meaning of transverse presentation

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• Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

• Down, with the back facing the birth canal.
• Sideways, with one shoulder pointing toward the birth canal.
• Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

• An attempt to deliver the baby in the breech position is not successful.
• You do not want to try to have the baby delivered vaginally in the breech position.
• An attempt to move the baby into a head-down position is not successful.
• You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

• Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
• Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
• Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
• Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
• Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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What is a Transverse Baby?

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In the final weeks of pregnancy, babies often settle down in a head down position. However, in rare cases, the baby can be seen lying sideways or in a transverse position, known as malpresentation.

Although this is common in early pregnancy when the babies are more mobile, most babies turn into the head down position by the last trimester. When this does not happen, the malpresentation called transverse lie results.

According to studies, this presentation is rare and is found in only 1 in 400 cases.

Risk Factors for Transverse Lie

Women with the following conditions are at a high risk for transverse presentation:

• High ratio of amniotic fluid to fetus
• Uterine abnormality
• Placenta previa
• Fibroids in the uterus
• Factors preventing fetal head engagement in the mother’s pelvis
• Narrow or contracted pelvis
• More than 2 babies in the womb

Diagnosis of Transverse Presentation

Abdominal examination— In transverse position, the presenting part of the fetus is typically the shoulder. During abdominal examination, the head or the buttocks cannot be felt at the bottom of the uterus and the head is usually felt in the side.

Vaginal examination— A shoulder may be felt during a vaginal examination. An arm of the fetus may even slip forward and the hand or elbow may be felt during pelvic examination.

Confirmation - An ultrasound scan of the uterus confirms the transverse lie position.

Complications of Transverse Lie

Transverse presentation can cause serious complications during delivery. Some of the consequences are listed below:

• Obstructed labor
• Umbilical cord or hand prolapse
• Postpartum hemorrhage
• Birth trauma
• Rupture of the uterus

Delivering a Transverse Baby

It is almost impossible to deliver a transverse baby vaginally. So if a baby is still lying sideways at term or when labor begins, a C-section (caesarean) may be the safest option for delivering the baby.

If a transverse position is confirmed near term, the woman may be advised to be admitted to the hospital, as there is a minor risk of the umbilical cord slipping out of the uterus once water breaks.

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This should be treated as a medical emergency and attended to immediately, as the cord may come out of the uterus before the baby and then the baby will need to be delivered quickly.

In some cases of transverse lie and shoulder presentation, the baby can be turned manually into the head down position using a process called external cephalic version.

In this process, a skilled medical professional applies pressure on the maternal belly and guides the head of the fetus into the correct position, all the while monitoring the fetal presentation on an ultrasound monitor. Although this procedure is largely painless, it can cause some discomfort to the mother.

This process should be tried only if there is no risk of membrane rupture. Although the fetus can be readily rotated to a head first presentation, it may easily turn back to the transverse position.

If external cephalic version is successful, the chance of a normal, vaginal birth is very high. If external cephalic version is not recommended due to some reason or if the procedure is unsuccessful, delivery needs to be performed via caesarean section.

If a woman goes into labor while the baby is in a transverse position, it can impact the shoulder of the fetus adversely. This is because, in such cases, the fetus in a folded position is under pressure to move down the birth canal.

An immediate C-section should be carried out in such cases, even if the fetus is not alive, as this can cause rupture of the uterus.

• https://www.nhs.uk/
• http://apps.who.int/iris/bitstream/10665/43972/1/9241545879_eng.pdf

Further Reading

• All Childbirth Content
• Visitor Policies for Cesarean Sections
• Breeched Birth: Caesarean Section or Vaginal Delivery?
• Natural Childbirth
• Anal Sphincter Injury During Childbirth

Last Updated: Dec 29, 2022

Susha Cheriyedath

Susha is a scientific communication professional holding a Master's degree in Biochemistry, with expertise in Microbiology, Physiology, Biotechnology, and Nutrition. After a two-year tenure as a lecturer from 2000 to 2002, where she mentored undergraduates studying Biochemistry, she transitioned into editorial roles within scientific publishing. She has accumulated nearly two decades of experience in medical communication, assuming diverse roles in research, writing, editing, and editorial management.

Please use one of the following formats to cite this article in your essay, paper or report:

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in Fetal Position and Presentation

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Other presentations

In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.

In brow presentation, the neck is moderately arched so that the brow presents first.

Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor. If they do not, a cesarean delivery is usually recommended.

In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

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What Is a Transverse Baby Position?

Why It Happens, How to Turn Your Baby, and Tips for a Safe Delivery

Causes and Risk Factors

Turning the fetus, complications, frequently asked questions.

A transverse baby position, also called transverse fetal lie, is when the fetus is sideways—at a 90-degree angle to your spine—instead of head up or head down. This development means that a vaginal delivery poses major risks to both you and the fetus.

Sometimes, a transverse fetus will turn itself into the head-down position before you go into labor. Other times, a healthcare provider may be able to turn the position.

If a transverse fetus can't be turned to the right position before birth, you're likely to have a cesarean section (C-section).

This article looks at causes and risk factors for a transverse baby position. It also covers how it's diagnosed and treated, the possible complications, and how you can plan ahead for delivery.

Marko Geber / Getty Images

How Common Is Transverse Baby Position?

An estimated 2% to 13% of babies are in an unfavorable position at delivery —meaning they're not in the head-down position .

Certain physiological issues can lead to a transverse fetal lie. These include:

• A bicornuate uterus : The uterus has a deep V in the top that separates the uterus into two sides; it may only be able to hold a near-term fetus sideways.
• Oligohydramnios or polyhydramnios : Abnormally low or high amniotic fluid volume (respectively).

