Your Baby's Position in the Womb

Ideally, by the time you're in labor, your baby will be head-down facing your back, but babies end up in all sorts of positions. Here's what to know about different fetal positions.

pregnant woman lying on side
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Your baby moves around extensively in the womb, but they'll settle into a final position late in your pregnancy, according to Laura Riley, M.D., an OB-GYN in New York City. Not all baby positions are created equal when it comes to labor and delivery, and certain positions may require intervention for birth.

Read on for everything you need to know about baby positions in the womb and how to tell if your baby is facing head-down.

Anterior Position

The anterior position (also called occiput anterior) is ideal for giving birth. In this position, your baby's head is down near the birth canal, facing your back. This head-first position allows the cervix to stretch, making it easier to deliver the rest of your baby's body.

So when does a baby go head down, since they're constantly moving around in the womb? According to Dr. Riley, most babies instinctively settle this way between 32 and 36 weeks of pregnancy.

Posterior Position

The posterior position (also known as occiput posterior position) means that the baby is face-up, or "sunny side up," instead of face-down, so the hardest part of their head rests near your lower back instead of your belly. In this position, the parent and baby are essentially back-to-back.

This position often results in longer labor since the baby's head has to rotate further to be born. It can also cause intense back pain during labor.

According to a 2015 study published in Trials, of the less-than-ideal fetal positions for labor, posterior is the most common: 15% to 32% of babies are in this position when labor begins and 10% to 20% of babies are still in this position by the second stage of labor. Posterior positioning contributes to about 18% of emergency cesarean sections.

The good news is babies in this position often turn to a more favorable position during labor. As a result, only about 8% of babies are still posterior when it's time to push, especially if an early epidural is avoided, says George Mussalli, M.D., director of Maternal Fetal Medicine at Bronx-Lebanon Hospital Center in New York City. In fact, according to a study published in the Journal of Perinatal Education, delaying an epidural until active labor (after 6 centimeters dilation) decreases the risk of posterior presentations.

Additionally, a 2014 literature review in BMC Pregnancy and Childbirth found that certain labor positions—like being on hands-and-knees—may encourage posterior babies to turn.

If your baby doesn't turn around on their own, a health care provider might try to rotate the baby manually. If that doesn't work—and your labor goes on for too long and starts to pose a threat to you or your baby—your doctor may recommend a C-section.

Breech Position

Breech position means the baby's butt or feet are presenting first; essentially, they are right-side up rather than head-down. About 3% to 4% of full-term babies are in breech presentation at term, according to the American Academy of Obstetricians and Gynecologists (ACOG).

Risks associated with a baby being in a breech position include umbilical cord prolapse (when the umbilical cord slips out before the baby) and the baby's head getting stuck during vaginal delivery.

If a C-section is required, there are also risks related to the surgery such as bleeding, infection, injury to surrounding abdominal structures, anesthesia complications, and higher risks with future pregnancies and births.

Due to the increased risks associated with this presentation, a health care provider may try to correct your baby's position with a "version" (external cephalic version or ECV). For a version, the doctor or midwife attempts to reposition the baby by pushing on your abdomen and the baby's head, says Dr. Riley.

The procedure is successful about half the time and carries some risks, including membrane rupture, fetal heart rate changes, placental abruption, and preterm labor. As a result, some people may not be good candidates for ECV due to their unique pregnancy risk factors.

What if your breech baby fails to turn head down? While vaginal breech deliveries can safely occur under some circumstances, research shows that it's safer for a breech baby to be delivered by cesarean section. A 2015 Cochrane review of three studies, including more than 2,000 participants, found that planned cesareans resulted in fewer fetal deaths or serious injuries; however, they did result in more postpartum abdominal pain for the gestational parent and increased future pregnancy-related risks.

Transverse Position

In a transverse position, your baby is lying across your uterus horizontally rather than vertically head-up or head-down. This position increases the likelihood that a shoulder will come through the birth canal first rather than the head.

A fetus is rarely positioned this way close to term. However, if this happens, researchers agree that a health care provider must perform a C-section to prevent complications, including cord prolapse, uterine rupture, and traumatic birth. In some instances an ECV might be successful.

How to Tell If Baby Is Head Down

So how can you tell if your little one is in the best position for delivery? A health care provider will feel your abdomen with their hands during prenatal visits. A suspected posterior, transverse, or breech position can be confirmed through ultrasound.

You might also determine your baby's position through fetal movements. For example, babies in a posterior position will kick the front middle portion of the abdomen, and your belly might look flattened.

In the breech position, on the other hand, you might feel kicks around your belly button if their legs are down (you may feel more normal kicks around your ribs if their legs are up). What's more, you might gauge a hard bulge near your ribs; this is your baby's head, and their whole body should move if you gently press it.

Updated by Nicole Harris
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