Labor Challenges

Transverse Position

The most common position for a baby to be in during labor is called the vertex, or head down position. A transverse baby is shoulder or back down, lying sideways across the abdomen. Transverse lie occurs in only 1 out of 2,500 births.

A transverse baby may be a temporary condition, or it may signal a baby who is unable to move to the vertex position. Common reasons for a transverse baby are multiple babies, low-lying placentas, small pelvic inlets, weak abdominal wall, and issues with the uterus or baby.

Why is a transverse baby a labor challenge?

Although it is possible for a breech baby to be safely born vaginally, it is almost always impossible for a transverse baby to be born vaginally. The baby is not able to fold himself in such as way as to fit a doubled up body with the shoulder coming first through the vagina.

For this reason, caregivers will attempt a version to move the baby into a better position or schedule a cesarean surgery before labor is expected to happen. Less than 20% of the babies who are transverse at 37 weeks will remain transverse when labor begins, so another option is to wait for labor to start and attempt to turn the baby or perform a cesarean if it is still necessary.

Potential Solutions

Use good posture and activity during pregnancy to encourage the baby to move. Try techniques that help the baby rotate.

Wait until labor begins to begin a cesarean to give the baby every opportunity to change positions.

Things to discuss with your health care provider:

Many midwives and doulas believe that using positioning and maneuvers to turn the baby before labor begins may help the baby turn into a head down position. Some women have tried doing lunges, walking up stairs two stairs at a time, or getting into a knee-chest position to try to encourage the baby to move. As long as there are no health issues that would make it dangerous, your caregiver may encourage you to try these positions and maneuvers.

Some women try placing a flashlight or headphones near their pubic bone, in an attempt to encourage the baby to move head down. Some experts recommend talking to the baby and telling him it is time to turn. Although no studies support the success of either of these methods, they seem to be harmless and your caregiver may encourage you to try them.

A medical method for turning the baby is called an external cephalic version. In this procedure, you will be given a medication that relaxes the uterus (tocolytic) and some doctors also use an epidural to minimize discomfort. Your caregiver will push and press your baby into a head down position. A Cochrane Review of the studies of external version has found that use of the tocolytic improves the success of turning the baby. You may want to discuss with your caregiver when external cephalic version may be recommended for you.

You may want to wait for labor to begin to have the cesarean surgery. This gives your baby every opportunity to change position. However, it will be important to have a strategy for getting to the hospital and beginning the surgery (if necessary) as the longer you labor the more your risk for uterine rupture.

References:

Hofmeyr GJ. Interventions to help external cephalic version for breech presentation at term (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.