Several risk factors can make it more likely for the fetus to be in a transverse lie, such as:

• The placenta being in an unusual position, such as blocking the opening to the cervix ( placenta previa ), which doesn't allow the fetus to reach the head-down position
• Going into labor early, before the fetus has had a chance to get into the right position
• Being pregnant with twins or other multiples, as the uterus is crowded and may not allow for much movement
• An abnormal pelvic structure that limits fetal movement
• Having a cyst or fibroid tumor blocking the cervix

Transverse fetal positioning is also more common after your first pregnancy.

It’s not uncommon for a fetus to be in a transverse position during the earlier stages of pregnancy. In most cases, though, they shift on their own well before labor begins. The transverse fetal position doesn't cause any signs or symptoms.

Healthcare professionals diagnose a transverse lie through an examination called Leopold’s Maneuvers. That involves feeling your abdomen to determine the fetal position. It's usually confirmed by an ultrasound.

You may also discover a transverse fetal lie during a routine ultrasound.

Timing of Transverse Position Diagnosis

The ultrasound done at your 36-week checkup lets your healthcare provider see the fetal position as you get closer to labor and delivery. If it's still a transverse lie at that time, your medical team will look at options for the safest labor and delivery.

Approximately 97% of deliveries involve a fetus positioned with the head down, in the best position to slide out. That makes a vaginal delivery easier and safer.

A transverse position only happens in about 1% of deliveries. In that position, the shoulder, arm, or trunk of the fetus may present first. This isn't a good scenario for either of you because a vaginal delivery is nearly impossible.

In these cases, you have two options:

• Turning the fetal position
• Having a C-section

If the fetus is in a transverse lie late in pregnancy, you or your healthcare provider may be able to change the position. Turning into the proper head-down position may help you avoid a C-section.

Medical Options

A healthcare provider can use one of the following techniques to attempt re-positioning a fetus:

• External cephalic version (ECV) : This procedure typically is performed at or after 36 weeks of pregnancy; involves using pressure on your abdomen where the fetal head and buttocks are.
• Webster technique : This is a chiropractic method in which a healthcare professional moves your hips to allow your uterus to relax and make more room for the fetus to move itself. (Note: No evidence supports this method.)

A 2020 study reported a 100% success rate for trained practitioners who used turning to change a transverse fetal lie. Real-world success rates are closer to 60%.

At-Home Options

You may be able to encourage a move out of the transverse position at home. You can try:

• Getting on your hands and knees and gently rocking back and forth
• Lying on your back with your knees bent and feet flat on the floor, then pushing your hips up in the air (bridge pose)
• Talking or playing music to stimulate the fetus to become more active
• Applying some cold to your abdomen where the fetal head is, which may make them want to move away from it

These methods may or may not work for you. While there's anecdotal evidence that they sometimes work, they haven't been researched.

Talk to your healthcare provider before attempting any of these techniques to ensure you're not doing anything unsafe.

Can Babies Go Back to Transverse After Being Turned?

Even if the fetus does change position or is successfully moved, it is possible that it could return to a transverse position prior to delivery.

Whether your child is born via C-section or is successfully moved so you can have a vaginal delivery, potential complications remain.

Cesarean Sections

C-sections are extremely common and are generally safe for both you and the fetus. Still, some inherent risks are associated with the procedure, as there are with any surgery.

The transverse position can force the surgeon to make a different type of incision, as the fetal lie may be right where they'd usually cut. Possible C-section complications for you can include:

• Increased bleeding
• Bladder or bowel injury
• Reactions to medicines
• Blood clots
• Death (very rare)

In rare cases, a C-section can result in potential complications for the baby , including:

• Breathing problems, if fluid needs to be cleared from their lungs

Most C-sections are safe and result in a healthy baby and parent. In some situations, a surgical delivery is the safest option available.

Vaginal Delivery

If the fetus is successfully moved out of the transverse lie position, you'll likely be able to deliver it vaginally. However, a few complications are possible even after the fetus has been moved:

• Labor typically takes longer.
• Your baby’s face may be swollen and appear bruised for a few days.
• The umbilical cord may be compressed, potentially causing distress and leading to a C-section.

Studies suggest that ECV is safe, effective, and may help lower the C-section rate.

Planning Ahead

As with any birth, if you experience a transverse fetal position, you should work with your healthcare provider to develop a delivery plan. If the transverse position has been maintained throughout the pregnancy, the medical team will evaluate the position at about 36 weeks and make plans accordingly.

Remember that even if the fetal head is down late in pregnancy, things can change quickly during labor and delivery. That means it's worthwhile to discuss options for different types of delivery in case they become necessary.

A transverse baby position, or transverse fetal lie, is the term for a fetus that's lying sideways in the uterus. Vaginal delivery usually isn't possible in these cases.

If the fetus is in this position near the time of delivery, the options are to turn it to make vaginal delivery possible or to have a C-section. A trained healthcare provider can use turning techniques. You may also be able to get the fetus to turn at home with some simple techniques.

Both C-section and vaginal delivery pose a risk of certain complications. However, these problems are rare and the vast majority of deliveries end with a healthy baby and parent.

A Word From Verywell

Pregnancy comes with many unknowns, and the surprises can continue up through labor and delivery.

Talking to your healthcare provider early on about possible scenarios can give you time to think about possible outcomes. This helps to avoid a situation where you’re considering risks and benefits during labor when quick decisions need to be made.

