Fetal Positions

What does fetal positioning mean?

Fetal positioning refers to a fetus’s position in your uterus before birth. Your pregnancy care provider may call it fetal presentation or the presentation of the fetus (although this usually refers to which part of a fetus’s body will move into the birth canal first). Knowing the position of the fetus helps a pregnancy care provider determine if it’s safe for you to have a vaginal delivery or if they should consider a C-section (cesarean delivery).

Why does the position of the baby at birth matter?

During childbirth, your healthcare provider’s goals are to safely deliver your baby and make sure you’re healthy after delivery. A vaginal delivery can become more challenging, or even unsafe, if the fetus is in certain positions.

What are the different fetal positions?

Sometimes, your baby doesn’t get into the perfect position before birth. There are several positions that a fetus can be in, and some of these positions could come with complications during childbirth.

Possible fetal positions can include:

• Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth mother's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left. This is called left occiput anterior or right occiput anterior.
• Occiput or cephalic posterior: Sometimes, a fetus is head down, but it’s facing up. With its head up, the fetus is looking at the birth mother's belly. You may hear this position nicknamed “sunny side up.” Like occiput anterior, the fetus may be slightly to the left (left occiput posterior) or slightly to the right (right occiput posterior). A vaginal delivery may still be safe.
• Frank breech: In a frank breech, a fetus’s butt leads the way into the birth canal. Its hips are flexed and its knees are extended up toward its face.
• Complete breech: In this position, the fetus is positioned with the buttocks first and both the hips and the knees are flexed underneath it.
• Transverse lie: The fetus is sideways across the uterus on its back.
• Footling breech: The fetus has one or both of its feet entering the birth canal first.

All breech positions increase your chances of having a C-section delivery because a vaginal delivery can become unsafe. In many cases, your healthcare provider will recommend a C-section instead of a vaginal birth.

What is the most ideal fetal position?

Ideally, the fetus is head down, facing the birth mother's back, with its chin tucked to its chest. This position is called cephalic or occiput anterior presentation. It’s the safest fetal position because it carries the least amount of risk to both the birth mother and the fetus. It’s very common for a fetus to turn into this position naturally by the 36th week of pregnancy.

What is fetal attitude?

Fetal attitude describes the position of specific parts of a fetus’s body. The ideal fetal attitude is when the fetus has its:

• Chin tucked into its chest.
• Arms and legs drawn into the center of its chest.

But, there can be times the fetal attitude is irregular. For example, its chin is tilted back instead of tucked.

What is fetal lie?

Fetal lie describes how the fetus’s spine lines up with its birth mother's spine. Ideally, they line up vertically because the fetus’s head is down in the birth canal. This is called longitudinal lie. If the fetus is sideways or horizontally across the uterus, it’s in a transverse lie.

How do they know which position it’s in?

Your healthcare provider will check fetal positioning by touching or gently pressing on parts of your abdomen during your regular prenatal appointments. This will happen during most of your appointments in the third trimester. If your provider is unsure, they may also do an ultrasound to check fetal positioning.

What position is the most unfavorable fetal position?

Breech position is probably the most unfavorable fetal position because it comes with the most risks. There are several different types of breech positions, and each position comes with its own potential dangers. Your pregnancy care provider can discuss these risks with you and let you know what they feel is the best way to deliver your baby.

Is my baby at risk if they’re in a breech position?

Before delivery, there’s no risk to a fetus in a breech position. But there are risks to attempting a vaginal delivery on a fetus in the breech position.

When should my baby move into position for birth?

Typically, the fetus moves into position for birth in the third trimester. This happens in the last few weeks of your pregnancy (often between weeks 32 and 36).

Can my healthcare provider turn or reposition my baby before birth?

There are several ways that your healthcare provider can try and turn the fetus before you go into labor. These methods don’t always work, but if they can be done safely, your provider may recommend giving it a try.

The most common way for a provider to turn a fetus is external cephalic version (ECV). But there are other techniques you can try at home on your own. Even though there isn’t a guaranteed success rate, these at-home methods are usually worth a try.

External cephalic version (ECV)

ECV is one noninvasive way to turn the fetus and improve your chances of having a vaginal birth. Your pregnancy care provider performs ECV in the labor and delivery unit in case of a complication. This procedure involves a provider lifting the fetus’s buttocks in an upward position and then applying pressure through the abdominal wall to your uterus to rotate the fetal head forward or backward. The best time to perform this procedure is between 36 to 38 weeks of pregnancy.

Changing your position

Sometimes, you can encourage a fetus to move by changing your position. Keep in mind that while these exercises won’t hurt, they might not work. However, experts often feel that if there’s a chance that the exercises might encourage a fetus to turn, they’re worth trying. These positions typically involve doing yoga-like poses. Two specific movements that your provider may recommend include:

• Getting on your hands and knees and gently rocking back and forth.
• Pushing your hips up in the air while lying on your back with your knees bent and feet flat on the floor (bridge pose).

Using stimulating sounds to encourage movement

Another thing you can try to get a fetus to change position is stimulation. Music, talking, temperature changes and light could interest the fetus. While in your uterus, the fetus can hear music, see light changes through your skin and even hear your voice as you talk. Applying cool temperatures to the top of your abdomen where the fetus’s head is could also prompt it to move away and downward. There’s no guarantee that stimulation will make the fetus move, but it’s often worth a try.

A chiropractic technique, the Webster technique, may help shift your hips and relax your uterus. Some providers even recommend acupuncture to help your body relax. For both of these techniques, you need to see a professional that your healthcare provider recommends.

Can my baby change position on their own?

It’s always possible that the fetus will reposition itself. In the weeks leading up to birth, there’s still time to change position. Most find their own way into the correct position before birth.

How is the baby delivered when they’re breech or in another position?

When a fetus is in a breech position or another abnormal position, your healthcare provider may suggest a C-section delivery because it’s safer. Different healthcare providers have various levels of comfort with vaginal deliveries of breech babies. Talk to your provider about the risks and benefits of different types of birth for a breech baby.

Does anything increase my risk of having a dangerous fetal position?

Several factors could increase the risk of a fetal position like a breech presentation. These can include:

• Going into labor too early and having a premature baby. In this case, the fetus may not have had time to turn into the ideal position.
• Having a placental condition like placenta previa or placental abruption. These conditions could prevent the fetus from turning and getting into the right position for birth.
• Having a multiple pregnancy. When there’s more than one fetus, it can be difficult for each one to get into position.
• Having a uterus that’s irregularly shaped. The uterus is typically shaped like an upside-down pear. If it has a different shape, there might not be enough room for a full-grown fetus to move into position for birth.