5 Ways To Turn A Baby From Transverse Lie Position

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A transverse lie position is when your baby lies horizontally in your uterus. This means the baby’s head can be on one side of the mother’s body and the feet on the other side instead of the head in an up or down position. As the pregnancy advances, the baby grows and moves in the womb. Towards the end of pregnancy, most babies move to a head-down position, and this is helpful in normal vaginal delivery. Less commonly, some babies may not take up common positions and require cesarean sections to deliver them.

Read about the causes, types, risks, and other factors related to the transverse lie position.

What Is A Transverse Baby Or Transverse Lie?

When the baby lies horizontally in the uterus, instead of an ideal vertical or head-down position, it is called a transverse or longitudinal lie. In simple terms, it can be said that the baby is lying sideways, with its head either on the left or right side of the uterus. It is rare and could occur in one among 300 pregnancy cases (1).

The position is normal during the initial stages of pregnancy or till 26 weeks. However, it could be considered abnormal when the due date is nearing. With the baby in such a position, it is not possible to go for a normal delivery.

The baby may come to the sideways position due to different reasons.

What Are The Causes Of Transverse Baby Position?

Usually, a transverse baby at 32 weeks and 36 weeks of pregnancy, settles down in one position during this time. In some cases, babies could naturally come to the transverse lie position. In other cases, the reasons could be:

  1. Excess amniotic fluid: Polyhydramnios or too much of amniotic fluid in the womb could increase the chances of fetal malposition. The average level of amniotic fluid is 800ml in the 34th week. However, it should be around 600ml when the baby is developed. Otherwise, the baby could move sideways and get into a transverse lie position (2).
  1. Twin pregnancy: In certain situations, it is possible that the second twin comes to a transverse lie position once the first twin is delivered (3).
The second twin may move to a transverse lie position after the first is delivered

Image: Shutterstock

  1. Multiple pregnancies: Grand multipara is the term given when a woman has given birth to more than two times. This is also one of the causes of a baby’s transverse lie position (4). However, these kinds of cases have dropped in recent times.
  1. Placenta previa: It is the condition when the placenta blocks the uterus, and so the baby comes to a transverse position (5).
  1. Fetopelvic disproportion: It is the condition when the fetal head is unable to pass through the mother’s pelvis. And so the fetal position can change from normal to transverse (4).
Quick fact
Uterine malformations and prematurity are some other possible causes of transverse lie position (4).

The doctor or midwife would assess your baby’s position with proper diagnosis.

How Is The Diagnosis Done?

An ultrasound may confirm fetal transverse position

Image: Shutterstock

Early diagnosis through abdominal and vaginal examination could determine the position of the baby. The abdominal examination can suspect fetal transverse lie when (6):

  1. Fundal height is less than what it should be. according to the gestational age.
  2. The fetal head is in iliac fossa (part of the hip bone) at some higher level.
  3. The heart rate of the fetus is heard below the umbilicus.

Vaginal examination in early and late stages of pregnancy, through the cervix, could also confirm the fetal transverse position. The ultrasound also confirms the same.

Quick fact
The asymmetrical abdomen appearance, the fetal head on one side of the flank and the buttocks on the other, and the inability to palpate the head or breech at the upper and lower ends of the uterus might also indicate a transverse lie (13).

The exact transverse lie position of the fetus can be determined through shoulder presentations.

What Are The Transverse Lie Positions?

There are four shoulder presentations of transverse lie (7):

  1. Dorsoanterior: The position of the fetus is towards the front
  2. Dorsoposterior: The position of the fetus is towards the back
  3. Dorsosuperior: This is the position where the fetal back is up
  4. Dorsoinferior: This is the position where the fetal back is down

As the transverse baby bump position is not considered normal, there could be certain risks when delivering the baby.

What Are The Risks For The Baby In Transverse Lie?

It is not possible for a natural or vaginal delivery when the baby is in a transverse lie. Hence, in every case of a transverse baby, when to schedule C-section would be a major question to answer. Along with that, there could be other risks too.

  1. Diminished oxygen supply: The position decreases the flow of oxygen to the baby, which requires assisted delivery or immediate delivery through C-section to ensure the baby’s survival (8).
  1. Uterine rupture: The baby’s side position is an abnormal presentation, and there could be chances of the uterus being ruptured.
  1. Prolapsed umbilical cord: The baby’s transverse position could cause the umbilical cord to drop into the birth canal. This could be risky for the baby, because of which doctors go with the c-section delivery to bring out the baby safely (9).
  1. Infections: Cesarean delivery, rupture of membranes, and such complications due to transverse position  could be responsible for infections.
  1. Umbilical cord compression: Transverse position of the fetus can cause stretching and twisting of the umbilical cord leading to cord compression , which is very harmful to the baby. This could reduce the oxygen and blood flow to the fetus.

    Transverse position of the fetus can cause twisting of the umbilical cord

    Image: Shutterstock

To keep away the risks associated with the transverse lie position of the fetus, doctors could try to turn the baby to a different and safe position.

How To Turn A Baby From Transverse Lie?