Ideally, a baby should be in the cephalic position (head down) at 32 weeks. If not, a doctor will examine the fetal position at around the 36-week mark and determine what should happen next to ensure a smooth delivery. Whether this involves a cesarian section will depend on the specific case.

Less than 1% of babies are born in the transverse position. In many cases, a doctor might recommend a cesarian delivery to ensure a more safe delivery. The risk of giving birth in the transverse lie position is greater before a due date or if twins or triplets are also born.

A planned cesarian section, or C-section, is typically performed in the 39th week of gestation. This is done so the fetus is given enough time to grow and develop so that it is healthy.

In some cases, a doctor may perform an external cephalic version (ECV) to change a transverse fetal lie. This involves the doctor using their hands to apply firm pressure to the abdomen so the fetus is moved into the cephalic (head-down) position.

Most attempts of ECV are successful, but there is a chance the fetus can move back to its previous position; in these cases, a doctor can attempt ECV again.

The American College of Obstetricians and Gynecologists. If your baby is breech .

Tempest N, Lane S, Hapangama D.  Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position in the second stage of labor: a prospective observational study .  Acta Obstet Gynecol Scand . 2020;99(4):537-545. doi:10.1111/aogs.13765

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Congenital uterine anomalies .

Figueroa L, McClure EM, Swanson J, et al.  Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries .  Reprod Health.  2020;17 (article 19). doi:10.1186/s12978-020-0854-y

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Placenta previa .

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Your baby in the birth canal .

Van der Kaay DC, Horsch S, Duvekot JJ.  Severe neonatal complication of transverse lie after preterm premature rupture of membranes .  BMJ Case Rep . 2013;bcr2012008399. doi:10.1136/bcr-2012-008399

Oyinloye OI, Okoyomo AA.  Longitudinal evaluation of foetal transverse lie using ultrasonography .  Afr J Reprod Health ; 14(1):129-133.

Nishikawa M, Sakakibara H. Effect of nursing intervention program using abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment .  Reprod Health  2013;10 (article 12). doi.org/10.1186/1742-4755-10-12

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Delivery presentations .

Dalvi SA. Difficult deliveries in Cesarean section .  J Obstet Gynaecol India . 2018;68(5):344-348. doi:10.1007/s13224-017-1052-x

Zhi Z, Xi L. Clinical analysis of 40 cases of external cephalic version without anesthesia .  J Int Med Res . 2021;49(1):300060520986699. doi:10.1177/0300060520986699

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Questions to ask your doctor about labor and delivery .

Nemours KidsHealth. Cesarean sections .

By Elizabeth Yuko, PhD Yuko has a doctorate in bioethics and medical ethics and is a freelance journalist based in New York.

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General considerations, diagnosis of position: transverse lie.

• MECHANISM OF LABOR: TRANSVERSE LIE
• PROGNOSIS: TRANSVERSE LIE
• MANAGEMENT OF TRANSVERSE LIE
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When the long axes of mother and fetus are at right angles to one another, a transverse lie is present. Because the shoulder is placed so frequently in the brim of the inlet, this malposition is often referred to as the shoulder presentation. The baby may lie directly across the maternal abdomen ( Fig. 26-1 ) or may lie obliquely with the head or breech in the iliac fossa ( Figs. 26-2A and B ). Usually the breech is at a higher level than the head. The denominator is the scapula (Sc); the situation of the head determines whether the position is left or right, and that of the back indicates whether it is anterior or posterior. Thus, LScP means that the lie is transverse, the head is on the mother's left side, and the baby's back is posterior. The part that actually lies over the pelvic brim may be the shoulder, back, abdomen, ribs, or flank. This is a serious malposition whose management must not be left to nature.

FIGURE 26-1.

Transverse lie: LScP.

FIGURE 26-2.

Oblique lie.

The incidence of transverse lie is around 1:500. The incidence is higher before term (as high as 1 in 50 at 32 weeks' gestation).

This abnormality is more common in multiparas than primigravidas because of the laxness of the uterine and abdominal muscles. Similar condition in which there is relatively excess space for the fetus are polyhydramnios and prematurity. Other causes include anything that prevents engagement of the head or the breech, such as placenta previa; an obstructing neoplasm; multiple pregnancies; fetal anomalies; fetopelvic disproportion; contracted pelvis; and uterine abnormalities such as uterus subseptus, uterus arcuatus, and uterus bicornis. In many instances, no etiologic factor can be determined, and we assume that the malposition is accidental. The head happens to be out of the lower uterine segment when labor starts, and the shoulder is pushed into the pelvic brim.

Abdominal Examination

The appearance of the abdomen is asymmetrical

The long axis of the fetus is across the mother's abdomen

The uterine fundus is lower than expected for the period of gestation. It has been described as a squat uterus. Its upper limit is near the umbilicus, and it is wider than usual

Palpation of the upper and lower poles of the uterus reveals neither the head nor the breech

The head can be felt in one maternal flank. The buttocks are on the other side

Fetal Heart

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What happens when my baby is in transverse lie?

What is a transverse baby?

Is a transverse baby healthy, will my baby stay in the transverse position, how will i know if my baby is in transverse lie in late pregnancy, what causes a baby to stay transverse, what will happen if my baby stays in the transverse position near my due date, what will happen if i have a cord prolapse, baby in transverse lie position.

• you have too much amniotic fluid in your womb (polyhydramnios)
• you’ve had multiple pregnancies
• you have any problems with the womb
• you have placenta praevia
• you have fibroids or ovarian cysts

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Can I tell how my baby's lying based on his movements?

