Expert / 30 May, 2023 / My Baba

Baby Positions In The Womb Before Birth

Lesley Bland, a registered midwife at My Expert Midwife explains the different baby positions in the womb and what this could mean for the type of birth you have.

Getting into position

From your first appointment with a midwife, you will be encouraged to monitor your baby’s movements later in pregnancy. You can expect to feel your baby start to move any time from about 14-16 weeks. However, some pregnant women are much later (up to 24 weeks) before they notice movements. Babies are all individuals, and every pregnancy is unique, so it is perfectly normal that some women notice movements earlier than others.

Your baby’s pattern of movements

Baby’s movements are used, as part of a bigger picture, to inform midwives of their wellbeing, and once your baby falls into their “pattern of movements” you will be asked to monitor this and to alert your care team if there has been any change which may suggest your baby is showing signs of being unwell. As a baby grows, you will experience bigger, stronger movements as they get into weird and wonderful positions. This pattern of movements should continue to birth (it is an Old Wives’ Tale that babies move less towards the end of pregnancy as they run out of space!).

From about 32 weeks gestation, you can expect your baby to begin to settle into their pre-birth position, ideally head-down (cephalic), but some may present breech (bottom or feet first) or transverse (diagonal or horizontal lie). Cephalic presentation is the ideal position for a baby to birth vaginally, although a baby who is breech with their bottom presenting may still birth vaginally, usually with increased surveillance and support from midwives and/or the obstetric team.

If your baby is either a footling breech (feet presenting first) or a baby who is transverse (diagonal or horizontal lie), then you would be strongly advised to have a Caesarean section to reduce the risks associated with these presentations, such as cord prolapse.

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Finding out your baby’s position

As labour approaches, your midwife will want to know what position your baby is in. At your 36-week antenatal appointment, your midwife will ask your permission to complete an ‘abdominal palpation’ – an examination where they use their hands to identify the baby’s head and bottom and what position they are in, where baby’s back is, and identify the limbs. This gives your midwife an image of how your baby is positioned (where baby’s back is) in the womb and what is the “presenting part” (the part of the baby that is presenting to the pelvic inlet and will lead through the birth canal in labour).

Your midwife will document the findings in your notes and will refer you for an obstetric clinic appointment if they are concerned that baby is not cephalic (head down) to discuss your options and preferences for birth.

So, what do the different positions mean?

Different baby positions have different names – you have probably heard of babies being in the Breech position, but there are other positions your baby may be in too:

• Anterior – this refers to the position of your baby’s back. Anterior means their back is at the front nearest your abdomen – back to tum!
• Posterior – is a variation on normal referring to the position of your baby’s back where their back against your back – back to back!
• Breech – refers to when baby’s bottom or foot/feet are the presenting (leading) part closest to the pelvic inlet. If baby is breech at 36 weeks your midwife will refer you for an ultrasound scan to confirm and an obstetric clinic appointment.
• Transverse Lie refers to a baby lying horizontally or diagonally in the womb rather than in the preferred head-down position. If baby is transverse at 36 weeks, your midwife will refer you for an ultrasound scan to confirm and an obstetric clinic appointment.
• Cephalic – this refers to the presentation of a baby when its head is down and closest to the pelvic inlet. This is classed as the optimal presentation for labour.
• Aysnclitic head – when baby’s head is tipped slightly towards one side and the diameter of this position makes passage through the pelvis and birth canal more difficult and can slow labour down.
• Face/brow presentation – Occasionally, a baby will insist on coming face or even brow first, both of which occur when baby hyperextends their neck, meaning the back of their head is touching their back rather than their chin flexing towards their chest.

Can I try to change my baby’s position before birth?

If your baby is not in the optimal cephalic (head down) position as you approach labour, you can try a few things to move them. You will be referred for an obstetric antenatal clinic appointment if your baby is confirmed to be breech or transverse.

Baby’s head is designed to pass through the birth canal as the boney plates of the skull are soft and malleable, meaning they are able to glide across each other, but this usually only happens when the cervix has dilated a full 10cm, whereas a bottom or a foot are smaller and can slip through a cervix that is not fully dilated meaning the body or head may get entrapped, or the cord may drop down the birth canal ahead of baby (cord prolapse), both are clinical emergencies.

The obstetrician will discuss all risks and benefits of options for birth and if appropriate, offer ECV (External Cephalic Version) where with the aid of medication to relax the uterus and careful observation, the obstetrician will carefully try to turn baby into the preferred cephalic position. Some babies refuse to be moved or move but then turn back again.

Exercises and holistic treatments to help baby move

There are several exercises and holistic treatments that have some evidence to support encouraging baby to move into that optimal cephalic position through the relaxation of the uterus and surrounding pelvic muscles:

• Child’s Pose – held for 10-15 mins up to 3 times daily.
• Rocking forwards and backwards on hands and knees and drawing pelvic circles in the air.
• Bridge position – lie on your back, feet on the floor, legs bent and raise your hips to form a bridge. Hold for 10-20 minutes up to 3 times a day.
• Acupuncture – Chinese medicine is believed to relax the uterus and stimulate baby to move.
• Moxibustion – Chinese medicine involves burning a dried plant over the abdomen to increase the flow of qi (Chinese life force).
• Music, light, heat, cold – works on the premise that baby will move towards stimulants that they enjoy; their favourite music played, or a bright torch shone at the bottom of your abdomen, a bag of ice or frozen vegetables at the top of your uterus and a lovely warm wheat bag or hot water bottle at the bottom.
• Walk – on the flat, kerb walk, up and down steps/stairs, lunge walk.
• Dance – think of shaking or twerking that bottom.
• Keep mobile – the worst position you can be in is slouched in a chair so get up and move freely.

Don’t panic if your baby is not in the ideal position.

Do not panic about the position of your baby. What will be will be, so relax! Most babies will be breech, transverse, posterior and anterior at some stage of your pregnancy, and truthfully it does not matter what position your baby is in until labour starts. However, with advancements in technology and clinical practice, a malpositioned baby is more likely to be identified prior to the onset of labour and a plan of care, be it vaginal or operative birth, put in place following discussion between yourself and an obstetrician.

Breech and transverse lie at the end of pregnancy is uncommon, with only 3-4% of babies presenting breech at full term and less than 1% presenting transverse. There are some risk factors that make a breech or transverse lie more likely:

• Multiple pregnancy (more than one baby)
• Polyhydramnios (excess level of amniotic fluid around baby)
• Placental location (when the placenta is low-lying or completely covers the opening of the uterus)
• Bi-cornuate uterus (heart-shaped)
• Pre-term (before 37 weeks) birth

But the most important thing to remember is that you are at the centre of any decision-making process and should be fully informed of the risks and benefits of all birth options. Any decision will always be made in the best interests of you and your baby, and the ultimate outcome is a healthy mum and healthy baby.

Article by Lesley Bland, a registered midwife at My Expert Midwife.

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