When a baby lies horizontally across the uterus instead of in a head-down position, it is known as a transverse lie. While this position is common earlier in pregnancy, it becomes a concern as the due date approaches. This article explores various methods to encourage the baby to move into a head-down position for a safer delivery.
Understanding Transverse Lie
A transverse lie occurs when the baby lies sideways in the womb. While common earlier in pregnancy (e.g., 1 in 50 at 32 weeks), a transverse lie is rare at term (approximately 1 in 300 to 1 in 500 pregnancies). Diagnosis involves a physical abdominal examination and is confirmed with an ultrasound scan.
For a vaginal birth, a head-down position is needed, as a transverse lie can lead to complications such as umbilical cord prolapse or obstructed labor. Cord prolapse, where the umbilical cord exits before the baby, is a concern as it can compress the cord and restrict oxygen to the baby. Interventions to encourage repositioning are considered in the late third trimester, around 36 to 37 weeks, when the baby is larger and less likely to spontaneously turn.
Medical Procedures to Reposition
External Cephalic Version (ECV) is a medical procedure performed by an obstetrician to manually turn a baby from a transverse or breech position to a head-down position. During an ECV, the healthcare provider applies gentle but firm pressure to the mother’s abdomen to encourage the baby to rotate. This procedure is performed after 37 weeks of gestation, when the baby’s lungs are more mature.
Pain management options, such as an epidural or other medications, can be used to help the mother relax and reduce discomfort during the procedure. The baby’s heart rate is closely monitored before, during, and after the ECV to ensure their well-being. Success rates for ECV vary, with an average success rate around 60%.
While ECV is considered safe, there are potential risks, including temporary changes in the baby’s heart rate, premature rupture of membranes, or, rarely, placental abruption. Contraindications for ECV include certain placental issues like placenta previa, multiple pregnancies, or a history of a previous C-section, which increase risks. ECV should only be attempted in a setting where emergency C-section services are available for complications.
Non-Medical Approaches
Non-medical techniques to encourage a baby to turn are explored by some, often alongside medical consultation. One such approach involves specific exercises, such as those promoted by programs like Spinning Babies, which aim to create more space in the pelvis for the baby to move. These techniques involve movements like forward-leaning inversions or pelvic tilts, which can help shift the baby’s position.
Chiropractic care, particularly the Webster technique, focuses on aligning the mother’s pelvis and releasing tension in uterine ligaments. The principle behind this technique is that by optimizing pelvic balance, the baby can have an easier time moving into a head-down presentation. This method is considered gentle and aims to create a more accommodating environment for fetal rotation.
Acupuncture and moxibustion are traditional Chinese medicine practices considered by some parents. Moxibustion involves burning dried mugwort near specific acupuncture points, often on the little toe (Bladder 67), to generate warmth and stimulate movement. Research suggests that moxibustion, especially when combined with positional exercises, can increase fetal movement and the chance of turning a breech baby. These non-medical methods should always be discussed with and approved by a healthcare provider before attempting them, as scientific evidence for their effectiveness varies.
What If Repositioning Isn’t Successful?
If attempts to reposition the baby, whether through medical procedures or non-medical approaches, are unsuccessful and the baby remains in a transverse lie as the due date approaches, a planned Cesarean section (C-section) is recommended. This decision is made to ensure the safety of both the mother and the baby, as a vaginal delivery is not possible with a transverse lie.
A planned C-section is scheduled around the 39th week of gestation to allow the baby sufficient time for growth and development. It is important for expectant parents to have an open discussion with their healthcare team about their birth plan and to prepare for the possibility of a C-section if the baby does not turn. This preparation can help manage expectations and ensure a safe delivery experience.