Some abdominal massage techniques can help reposition your baby

Image: iStock

If the transverse position has been detected in the early stages or before the baby has settled down, there are some ways through which the baby can be turned. However, these are performed only on the doctor’s advice, based on your medical condition.

  1. Chiropractic care: One of the chiropractic techniques, termed as the Webster technique, could help turn the baby from the transverse lie position to the vertex or head down position. There is no pressure exerted on the baby during the procedure, which is considered to be effective and safe (10).
  1. Massage: Some abdominal massage techniques can reposition your baby from sideways to normal head down position. This will help the baby to come into alignment for delivery.
  1. Pulsatilla: It is a homeopathy therapy that is known to help change the position of the transverse and breech babies (11). However, only a professional knows the right technique to perform this massage.
  1. External cephalic version: The method is used by the doctors to shift the position of the baby from transverse to head down. This technique is performed during or around 37 weeks or much before the labor starts (12).
Quick fact
The external cephalic version can’t be attempted if a woman is carrying more than one fetus, there are abnormalities of the reproductive system, the placenta is in the wrong place, or there’s a placental abruption (14).
  1. Forward leaning inversion: This exercise can shift the position of the baby. However, it can be performed only in a healthy pregnancy and with the doctor’s approval.

Some common questions regarding transverse lie are answered in the next section.

Frequently Answered Questions

1. What happens if the baby cannot be turned?

If the professionals and doctors are not able to turn the transverse position of the baby to a head down position, they will go with a cesarean, which can safely bring out the baby into the world.

2. What happens if I am having twins?

In case the first twin is lying in a transverse position, doctors usually perform a c-section. However, if the first twin is delivered normally, then the second twin might come to a transverse position. In this case, doctors try to turn the second baby through internal cephalic version (manual intrauterine procedure to change transverse lie to breech) or external cephalic version and then decide whether or not to schedule c-section (4).

3. How long can a baby stay in the transverse lie position?

Most of the babies settle down in a normal position or the head-down position by the end of the second trimester or beginning of the third trimester. It is usually between 28 to 30 weeks. However, some babies also move around after the beginning of the third trimester, and tend to take the normal position by the 31st or 34th week. If they do not come to a normal position, they can stay transverse up to the last stage too.

The transverse lie position is uncommon and observed in a few babies nearing the delivery date. It might be caused by several reasons, such as excess amniotic fluid and multiple pregnancies. There are several types of transverse lie positions, and it is unsafe to proceed with standard vaginal delivery in such a situation. However, the baby can be delivered safely with the help of a cesarean section. Therefore, it is advised that you consult your doctor and take their opinion on which mode of delivery is safe for the mother and baby.

Infographic: Synopsis Of The Transverse Lie Position

What causes a baby to lie in a transverse position in the mother’s womb? Can it harm the baby? How do you turn a baby into a normal position? This infographic gives an easy reference to these questions.

ways to turn a baby from transverse lie [Infographic]
Illustration: MomJunction Design Team

Key Pointers

  • When a baby lies in the horizontal position in the uterus, it is called the transverse lie.
  • Most babies shift to the head-down position by the end of the second trimester.
  • Vaginal delivery of a baby in a transverse lie is not possible. Cesarean section is the safest option to deliver the baby.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. O. Cetin et al.; A Fatal and Extremely Rare Obstetric Complication: Neglected Shoulder Presentation at Term Pregnancy; Case Reports in Obstetrics and Gynaecology (2015)
2. Polyhydramnios: Complications of Too Much Amniotic Fluid; Birth Injury Help Center
3. 4 Questions to Ask if Your Doctor Suggests a Scheduled C-Section; UNC Health Talk
4. Transverse lie and shoulder presentation; Essential Obstetrics and Newborn Care: Medicins Sans Frontierers
5. O. I. Oyinloye and A A Okoyomo; Longitudinal Evaluation of Foetal Transverse Lie using Ultrasonography; African Journal of Reproductive Health (2010)
6. Ali R, Abrar A. Transverse lie; predisposing factors, maternal and perinatal outcome. Professional Med J Apr-Jun 2011;18(2): 208-211.
7. S Dhakal; Spontaneous Vaginal Delivery of an Average Sized Dead Baby with Hand Prolapse At Term: A Case Report; NJOG
8. Malpresentation; Pregnancy, Birth and Baby’s
9. Prolapsed Umbilical Cord; Mother & Child Glossary
10. K. Flegal; Elements of Being Chiropractic Center; birthways.org
11. Homeopathy for Breech; Better Birth

12. External Cephalic Version (Version) for Breech Position; Michigan Medicine University of Michigan
13. George Tawagi; Transverse Lie; Oxorn-Foote Human Labor & Birth, 6e.
14. If Your Baby Is Breech; The American College of Obstetricians and Gynecologists
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Rebecca Malachi

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU). She has been into health and...
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Dr. Neha Singh

(MS OB/GYN)
Dr Neha Singh has over eight years of experience as a gynaecologist and more than four years experience as an IVF specialist and endoscopic surgeon. She won an award for her paper on ‘Maternal & Child Health' in UPCOG 2016. She is a senior consultant and clinical head at NOVA IVF, Gorakhpur, India. She is also an assistant global coordinator...
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