Low-lying placenta and placenta praevia

Breech birth

Abnormalities of the uterus in pregnancy

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Transverse Lie Baby Position: Causes, Complications & Treatment

What Is a Transverse Lie Position?

Causes of the transverse lie position, diagnosis of the transverse lie position, types of transverse lie position, complications arising from a transverse lie position, what if you’re pregnant with twins, what are the effective methods for repositioning a baby from a transverse lie.

A longitudinal lie is a position assumed by a normal baby before labour. A transverse baby position, on the other hand, is when the baby lies across the stomach with her head facing away from the birth canal. As this interferes with the delivery, different techniques are used to correct a transverse lie position. Keep reading for everything you need to know about the fetal transverse position. Understanding the implications and corrective measures for fetal positions is crucial for ensuring a smooth and safe delivery process.

If you can’t feel your baby’s head near the pelvis when the abdominal region is palpitated, and feel it in one of the flanks , your baby is in a transverse lie position. A transverse lie is a position in which the baby lies sideways. This makes a vaginal pregnancy impossible. In most of the cases, a C-section is recommended. If a transverse position baby is diagnosed late during the pregnancy, the chances of the baby staying in that position until birth are high.

There are many reasons why babies assume the transverse lie position. The most common transverse lie causes are:

• An abnormal amount of amniotic fluid in the womb
• Being pregnant with twins
• Flexible abdominal muscles, which make it easier for the baby to move around in the womb
• Malformations of the uterus or obstruction of the birth canal due to some reason
• Placenta previa, a condition where the placenta partially or completely covers the cervix, affecting the baby’s positioning.

The doctor can tell the position of the baby by placing her hands on the abdomen in a series of movements. This is known as Leopold’s Maneuvers. She may also request an ultrasound exam to confirm the position of your baby. Typically, the position of the baby is not a concern until the last trimester of pregnancy.

There are three commonly identifiable transverse lie baby symptoms or presentations in mothers.

They are :-

• Left-Shoulder Presentation  – This is when the baby’s left shoulder faces the birth canal. What makes this dangerous is the cord may prolapse and leave the birth canal before the baby leaves, thus, making pregnancy impossible in this position.
• Right-Shoulder Presentation – When the baby’s right shoulder faces the bottom of the uterus, then that’s a right-shoulder presentation. The baby’s head can face either side in this presentation, and the position needs to be changed, or else, mothers have to go through a caesarean.
• Back-Down Presentation – If your baby lies on her back with neither shoulder facing in the direction of the birth canal, then that’s a back-down presentation. This position makes it impossible for labour to move forward since there’s no way the baby can exit in this position.
• Oblique Lie – This occurs when the baby is positioned diagonally in the uterus, with the head on one side and the feet on the other. This oblique presentation can complicate labor and delivery, requiring careful management to ensure a positive outcome.

When your baby is in the transverse lie position, the complications or transverse lie baby risks that arise are:

• Poor oxygen and blood supply due to umbilical cord prolapse . This can result in the death of the baby.
• Since the baby can’t pass through the vagina in such a position, a C-section will be required.
• Prolonged labour can lead to infections.
• Prolonged attempts at vaginal delivery with a transverse lie may lead to uterine rupture, a serious complication requiring emergency medical intervention. This poses risks to both the mother and the baby.

In the case of twins, if the second twin is in a transverse position then there are chances of vaginal delivery, as the uterine contractions change the position suitable for vaginal delivery. However, it may not be true in every case. In such a scenario, a cesarean may be needed, especially if the baby is big.

Wondering how to turn a transverse baby? Here are some professional options as well as options you can try at home.

1) Professional Option

If exercises and natural remedies fail, then it’s time to turn to some professional help. Here’s what you can do If there’s no success after 37 weeks of pregnancy .

1. External Cephalic Version (ECV)

A medical procedure performed by healthcare providers where external manipulation is used to turn the baby into a head-down position, reducing the risk associated with a transverse lie.

2. Amnioinfusion

This technique involves introducing a saline solution into the amniotic cavity to create more space and encourage the baby to move into the proper head-down position for delivery.

3. Cesarean Section (C-Section)

In cases where other interventions are unsuccessful or deemed unsafe, a cesarean section may be recommended to ensure a controlled and timely delivery, minimizing risks associated with a transverse lie.

2) Options That Can Be Tried at Home

While addressing a transverse lie baby position at home, it’s essential to approach potential solutions cautiously and consult with a healthcare professional for guidance. Here are some options that may be considered, but it’s crucial to ensure safety and efficacy:

• Pelvic Tilts and Exercises: Gentle exercises and pelvic tilts may help encourage the baby to move into a head-down position. Consult with a healthcare provider or a certified prenatal fitness instructor for appropriate exercises.
• Optimal Maternal Positioning: Maintaining certain positions, such as hands and knees, may help create more space for the baby to turn naturally. Regularly adopting these positions, especially during periods of fetal activity, can be attempted with guidance from healthcare professionals.
• Cold and Warm Compresses: Applying a cold pack to the top of the abdomen and a warm pack to the lower abdomen, while being cautious of temperature, could potentially encourage the baby to move. However, this should be done under supervision and guidance to avoid any adverse effects.

1. Is the Transverse Position Considered Healthy for a Baby?

No, the transverse lie position is not considered healthy for a baby. Is transverse position dangerous for a baby? Yes, as it can lead to complications such as umbilical cord prolapse, fetal distress, and difficulties during delivery.

