Baby Positions During Pregnancy: What African Women Need to Know

 

By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health), Freelance Medical Writer. Medical review by The DLHA Team

A black pregnant lady holding her bulging abdomen in her hands with side image showing common (cephalic) baby position .

Click on image to enlarge.

 

Highlights

• Baby positions in the womb change as pregnancy progresses, with most babies naturally settling into a head-down (cephalic) position for delivery.

• Common terms used by healthcare providers to describe baby positions include presentation, position, and lie, each indicating different aspects of the baby's orientation in the womb.

• Normal baby positions, such as the vertex (cephalic) presentation, are optimal for smooth delivery, while abnormal positions, like breech or transverse lie, may complicate labour.
• Various factors from both the mother and baby, including the shape of the pelvis, the presence of fibroids, multiple pregnancies, and congenital anomalies can influence the baby’s position in the womb.

• Abnormal baby positions can be diagnosed through physical examination and ultrasound, with some positions only accurately identified during labour.

• Abnormal baby positions may require interventions such as External Cephalic Version, vaginal delivery under specific conditions, or a caesarean section to ensure a safe birth.

   

Introduction

As pregnancy progresses, the way the baby lies in the womb of the baby varies because of many factors. It is usual for the position to vary in the early months of pregnancy because of the smaller size of the baby to the size of the womb and the water(amniotic fluid) At less than 28 weeks of pregnancy, about 25% of babies are in breech presentation, this number reduces to 1 in 25 in labour. This is because, towards delivery, the baby takes the best possible position to enable a smooth labour process.

While the position may not matter in the early months of pregnancy, the outcome of your pregnancy may be affected if the abnormal baby position persists till delivery. Most babies occupy the normal head-down position in the last few weeks of pregnancy. Any position other than this is considered abnormal.

This article aims to educate African women on the different positions a baby can take during pregnancy, the dangers and effects of abnormal baby positions and how they are managed.

To get started, let us get to know some common terms that are used in describing baby positions during pregnancy.

 

Some Common Terms about Baby Positions During Pregnancy

During your antenatal visits, you may hear your doctors and nurses describe the position of the baby using different terms. [1] Here are some of the terms:

Presentation: This is the part of the baby that lies close to your birth canal (see figure 1). 

The presentation can be: 

• Cephalic—if the head of your baby is down and is the part to be born first
• Breech—if the head is up and the buttock is close to your birth canal
• Shoulder—if your baby is lying across your womb and the shoulder is the part that is closest to the birth canal
• Compound—your baby’s hands or legs are present in the birth canal alongside the head or buttocks. [2]

Figure 1: Showing types of foetal presentations during pregnancy. Click on image to enlarge.

 

Position: Refers to the direction of the baby’s skull in a cephalic presentation. There are three main positions (see figure 2):

• Occipito-anterior—if the back of the skull(occiput) is towards your front and your baby is looking backwards
• Occipito-posterior—if the back of your baby’s skull is towards your back and your baby is looking forward. It means that your baby’s back is lying against your spine.
• Occipito-transverse—If the back of the baby’s skull is towards your side. This means that your baby is looking towards your side

Figure 2 showing types of cephalic presentations. Click on image to enlarge.

 

Lie: This is how the baby is lying in the womb about the spine of the mother. There are three different types (see figure 3):

• Longitudinal lie–when the baby is lying parallel(in the same direction) with the spine of the mother
• Transverse lie–when the baby is lying across (90 degrees) the spine of the mother.
• Oblique lie–when the baby lies at 45 degrees to the spine of the mother. This position is in between the longitudinal and transverse lie.
• Unstable lie–This is when the baby’s lie changes in between consecutive examinations after 36 weeks of pregnancy.

Figure 3 showing baby in different lie in the womb during pregmany. Click on image to enlarge

         

What Are Normal Baby Positions in the Womb?

Most babies lie head down towards the end of the pregnancy. This is because of the pear-shaped nature of the womb. This gives more room in the upper part of the womb as the womb is more narrowed in the lower part. Because of this, the baby takes the position of best fit. The smaller head takes the narrow portion while the buttock which is broader and the limbs (legs) of the baby occupy the more spacious part of the womb. This is the cephalic presentation.

