Baby Position in Womb: Impact on Labor

As your due date approaches, the excitement of meeting your little one builds. You feel extra kicks and wiggles as your baby explores its home within you. From the size of a lemon seed to a watermelon, your baby has grown in size and weight, leaving lesser and lesser room for them to twist and turn.  

These kicks that you feel may help you understand your baby’s position in the womb. Are they head-down, breech, or stuck in between? How would that affect your delivery? So we spoke to Dr. Krishna, a leading obstetrician, who shared the link between your baby’s position and how it impacts delivery. 

What method you choose for your delivery is a personal choice. But if it is a vaginal birth, you need to be prepared for the unexpected - especially if your baby in the womb is not in an ideal position. So, what is the perfect position? 

According to doctors, if your baby’s head faces downward during labour, the risks are less. On the other hand, a baby facing upwards or sideways may pose complications to both mother and baby. The risks include: 

• Head entrapment: Your baby’s head may get stuck in the uterus.
• Umbilical cord: If the baby wraps the cord around their neck, it may affect their oxygen levels. It can also intertwine around the baby’s arm, making pushing the little one out difficult. 

Cephalic Position

The cephalic position of the baby is when the head is down and the chin is tucked into the chest. With the baby facing your back, the baby can freely move their head and neck. This allows them to press on the cervix and keep it open during delivery. 

Also known as the occipito-anterior presentation, it is the safest position for delivery. 

Breech Position

A breech position happens when the baby in your womb has their feet or buttocks for delivery first. If the position cannot be changed naturally, doctors advise a C-section to protect both the mother and the baby. There are different types of breech positions, and an ultrasound closer to your due date will determine the actual place and position of the baby. The call for whether or not you will need a C-section is finalised then.

Transverse Position

A transverse baby position is when your little one lies horizontally in the womb. It is possible that during your entire pregnancy, your baby will lie side to side, but to remain this way is rare. If your baby is in a transverse lying position, the delivery mode is decided closer to your due date. 

If there is no change in the position, babies in a transverse lie are delivered through a C-section. 

A vertex-position baby is ideally the safest one for vaginal births. A baby in the womb will get into the vertex position closer to the due date. It is even possible for breech-position babies to move at the last minute. 

Once your baby has their head low enough in the pelvis, you’re ready. After a final ultrasound determines the safety of the position, the baby is encouraged to move through the birth canal and is pushed out through the vagina. Since the birth canal is a tight space, the baby has to move their head to keep the cervix open. So when a baby is in their final vertex position, the chances of moving again reduce, making it ideal for delivery. 

But sometimes it does happen that despite the baby in the womb being in vertex position, there are complications. When the baby weighs over 4.5 kg, it is difficult for them to move out of the birth canal. The risk of a vaginal tear is also very high. In cases like these, an alternate delivery option, like a C-section, is suggested. 

Benefits of Vertex Position for Labour and Delivery 

These are some of the benefits of vertex position during delivery:

• Baby drop: When the crown of your baby’s head moves down to the pelvis, it can easily flex its way out of the birth canal.
• Uterus shape: Between 32 to 36 weeks of your pregnancy, your baby gets into their final position. The vertex position allows the baby to fit their head to the shape of the birth canal. So when the time for labour arrives, you are ready to push your baby out.
• Less painful: Since your baby’s head and neck can move freely in a vertex position, the birthing process is quicker and less painful.
• Low risk: Your baby’s position in the womb can determine the duration and risk of your delivery. In the vertex position, the chances of the umbilical cord falling in the vaginal canal before the baby is low. Also known as cord prolapse, the event can put both you and your baby’s health at risk

Among the many challenges, one is having a ‘sunny-side-up’ baby. A term jokingly used among doctors, an occipito-posterior position means the baby’s head faces the mother’s stomach. When the baby’s occipital bone or skull presses against the back of your pelvis, they are born facing up.

This position is painful because the baby’s back extends along your spine. The chin is lifted inside the womb, making the head appear larger as it lowers to the pelvis. It happens because the head circumference measures more from the back versus the front. 

A posterior baby position in the womb delays delivery, causing back pain. You may need an epidural to ease the discomfort during delivery. The chances of instrumental delivery or a C-section are more in the case of occipito-posterior or face presentat

Though a breech baby position in the womb is not ideal for delivery, you can still have a healthy newborn. 