2. What Happens if Your Baby Cannot Be Turned?

If attempts to turn the baby into a head-down position are unsuccessful or deemed unsafe, a cesarean section (C-section) may be recommended to ensure a controlled and timely delivery, minimizing risks associated with a transverse lie.

3. What Is the Typical Duration for a Baby to Remain in the Transverse Lie Position?

There is no fixed duration for a baby to remain in the transverse lie position. However, it is crucial to address this position promptly to avoid complications. The position should ideally be corrected before labor begins, and medical interventions may be necessary to ensure safe delivery.

A transverse pregnancy is often fraught with risks to the mother as well as the baby. Having a baby lying in the transverse position can surely worry mothers. But in most cases, certain medical techniques prove useful in getting the baby to assume the head-down position.

References/Resources:

1. Yolli. H, Cim. N, Yıldızhan. R, Sahin. H; A Fatal and Extremely Rare Obstetric Complication: Neglected Shoulder Presentation at Term Pregnancy (Case Reports in Obstetrics and Gynecology); Hindawi; https://www.hindawi.com/journals/criog/2015/819874/#B7 ; August 2015

2. Polyhydramnios: Too Much Amniotic Fluid; Birth Injury Help Center; https://www.birthinjuryhelpcenter.org/amniotic-fluid-excess.html

3. Transverse lie and shoulder presentation; Medicins Sans Frontierers; https://medicalguidelines.msf.org/en/viewport/ONC/english/7-6-transverse-lie-and-shoulder-presentation-51417541.html

4. Ali. R, Abrar. A; Transverse lie; predisposing factors, maternal and perinatal outcome; The Professional Medical Journal; https://applications.emro.who.int/imemrf/Professional_Med_J_Q/Professional_Med_J_Q_2011_18_2_208_211.pdf

5. Malpresentation; Pregnancy, Birth & Baby; https://www.pregnancybirthbaby.org.au/malpresentation

6. Boushra. M, Stone. A, Rathbun. K; Umbilical Cord Prolapse; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK542241/

7. External Cephalic Version for Breech Position; Michigan Medicine University of Michigan; https://www.uofmhealth.org/health-library/hw180146

Also Read: 

Shoulder Presentation Assisted Delivery (Forceps and Ventouse) Fetal Cephalic Presentation during Pregnancy Baby’s Positions in the Womb and How to Discover Them

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7.6 Transverse lie and shoulder presentation

A transverse lie constitutes an absolute foeto-pelvic disproportion, and vaginal delivery is impossible.

This is an obstetric emergency, because labour is obstructed and there is a risk of uterine rupture and foetal distress.

7.6.1 Diagnosis

• The uterus is very wide: the transverse axis is virtually equivalent to the longitudinal axis; fundal height is less than 30 cm near term.
• On examination: head in one side, breech in the other (Figures 7.1a and 7.1b). Vaginal examination reveals a nearly empty true pelvis or a shoulder with—sometimes—an arm prolapsing from the vagina (Figure 7.1c).

Figures 7.1 - Transverse lie and shoulder presentation

7.6.2 Possible causes

• Grand multiparity (5 deliveries or more)
• Uterine malformation

Twin pregnancy

• Prematurity
• Placenta praevia
• Foeto-pelvic disproportion

7.6.3 Management

This diagnosis should be made before labour begins, at the last prenatal visit before the birth.

At the end of pregnancy

Singleton pregnancy.

• External version 4 to 6 weeks before delivery, in a CEmONC facility ( Section 7.7 ).
• If this fails, delivery should be carried out by caesarean section, either planned or at the beginning of labour (Chapter 6, Section 6.4.1 ).
• External version is contra-indicated.
• If the first twin is in a transverse lie (unusual): schedule a caesarean section.
• If the second twin is in a transverse lie: there is no indication for caesarean section, but plan delivery in a CEmONC facility so that it can be performed if necessary. Deliver the first twin and then, assess the foetal position and give a few minutes for the second twin to adopt a longitudinal lie. If the second twin stays in a transverse lie, and depending on the experience of the operator, perform external version ( Section 7.7 ) and/or internal version ( Section 7.8 ) on the second twin.

During labour, in a CEmONC facility

Foetus alive and membranes intact.

• Gentle external version, between two contractions, as early as possible, then proceed as with normal delivery.
• If this fails: caesarean section.

Foetus alive and membranes ruptured

• Multipara with relaxed uterus and mobile foetus, and an experienced operator: internal version and total breech extraction.
• Primipara, or tight uterus, or immobile foetus, or engaged arm, or scarred uterus or insufficiently-experienced operator: caesarean section.
• Incomplete dilation: caesarean section.

Caesarean section can be difficult due to uterine retraction. Vertical hysterotomy is preferable. To perform extraction, grasp a foot in the fundus (equivalent to a total breech extraction, but by caesarean section).

Foetus dead

Embryotomy for transverse lie (Chapter 9, Section 9.7.7 ).

During labour, in remote settings where surgery is not available

Try to refer the patient to a CEmONC facility. If not feasible:

• Attempt external version as early as possible.
• If this fails, wait for complete dilation.
• Perform an external version ( Section 7.7 ) combined with an internal version ( Section 7.8 ), possibly placing the woman in various positions (Trendelenburg or knee-chest).
• Put the woman into the knee-chest position.
• Between contractions, push the foetus back and try to engage his head.
• Vacuum extraction (Chapter 5, Section 5.6.1 ) and symphysiotomy (Chapter 5, Section 5.7 ) at the slightest difficulty.
• Incomplete dilation: Trendelenburg position and watchful waiting until complete dilation.

