother and child. An undersupply of oxygen to the fetus is the result, since a natural birth is not possible due to the conditions of mother and child. This threatens the unborn child with death by suffocation. The expectant mother is also in mortal danger as a result.
Prevention
Pelvic anomalies are the most common cause of setting anomalies. A pelvic anomaly may be congenital and thus cannot be prevented. However, acquired pelvic anomalies also exist, such as those that can occur because of faulty posture. In order to prevent acquired pelvic anomalies in this way, it is advisable to attend a posture school. With the prevention of pelvic malpositions, the risk of postural anomalies at the birth of a child is also reduced. However, an attitude abnormality cannot be safely ruled out even if there is no pelvic abnormality in the expectant mother.
Follow-up
In the case of an insertion anomaly, no measures of follow-up care are usually possible or necessary. This complication must always be treated immediately by a physician, otherwise death of the child and also death of the mother may occur in the worst case. The earlier the setting anomaly is detected, the better is usually the further course of this complaint. A cure is not always possible. The aftercare itself is mostly focused on the treatment of the wound after the caesarean section in the mother. In any case, the mother should rest and take it easy after this procedure. In any case, bed rest should be observed, and stressful and physical activities should also be avoided as much as possible. In many cases, the support of the mother’s own family and parents is also necessary. Loving and intensive care of the mother and the child always have a positive effect on the further course of the attitude anomaly. As a rule, no further measures of aftercare are necessary for this disease. However, regular examinations may be useful after the wound has healed. Life expectancy is not reduced if the attitude anomaly is successfully treated.
What you can do yourself
A birthing mother should obtain timely and comprehensive information about possible complications as well as various options for birthing in advance of the birth. The choice of the right method depends on the individual circumstances and should always be made in consultation with the obstetricians. The better informed the expectant mother is about the birth process, the more prepared she can be to respond to unplanned developments that may occur during a birth that is taking place. Breathing techniques should be practiced sufficiently and the conditions created for an undisturbed birth process. It is helpful to talk to experienced people and to ask any questions that arise early on and have them answered. During the developments of the birth process, it is important to work closely with the obstetric team and follow their instructions. The expectant mother should not panic and give feedback about any changes in her body. Despite pain and possible irregularities, the mother helps herself and the unborn child if she remains calm. The psyche of the affected person should be stable months before the birth so that as few complications as possible occur. If there is any doubt about this, it is helpful to seek support and help in good time. This alleviates the stresses and strains during a birth for both mother and child.