The following are the different types of breech positions: 

• Frank breech: The baby folds itself in half, where the legs and head are near the mother’s ribs. The buttocks face downwards towards the cervix.
• Complete breech: The baby’s head is near the ribs, while the feet and knees are below the buttocks. In this position, both the knees are bent, and the hips open.
• Incomplete breech: In an incomplete or footling breech, the baby’s head is up, but one or both feet are below the buttocks. It may so happen that only one foot is pointed at the cervix while the other is folded up. 

Risks of a breech baby position: 

• Birth trauma: Babies born in the breech position have a higher chance of experiencing trauma during delivery.
• Injury: If a breech baby in the womb is delivered vaginally, it increases the risk of injury. The umbilical cord can form a loop, cutting off oxygen and blood flow to the baby during the process.   

In cases of a breech baby, ECV may be used. ECV, or External Cephalic Version, is a minimally invasive technique to turn the baby's head down. Slight pressure is applied to the abdomen, which is not dangerous but may be uncomfortable. 

Sleeping Positions to Turn a Breech Baby 

If your baby in the womb is in a breech position, certain sleeping positions can be helpful. But make sure to discuss it with your obstetrician before you try them.

• Left turn: Sleeping on your left side is advised during pregnancy for better blood circulation to the placenta. It can also help your baby with more space to move and reverse the breech position.
• Breech tilt: Also known as a pelvic tilt, this involves you lying on your back with your hips elevated. The position can help the baby move away from the pelvis. Gravity and space allow the baby to flip its head down, bringing it into a safe delivery position.
• Downward dog: An inverted sleeping position where your hips are higher than your shoulders helps them reposition within the womb. 

Before you approach your due date, your baby in the womb twists and stretches quite a bit. You will feel those unpleasant midnight kicks in the rib. But these late pregnancy signs significantly impact your labour and delivery. Usually, if the baby comes out headfirst, it is called a cephalic presentation. 

Toward the end of your pregnancy, you can feel something called lightning. It is your baby dropping into your abdomen and signalling that your body is preparing for labour. 

36 Weeks Pregnant: Baby Position 

At 36 weeks pregnant, your baby’s position in the womb gradually drops. You will begin to feel pressure in your lower belly. The baby will also press on your bladder, so you may need to pass urine more often. It can get uncomfortable if your baby is low, so put your feet up and enter your nesting period. 

37 Weeks Pregnant: Baby Position

At 37 weeks, you complete the full term! It means you can go into labour anytime. At this point, most babies will be head down, facing the mother’s back. If you see your bump drop, it’s your baby’s head moving down into the pelvis. 

38 Weeks Pregnant: Baby Position 

At 38 weeks, your baby's position is similar to that in 37 weeks, sitting low in your pelvis. You may feel a lightning-like sensation in your vagina caused due to pressing of nerves. You may also begin experiencing Braxton Hicks, also known as practice contractions. 

A baby in the womb will move all over in the first and second trimester. From the third trimester, at 28 weeks, they begin to position themselves for delivery. By the 36th week, most babies will settle into their final position and not move due to the lack of space in the womb. 

You will feel your uterus grow in size to accommodate your growing baby until delivery. 

It is not uncommon for a baby in the womb to be in a transverse position during early pregnancy. Usually, they will flip their head down on their own in the third trimester. Only an ultrasound closer to your due date will tell you the exact position of your baby. 

In case your transverse baby does not reposition, your doctor may suggest the following to manage the situation: 

• ECV after 36 weeks to reverse the baby into vertex position using light pressure on your abdomen.
• Webster technique to move your hips, allowing the uterus to make more space for the baby to move. 

Techniques to Turn a Transverse Baby

Why is my baby transverse? It is a common question that worries you and many other mothers. These home remedies can help you naturally turn a transverse baby in the womb:

• Try the downward dog pose and gently rock back and forth.
• Lie on your back and push your hips in the air.
• Talk to the baby or play music to make the baby more active and facilitate movement. 

Do remember to reach out to your obstetrician to assess the safety of these remedies before you try any.
 

Your baby’s position in the womb constantly changes throughout your pregnancy. They settle down only closer to your delivery date. So, if you have concerns about their position, speak to your doctor. If you are planning to have a vaginal delivery, planning your options will make your birthing experience stress free.