Try to refer the patient, even if referral takes some time. If not feasible, embryotomy for transverse lie (Chapter 9, Section 9.7.7 ).

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Abnormal Fetal lie, Malpresentation and Malposition

Original Author(s): Anna Mcclune Last updated: 1st December 2018 Revisions: 12

• 1 Definitions
• 2 Risk Factors
• 3.2 Presentation
• 3.3 Position
• 4 Investigations
• 5.1 Abnormal Fetal Lie
• 5.2 Malpresentation
• 5.3 Malposition

The lie, presentation and position of a fetus are important during labour and delivery.

In this article, we will look at the risk factors, examination and management of abnormal fetal lie, malpresentation and malposition.

Definitions

• Longitudinal, transverse or oblique
• Cephalic vertex presentation is the most common and is considered the safest
• Other presentations include breech, shoulder, face and brow
• Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) – this is ideal for birth
• Other positions include occipito-posterior and occipito-transverse.

Note: Breech presentation is the most common malpresentation, and is covered in detail here .

Fig 1 – The two most common fetal presentations: cephalic and breech.

Risk Factors

The risk factors for abnormal fetal lie, malpresentation and malposition include:

• Multiple pregnancy
• Uterine abnormalities (e.g fibroids, partial septate uterus)
• Fetal abnormalities
• Placenta praevia
• Primiparity

Identifying Fetal Lie, Presentation and Position

The fetal lie and presentation can usually be identified via abdominal examination. The fetal position is ascertained by vaginal examination.

For more information on the obstetric examination, see here .

• Face the patient’s head
• Place your hands on either side of the uterus and gently apply pressure; one side will feel fuller and firmer – this is the back, and fetal limbs may feel ‘knobbly’ on the opposite side

Presentation

• Palpate the lower uterus (above the symphysis pubis) with the fingers of both hands; the head feels hard and round (cephalic) and the bottom feels soft and triangular (breech)
• You may be able to gently push the fetal head from side to side

The fetal lie and presentation may not be possible to identify if the mother has a high BMI, if she has not emptied her bladder, if the fetus is small or if there is polyhydramnios .

During labour, vaginal examination is used to assess the position of the fetal head (in a cephalic vertex presentation). The landmarks of the fetal head, including the anterior and posterior fontanelles, indicate the position.

Fig 2 – Assessing fetal lie and presentation.

Investigations

Any suspected abnormal fetal lie or malpresentation should be confirmed by an ultrasound scan . This could also demonstrate predisposing uterine or fetal abnormalities.

Abnormal Fetal Lie

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted – ideally between 36 and 38 weeks gestation.

ECV is the manipulation of the fetus to a cephalic presentation through the maternal abdomen.

It has an approximate success rate of 50% in primiparous women and 60% in multiparous women. Only 8% of breech presentations will spontaneously revert to cephalic in primiparous women over 36 weeks gestation.

Complications of ECV are rare but include fetal distress , premature rupture of membranes, antepartum haemorrhage (APH) and placental abruption. The risk of an emergency caesarean section (C-section) within 24 hours is around 1 in 200.

ECV is contraindicated in women with a recent APH, ruptured membranes, uterine abnormalities or a previous C-section .

Fig 3 – External cephalic version.

Malpresentation

The management of malpresentation is dependent on the presentation.

• Breech – attempt ECV before labour, vaginal breech delivery or C-section
• Brow – a C-section is necessary
• If the chin is anterior (mento-anterior) a normal labour is possible; however, it is likely to be prolonged and there is an increased risk of a C-section being required
• If the chin is posterior (mento-posterior) then a C-section is necessary
• Shoulder – a C-section is necessary

Malposition

90% of malpositions spontaneously rotate to occipito-anterior as labour progresses. If the fetal head does not rotate, rotation and operative vaginal delivery can be attempted. Alternatively a C-section can be performed.

• Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) - this is ideal for birth

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted - ideally between 36 and 38 weeks gestation.

• Breech - attempt ECV before labour, vaginal breech delivery or C-section

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Obstetric and Newborn Care I

10.02 key terms related to fetal positions.

a. “Lie” of an Infant.

Lie refers to the position of the spinal column of the fetus in relation to the spinal column of the mother. There are two types of lie, longitudinal and transverse. Longitudinal indicates that the baby is lying lengthwise in the uterus, with its head or buttocks down. Transverse indicates that the baby is lying crosswise in the uterus.

b. Presentation/Presenting Part.

Presentation refers to that part of the fetus that is coming through (or attempting to come through) the pelvis first.

(1) Types of presentations (see figure 10-1). The vertex or cephalic (head), breech, and shoulder are the three types of presentations. In vertex or cephalic, the head comes down first. In breech, the feet or buttocks comes down first, and last–in shoulder, the arm or shoulder comes down first. This is usually referred to as a transverse lie.

(2) Percentages of presentations.

(a) Head first is the most common-96 percent.

(b) Breech is the next most common-3.5 percent.

(c) Shoulder or arm is the least common-5 percent.

(3) Specific presentation may be evaluated by several ways.

(a) Abdominal palpation-this is not always accurate.

(b) Vaginal exam–this may give a good indication but not infallible.

(c) Ultrasound–this confirms assumptions made by previous methods.

(d) X-ray–this confirms the presentation, but is used only as a last resort due to possible harm to the fetus as a result of exposure to radiation.

c. Attitude.

This is the degree of flexion of the fetus body parts (body, head, and extremities) to each other. Flexion is resistance to the descent of the fetus down the birth canal, which causes the head to flex or bend so that the chin approaches the chest.

