It is ideal for the baby to be head-down facing the mother’s back during labor, but babies can end up in all sorts of positions. Here’s what to know about different fetal positions during pregnancy and delivery.
The baby moves around extensively in the womb but settles into a final position late in the pregnancy. The position of the baby matters for a smooth delivery, and certain positions may require intervention for birth.
Anterior Position
The anterior position is ideal for giving birth. In this position, the baby’s head is down near the birth canal, facing the mother’s back. This head-first position allows the cervix to stretch, making it easier to deliver the rest of the baby’s body. Most babies instinctively settle in this position between 32 and 36 weeks of pregnancy.
Posterior Position
The posterior position means that the baby is face-up, or “sunny side up,” instead of face-down. The hardest part of their head rests near the mother’s lower back instead of the belly. In this position, the parent and baby are essentially back-to-back.
This position often results in longer labor since the baby’s head has to rotate further to be born. It can also cause intense back pain during labor. According to a 2015 study, 15% to 32% of babies are in this position when labor begins, and 10% to 20% of babies are still in this position by the second stage of labor. Posterior positioning contributes to about 18% of emergency cesarean sections.
The good news is babies in this position often turn to a more favorable position during labor. In fact, delaying an epidural until active labor decreases the risk of posterior presentations. Certain labor positions may also encourage posterior babies to turn.
If the baby doesn’t turn around on their own, a health care provider might try to rotate the baby manually. If that doesn’t work and the labor goes on for too long, a doctor may recommend a C-section.
Breech Position
Breech position means the baby’s butt or feet are presenting first; essentially, they are right-side up rather than head-down. About 3% to 4% of full-term babies are in breech presentation at term. Risks associated with a baby being in a breech position include umbilical cord prolapse and the baby’s head getting stuck during vaginal delivery.
Due to the increased risks associated with this presentation, a health care provider may try to correct the baby’s position with a “version” (external cephalic version or ECV). For a version, the doctor or midwife attempts to reposition the baby by pushing on the abdomen and the baby’s head. The procedure is successful about half the time and carries some risks.
If the breech baby fails to turn head down, a cesarean section is safer. Research shows that planned cesareans resulted in fewer fetal deaths or serious injuries. However, they did result in more postpartum abdominal pain for the gestational parent and increased future pregnancy-related risks.
Transverse Position
In a transverse position, the baby is lying across the uterus horizontally rather than vertically head-up or head-down. This position increases the likelihood that a shoulder will come through the birth canal first rather than the head.
A fetus is rarely positioned this way close to term. However, if this happens, a health care provider must perform a C-section to prevent complications, including cord prolapse, uterine rupture, and traumatic birth.
How to Tell If Baby Is Head Down
A health care provider will feel the abdomen with their hands during prenatal visits to check the baby’s position. If you have concerns about your baby’s position or if you suspect that your baby is in a less-than-ideal position, talk to your healthcare provider. They can help determine your baby’s position and provide guidance on how to encourage your baby to move into a more favorable position for birth.
In summary, the position of your baby in the womb can have an impact on your labor and delivery. Ideally, your baby should be in the anterior position, head-down and facing your back. However, babies can end up in other positions, such as the posterior, breech, or transverse positions, which may require intervention during birth.
