A transverse lie occurs when a baby is positioned horizontally across the mother’s abdomen, rather than vertically head-down or bottom-down. This orientation is often called a shoulder presentation because the baby’s shoulder rests over the mother’s pelvic inlet. While common in early pregnancy, this position becomes a concern as the due date approaches. A baby in a true transverse lie cannot pass through the birth canal, requiring medical intervention for a safe delivery. All attempts to encourage the baby to turn must be discussed with and performed under the guidance of a healthcare provider.
Understanding Transverse Lie and Timing
Diagnosis of a transverse lie in late pregnancy is confirmed through physical examination and ultrasound imaging. During an exam, a healthcare provider may note the uterus feels wider than it is long, with the baby’s head or bottom palpable in the mother’s flanks. Ultrasound definitively confirms the baby’s horizontal position and identifies contributing factors, such as a low-lying placenta or excess amniotic fluid.
Intervention is urgent due to the risks associated with this position if labor begins spontaneously. The primary concern is an umbilical cord prolapse, which occurs if the membranes rupture while the baby is sideways. If the cord drops into the cervix, it can become compressed, restricting the baby’s oxygen supply. Doctors typically recommend active interventions, such as an External Cephalic Version, around 36 to 37 weeks of gestation, as the baby is unlikely to turn spontaneously afterward.
Medical Procedure: External Cephalic Version (ECV)
External Cephalic Version (ECV) is the most effective medical procedure used to manually rotate the baby into a head-down position from outside the mother’s body. This procedure is performed by an obstetrician or specialist in a hospital setting, allowing for immediate delivery if complications arise. ECV involves the provider placing hands on the mother’s abdomen and applying firm, steady pressure to gently guide the baby through a somersault.
To improve success and minimize discomfort, a tocolytic medication, such as terbutaline, is often administered to relax the uterine muscle. This relaxation makes the uterus more pliable, easing the manual rotation of the baby. The entire process is closely monitored using continuous fetal heart rate tracking and ultrasound to ensure the baby tolerates the movement.
Although ECV is commonly used for breech presentations, the success rate for turning a transverse lie is often higher, sometimes reaching 65% or more. This is because the baby is already positioned halfway to a vertical lie. ECV is contraindicated if there is a low-lying placenta, ruptured membranes, or any condition preventing a vaginal birth. If successful, the mother can attempt a vaginal delivery; if it fails, a scheduled cesarean section is arranged.
Maternal Positioning Techniques
Specific maternal positioning techniques leverage gravity to create more space in the lower uterus and encourage the baby to flip. These non-medical approaches are utilized in the third trimester but must be cleared by a healthcare provider first. A popular technique is the Forward-Leaning Inversion (FLI), which involves briefly placing the head lower than the pelvis to temporarily untwist and lengthen the uterine ligaments.
To perform the FLI, kneel on a couch or bed, then lower hands and forearms to the floor, holding the inverted position for about 30 seconds. This maneuver is usually performed multiple times daily to maximize its effect on the uterine ligaments and pelvic alignment. The Breech Tilt involves lying on one’s back with the hips elevated 12 to 18 inches above the head using pillows or a wedge, held for five to ten minutes at a time.
The Side-lying Release is designed to relax the muscles and ligaments on one side of the pelvis, potentially allowing the baby to drop and reposition. This involves lying on one side with the torso supported and one leg hanging off the edge of a bed or table. The goal of these techniques is to remove tension and restriction, giving the baby the opportunity to move spontaneously into a head-down position.
Complementary Therapies
Complementary therapies aim to influence the baby’s position by addressing maternal body mechanics and energy flow. Chiropractic care, specifically the Webster Technique, focuses on correcting sacral and pelvic misalignments. The principle is that a misaligned pelvis causes tension in surrounding ligaments, restricting space in the uterus and preventing the baby from turning.
By gently adjusting the sacrum and releasing ligament tension, the Webster Technique optimizes pelvic function, allowing the uterus to relax and giving the baby more room to move. Another option is moxibustion, a traditional Chinese medicine practice involving burning dried mugwort (moxa) near the acupuncture point Bladder 67 (BL67) on the little toe. The heat stimulates energy flow, relaxes uterine muscles, and encourages increased fetal activity, which may motivate the baby to somersault.
Delivery Plan If the Baby Stays Sideways
If all attempts to turn the baby are unsuccessful and the transverse lie remains near the end of pregnancy, a new delivery plan is necessary. The management plan universally involves a scheduled cesarean section (C-section). This procedure is typically planned for around 39 weeks of gestation, or earlier if labor begins spontaneously, to avoid the dangers of attempting a vaginal delivery.
A vaginal birth is unsafe because the baby’s shoulder is the presenting part, which cannot properly engage in the pelvis, leading to obstructed labor. If strong contractions occur while the baby is sideways, the pressure can cause uterine rupture, a life-threatening emergency. Scheduling a C-section bypasses the risks associated with labor and safely delivers the baby before the onset of contractions or membrane rupture.