(1) Types of attitude (see figure 10-2).

(a) Complete flexion. This is normal attitude in cephalic presentation. With cephalic, there is complete flexion at the head when the fetus “chin is on his chest.” This allows the smallest cephalic diameter to enter the pelvis, which gives the fewest mechanical problems with descent and delivery.

(b) Moderate flexion or military attitude. In cephalic presentation, the fetus head is only partially flexed or not flexed. It gives the appearance of a military person at attention. A larger diameter of the head would be coming through the passageway.

(c) Poor flexion or marked extension. In reference to the fetus head, it is extended or bent backwards. This would be called a brow presentation. It is difficult to deliver because the widest diameter of the head enters the pelvis first. This type of cephalic presentation may require a C/Section if the attitude cannot be changed.

(d) Hyperextended. In reference to the cephalic position, the fetus head is extended all the way back. This allows a face or chin to present first in the pelvis. If there is adequate room in the pelvis, the fetus may be delivered vaginally.

(2) Areas to look at for flexion.

(a) Head-discussed in previous paragraph, 10-2c(1).

(b) Thighs-flexed on the abdomen.

(c) Knees-flexed at the knee joints.

(d) Arches of the feet-rested on the anterior surface of the legs.

(e) Arms-crossed over the thorax.

(3) Attitude of general flexion. This is when all of the above areas are flexed appropriately as described.

d. Station.

This refers to the depth that the presenting part has descended into the pelvis in relation to the ischial spines of the mother’s pelvis. Measurement of the station is as follows:

(1) The degree of advancement of the presenting part through the pelvis is measured in centimeters.

(2) The ischial spines is the dividing line between plus and minus stations.

(3) Above the ischial spines is referred to as -1 to -5, the numbers going higher as the presenting part gets higher in the pelvis (see figure10-3).

(4) The ischial spines is zero (0) station.

(5) Below the ischial spines is referred to +1 to +5, indicating the lower the presenting part advances.

e. Engagement.

This refers to the entrance of the presenting part of the fetus into the true pelvis or the largest diameter of the presenting part into the true pelvis. In relation to the head, the fetus is said to be engaged when it reaches the midpelvis or at a zero (0) station. Once the fetus is engaged, it (fetus) does not go back up. Prior to engagement occurring, the fetus is said to be “floating” or ballottable.

f. Position.

This is the relationship between a predetermined point of reference or direction on the presenting part of the fetus to the pelvis of the mother.

(1) The maternal pelvis is divided into quadrants.

(a) Right and left side, viewed as the mother would.

(b) Anterior and posterior. This is a line cutting the pelvis in the middle from side to side. The top half is anterior and the bottom half is posterior.

(c) The quadrants never change, but sometimes it is confusing because the student or physician’s viewpoint changes.

NOTE: Remember that when you are describing the quadrants, view them as the mother would.

(2) Specific points on the fetus.

(a) Cephalic or head presentation.

1 Occiput (O). This refers to the Y sutures on the top of the head.

2 Brow or fronto (F). This refers to the diamond sutures or anterior fontanel on the head.

3 Face or chin presentation (M). This refers to the mentum or chin.

(b) Breech or butt presentation.

1 Sacrum or coccyx (S). This is the point of reference.

2 Breech birth is associated with a higher perinatal mortality.

(c) Shoulder presentation.

1 This would be seen with a transverse lie.

2. Scapula (Sc) or its upper tip, the acromion (A) would be used for the point of reference.

(3) Coding of positions.

(a) Coding simplifies explaining the various positions.

1 The first letter of the code tells which side of the pelvis the fetus reference point is on (R for right, L for left).

2 The second letter tells what reference point on the fetus is being used (Occiput-O, Fronto-F, Mentum-M, Breech-S, Shoulder-Sc or A).

3 The last letter tells which half of the pelvis the reference point is in (anterior-A, posterior-P, transverse or in the middle-T).

(b) Each presenting part has the possibility of six positions. They are normally recognized for each position–using “occiput” as the reference point.

1 Left occiput anterior (LOA).

2 Left occiput posterior (LOP).

3 Left occiput transverse (LOT).

4 Right occiput anterior (ROA).

5. Right occiput posterior (ROP).

6 Right occiput transverse (ROT).

(c) A transverse position does not use a first letter and is not the same as a transverse lie or presentation.

1 Occiput at sacrum (O.S.) or occiput at posterior (O.P.).

2 Occiput at pubis (O.P.) or occiput at anterior (O.A.).

(4) Types of breech presentations (see figure10-4).

(a) Complete or full breech. This involves flexion of the fetus legs. It looks like the fetus is sitting in a tailor fashion. The buttocks and feet appear at the vaginal opening almost simultaneously.

A–Complete. B–Frank. C–Incomplete.

(b) Frank and single breech. The fetus thighs are flexed on his abdomen. His legs are against his trunk and feet are in his face (foot-in-mouth posture). This is the most common and easiest breech presentation to deliver.

(c) Incomplete breech. The fetus feet or knees will appear first. His feet are labeled single or double footing, depending on whether 1 or 2 feet appear first.

(5) Observations about positions (see figure 10-5).

(a) LOA and ROA positions are the most common and permit relatively easy delivery.

(b) LOP and ROP positions usually indicate labor may be longer and harder, and the mother will experience severe backache.

(c) Knowing positions will help you to identify where to look for FHT’s.