There are variants of the cephalic presentation, like:

• Vertex presentation—when the central part of the skull is the part that comes out first during labour. This is considered the normal baby position.
• Brow presentation—when the brow (forehead ) of the baby is the part felt  during vaginal examination in labour
• Face presentation—when the face of the baby (the area involving the eyes, nose, and mouth) is felt through the vagina during labour. 

Figure 4: Showing variations in foetal cephalic presentation during pregnancy

 

Face presentation can be of two types: 

• Mento-anterior–if the chin (mentum) is towards the mother’s front.
• Mento-posterior–if the chin (mentum) is towards the mother’s back.

Brow and face presentation can only be detected in advanced labour. [3]

 

What Are Some Abnormal Baby Positions in the Womb?

Aside from the vertex (cephalic) presentation, every other baby’s position is considered abnormal. [4, 5]

These include:

• Breech presentation
• Brow presentation
• Face presentation
• Compound presentation
• Shoulder presentation
• Occipito-posterior position
• Transverse lie
• Oblique lie
• Unstable lie

Abnormal baby position if not well managed could lead to problems like: 

• Umbilical cord prolapse
• Fetal distress
• Death of the baby
• Birth asphyxia (inability to cry at birth)
• Prolonged labour
• Injuries to the baby and or the mother

 

How to Know Your Baby's Position During Pregnancy

Baby positions could be determined by your healthcare provider either during pregnancy or in labour.

During pregnancy, the way the baby is lying can be detected by your doctor or nurse through: 

• Physical examination 

This involves the palpation (feeling or massaging) of the baby through your abdomen. Your healthcare provider feels the head as a firm, narrow, and somewhat mobile mass while the buttocks are felt as a broad, soft and fixed part of the baby. The limbs are felt as tiny, movable bumps inside the womb.  

• Ultrasound examination 

This uses soundwaves to detect the different parts of the baby and provides an image of their location in the womb on a computer screen.

However, some abnormal positions of the baby can only be detected with accuracy when you are in labour.

These include: 

• Brow presentation
• Face presentation
• Compound presentation

 

Conditions that Affect Your Baby’s Position in the Womb 

Some conditions may affect your baby’s position in the womb. 

These are those that:

• Distort the normal shape of the womb 
• Distort the size or shape of the birth canal (pelvis)
• Increase the movement of the baby
• Limit the movement of the baby
• Affect the shape of the baby

These conditions may be from the mother, the baby or from both mother and baby.

From the mother

• Contracted (small pelvis) or any abnormal shape of the pelvis (android, gynaecoid, platypelloid pelvis)
• Abnormal shape of the womb
• Placenta praevia (placenta occupying the lower part of the womb)
• Tumours like fibroids in the womb
• Tumours outside the womb but in the pelvis, e.g., tumours in the ovaries
• Multiple births: this is due to the laxity of the walls of the womb. This is more common after the 5th birth.

From the baby

• Prematurity
• Growth restriction resulting in smaller babies
• Very long or very short umbilical cord
• Increased amniotic fluid volume
• Multiple pregnancies
• Babies with congenital anomalies like hydrocephalus, anencephaly, cystic hygroma (neck tumours)
• Babies with chromosomal problems like Down’s syndrome are likely to take an abnormal position

In some women, no definite cause can be found.

 

How to Manage Abnormal Baby Positions

Abnormal baby position may be normal in early pregnancy as the baby is smaller and moves freely within the womb. As your pregnancy progresses and the baby gets bigger, the baby assumes a more stable position. This is usually around 36 weeks of pregnancy.  

Therefore, if your baby is lying in an abnormal position before 36 weeks of pregnancy, there is no need for your doctor to do anything. Consider the case of Mrs. BN.

