By Liz Moorhead

 

As your due date approaches, your baby’s position can be more or less favorable for vaginal birth, meaning presenting fewer potential complications. There are three possible positions, with different variations, and loads of ways to attempt to reposition your baby if needed.
 

VERTEX
The most common position, when baby is head-down, happens in two ways:

    1. Occiput anterior

The most favorable birthing position, this is when the baby is head down, facing your back. Positioned this way, the baby’s head presses against the cervix, encouraging dilation and effacement.

     2. Occiput posterior

This is when the baby is head down, but looking forward, toward your pubic bone (also known as “sunny side up”). Babies can be born this way, but labor might take longer, and you might experience more pain in your back (“back labor”) because the hard part of baby’s head is pressed against your back. Up to a third of babies start facing this way and spontaneously turn themselves as birth approaches. Only about 5-8% of babies are born in the occiput posterior position.

BREECH
Baby’s feet, buttocks, or knees are down toward the vagina, and the head is up by your ribs. Around 25% of babies are breech before 28 weeks, but only 3-4% are breech at term. Most providers do not perform breech vaginal deliveries because of concerns about the umbilical cord dangerously tangling around the baby, but you may be able to find a provider who will deliver vaginally if that is your preference.

There are three different breech positions:

     1. Frank breech

Baby’s butt is down toward the bottom, with legs in front and feet close to the head.

   

     2. Complete breech

Legs are folded at the knees, with feet near baby’s buttocks.

   

     3. Incomplete breech (footling)

One or both of baby’s feet are pointing down, leading the way.


TRANSVERSE
Baby is lying sideways across your abdomen. Most babies will not remain in this position as labor nears, but a cesarean birth will be necessary if the baby does not move, as there is a risk of umbilical cord prolapse (delivering the cord before the baby).

REPOSITIONING

Your provider will begin assessing the baby’s position at 36-38 weeks, by using hands to feel your abdomen (called belly-mapping, or Leopold’s maneuver), or via ultrasound. After thirty-six weeks, it is unlikely the baby will change position on their own.

If baby is not vertex by thirty-six weeks, it is possible to try to reposition the baby to a more favorable position for vaginal birth. These options have a range of efficacy, and are to be attempted only with guidance from your provider.

 

External Cephalic Version (ECV, or a Version)

This is a procedure in which a provider uses the pressure of their hands on the outside of your abdomen to move the baby from a breech or transverse position to a vertex position. A provider will use an ultrasound for guidance, and tocolytic medicine to relax your uterus and prevent contractions. More than half of ECV’s are successful, but sometimes baby will move back into the breech or transverse position. Another ECV may be attempted, but the procedure is more difficult as pregnancy progresses and there is less room for movement in your uterus.

Gravity-based Strategies

It may be helpful to try to relax your pelvic muscles and use gravity to ease baby into position. Some ways to attempt this are through forward leaning inversion, lunges, squats, daily walks, and sitting on a chair backwards. There is not much scientific evidence that these methods work, but they are simple to attempt and there is no harm in trying them.

Chiropractic Adjustments

Some chiropractors are trained in a technique that uses gentle abdominal massage and small adjustments to the back to ease tension in the uterus (called the Webster technique). Be sure to consult your provider as there is little published research on this method.

Acupuncture and Moxibustion

Acupuncture is a method of inserting needles at different points of the body (acupoints) that are expected to influence the body. Moxibustion is a traditional Chinese method of burning herbs near the skin as a type of heat therapy and medicine. Some practitioners use acupuncture and moxibustion in combination to attempt to flip a breech baby. Speak with your provider if you are interested in these alternative methods.

Ice, Light and Sound

There are many ways to try to coax a baby down, and while there is no scientific evidence, some moms insist they work. You may try to create unpleasant sensations at the top of your abdomen, such as cold from an ice pack or bright light from a flashlight, to discourage baby from staying up high. Conversely, you could play pleasant music toward the bottom of your abdomen to encourage baby to move downward toward the sound. 


For more information about baby positions, what they mean, and what you can do to change them, check out our course Childbirth 101: From Labor through Postpartum and consult your healthcare provider.
 

About our Expert
Ashley Derderian Sousa is a board-certified lactation consultant and registered nurse with nearly ten years of experience in labor, delivery, and postpartum units. Through approachable methods and open and honest philosophy, she believes each journey to becoming a parent is a personal one that should be met with self-compassion. She is currently completing a Masters of Health Education.

About the Author
Liz Moorhead is a writer whose work has been featured in Jezebel, Refinery29, and the Washington Post. She lives just outside of Philly with her husband, two kittens, and four mud-covered sons.