1 Breech. This will be upper R or L quad, above the umbilicus.

2 Vertex. This will be lower R or L quad, below the umbilicus.

(d) An occiput in the posterior quadrant means that you will feel lumpy fetal parts, arms and legs (see figure 10-5 A). If delivered in that position, the infant will come out looking up.

(e) An occiput in the anterior quadrant means that you will feel a more smooth back (see figure 10-5 B). If delivered in that position, the infant will come out looking down at the floor.

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What Causes Breech Presentation?

Learn more about the types, causes, and risks of breech presentation, along with how breech babies are typically delivered.

What Is Breech Presentation?

Types of breech presentation, what causes a breech baby, can you turn a breech baby, how are breech babies delivered.

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Toward the end of pregnancy, your baby will start to get into position for delivery, with their head pointed down toward the vagina. This is otherwise known as vertex presentation. However, some babies turn inside the womb so that their feet or buttocks are poised to be delivered first, which is commonly referred to as breech presentation, or a breech baby.

As you near the end of your pregnancy journey, an OB-GYN or health care provider will check your baby's positioning. You might find yourself wondering: What causes breech presentation? Are there risks involved? And how are breech babies delivered? We turned to experts and research to answer some of the most common questions surrounding breech presentation, along with what causes this positioning in the first place.

During your pregnancy, your baby constantly moves around the uterus. Indeed, most babies do somersaults up until the 36th week of pregnancy , when they pick their final position in the womb, says Laura Riley , MD, an OB-GYN in New York City. Approximately 3-4% of babies end up “upside-down” in breech presentation, with their feet or buttocks near the cervix.

Breech presentation is typically diagnosed during a visit to an OB-GYN, midwife, or health care provider. Your physician can feel the position of your baby's head through your abdominal wall—or they can conduct a vaginal exam if your cervix is open. A suspected breech presentation should ultimately be confirmed via an ultrasound, after which you and your provider would have a discussion about delivery options, potential issues, and risks.

There are three types of breech babies: frank, footling, and complete. Learn about the differences between these breech presentations.

Frank Breech

With frank breech presentation, your baby’s bottom faces the cervix and their legs are straight up. This is the most common type of breech presentation.

Footling Breech

Like its name suggests, a footling breech is when one (single footling) or both (double footling) of the baby's feet are in the birth canal, where they’re positioned to be delivered first .

Complete Breech

In a complete breech presentation, baby’s bottom faces the cervix. Their legs are bent at the knees, and their feet are near their bottom. A complete breech is the least common type of breech presentation.

Other Types of Mal Presentations

The baby can also be in a transverse position, meaning that they're sideways in the uterus. Another type is called oblique presentation, which means they're pointing toward one of the pregnant person’s hips.

Typically, your baby's positioning is determined by the fetus itself and the shape of your uterus. Because you can't can’t control either of these factors, breech presentation typically isn’t considered preventable. And while the cause often isn't known, there are certain risk factors that may increase your risk of a breech baby, including the following:

• The fetus may have abnormalities involving the muscular or central nervous system
• The uterus may have abnormal growths or fibroids
• There might be insufficient amniotic fluid in the uterus (too much or too little)
• This isn’t your first pregnancy
• You have a history of premature delivery
• You have placenta previa (the placenta partially or fully covers the cervix)
• You’re pregnant with multiples
• You’ve had a previous breech baby

In some cases, your health care provider may attempt to help turn a baby in breech presentation through a procedure known as external cephalic version (ECV). This is when a health care professional applies gentle pressure on your lower abdomen to try and coax your baby into a head-down position. During the entire procedure, the fetus's health will be monitored, and an ECV is often performed near a delivery room, in the event of any potential issues or complications.

However, it's important to note that ECVs aren't for everyone. If you're carrying multiples, there's health concerns about you or the baby, or you've experienced certain complications with your placenta or based on placental location, a health care provider will not attempt an ECV.

The majority of breech babies are born through C-sections . These are usually scheduled between 38 and 39 weeks of pregnancy, before labor can begin naturally. However, with a health care provider experienced in delivering breech babies vaginally, a natural delivery might be a safe option for some people. In fact, a 2017 study showed similar complication and success rates with vaginal and C-section deliveries of breech babies.

That said, there are certain known risks and complications that can arise with an attempt to deliver a breech baby vaginally, many of which relate to problems with the umbilical cord. If you and your medical team decide on a vaginal delivery, your baby will be monitored closely for any potential signs of distress.

Ultimately, it's important to know that most breech babies are born healthy. Your provider will consider your specific medical condition and the position of your baby to determine which type of delivery will be the safest option for a healthy and successful birth.

ACOG. If Your Baby Is Breech .

American Pregnancy Association. Breech Presentation .

Gray CJ, Shanahan MM. Breech Presentation . [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Mount Sinai. Breech Babies .

Takeda J, Ishikawa G, Takeda S. Clinical Tips of Cesarean Section in Case of Breech, Transverse Presentation, and Incarcerated Uterus . Surg J (N Y). 2020 Mar 18;6(Suppl 2):S81-S91. doi: 10.1055/s-0040-1702985. PMID: 32760790; PMCID: PMC7396468.

Shanahan MM, Gray CJ. External Cephalic Version . [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 

Fonseca A, Silva R, Rato I, Neves AR, Peixoto C, Ferraz Z, Ramalho I, Carocha A, Félix N, Valdoleiros S, Galvão A, Gonçalves D, Curado J, Palma MJ, Antunes IL, Clode N, Graça LM. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? Acta Med Port. 2017 Jun 30;30(6):479-484. doi: 10.20344/amp.7920. Epub 2017 Jun 30. PMID: 28898615.

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