Mrs BN, is a 31-year-old woman in her third pregnancy who attended her antenatal care at a clinic at 33 weeks. Upon examination, she was informed that her baby was in a breech position. She returned home from the health facility in tears. On further review by a senior doctor, she was advised that there was no cause for alarm as the baby’s position would likely change before 36 weeks. At 36 weeks she was reexamined and it was confirmed that the baby had turned to head down position. She went on to have a normal vaginal delivery.

In a few women, this scenario may not be the reality as the abnormal position may persist till 36 weeks and beyond. If you find yourself in this condition, then there is a need for your healthcare provider to step in (intervene).

Your doctor would consider any of these options:

• External Cephalic Version (ECV) - i.e., attempt to change the baby’s position
• Vaginal delivery
• Caesarean section

I. External Cephalic Version (Changing the Baby's Position in the Womb) 

External Cephalic Version is a procedure that involves turning the baby from an abnormal position to the cephalic (head down) position.

The type of abnormal position that requires this procedure are:

• Breech presentation
• Transverse lie
• Oblique lie (sometimes)
• Unstable lie

The procedure would be done by your doctor under ultrasound guidance.

Before the procedure, your doctor would ensure that these conditions are met:

• Normal shape of the womb
• No tumour in the womb or pelvis
• No placenta praevia
• Adequate pelvis
• Normal baby’s heart rate
• No anomaly in the baby
• Normal level of the amniotic fluid

If these conditions are not met, the procedure may be difficult or dangerous.

If ECV fails or is not possible, your doctor will consider the other options.

Watch the video below to learn more about how ECV is performed

II. Vaginal Delivery

Vaginal delivery may be possible in these types of abnormal positions

• Breech presentation
• Compound presentation
• Occipito posterior position
• Brow position
• Face presentation(If the chin is towards the front of the mother)

In breech presentation, vaginal delivery may be considered if the following conditions are met:

• You are not a first-time mother
• Your baby has no anomalies
• Your pelvis is adequate
• You’ve not had a caesarean section or any other surgery on your womb
• The weight of your baby is neither too big nor too small
• The health facility has a staff with the skills to conduct the delivery

Conducting breech delivery requires a lot of skills and success is only possible if the health worker taking the delivery is well skilled. Because of this, most doctors would prefer to deliver the baby through a caesarean section. Your doctor will advise you on the best option that you can choose.  

Compound presentation, occipito-posterior position, brow presentation and face presentation may change to a normal presentation during labour and vaginal delivery will be possible. 

However, if they persist or lead to prolonged labour, the option of caesarean section would be considered by your doctor.

III. Caesarean Section

This is considered if ECV and vaginal delivery are not possible. It is also considered if complications arise along the way. It involves the delivery of the baby by cutting through your abdomen and your womb. It is an operation that is considered safe in most instances, though problems may arise occasionally

 

Conclusion

Babies can take different positions in pregnancy depending on the age of the pregnancy and other factors. While normal positions demand no special actions (intervention) to be taken, an abnormal baby position requires some interventions to ensure that the pregnancy ends successfully. This is why you need to be enlightened so that you make informed decisions with the guidance of your health provider.

 

References

1. Okemo J, Gulavi E, et al, Abnormal lie/presentation. [Internet] 2021 February. In The Continuous Textbook of Women’s Medicine Series – Obstetrics Module, Vol 10.  Glob. libr. women's med. DOI 10.3843/GLOWM.414593. Available from here.

2. Perkin RP. Compound presentations: Rare obstetric events. [Internet] 2024 May 24. [Cited 2024 Aug 20]; Available from here.  

3. Makajeva J, Ashraf M. Delivery, face and brow presentation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [Last updated 2023 Jan. 9]. Cited 2024 Aug 20. Available from here.  

4. John Hopkins Medicine. Abnormal presentation [Internet, n.d.]. Cited 2024 Aug 20]. Available from here.

5. Pilliod RA, Caughey AB. Fetal Malpresentation and Malposition: Diagnosis and Management. Obstet Gynecol Clin North Am. 2017 Dec;44(4):631-643. doi: 10.1016/j.ogc.2017.08.003. Available from here.

 

Related: Essential Guide to Labour for African Women and Men

 

Published: October 15, 2024

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