If you’ve just found out that your baby is lying transverse, or sideways, in your belly, you likely have a whole bunch of questions.
Here at The VBAC Link, we always encourage parents to do activities that will encourage their baby to get in an optimal position. With a transverse lie, this is especially important because transverse babies cannot be born vaginally.
In this blog, we dig into what transverse lie looks like. You’ll learn how to tell if you have a transverse baby, when it is a concern, and how to encourage that baby to get into a better position.
Originally written on Oct. 18, 2018, this post was updated and republished on April 13, 2020.
What does transverse lie mean?
Babies move around in all sorts of positions while they are hanging out in a mother’s belly. It is common for them to be constantly changing positions until a few weeks into the third trimester.
Up until 32-34 weeks of pregnancy, the baby’s position isn’t necessarily a problem or cause for concern. However, after that, if your baby is breech or transverse, you will want to start encouraging them to turn into a head-down position.
There are three main fetal positions your baby can be in.
A cephalic, or vertex presenting baby is a fancy way of saying that the baby is head-down, with the top of its head pressing against the mother’s pelvic floor.
A breech baby is head-up and bum, or feet down. We have an article dedicated to breech babies if you want to learn more about this position.
Many techniques used to get a breech baby head-down will be helpful to get a transverse baby head-down, too.
When a baby is in a transverse lie, it means the baby is lying in the womb sideways. It is normal for babies to be in this position in the early weeks and months of pregnancy.
By the early third trimester, especially beyond 34 weeks, providers really want to see the baby in a head-down position. Even a breech position is better than transverse because a breech baby can be born vaginally, and they are easier to turn.
Transverse or shoulder/back presentation occurs in one in 400 births and can cause serious complications for you and your baby.
What causes a baby to be transverse?
There are several reasons that impact what positions a baby decides to rest in and a few important factors impacting the likelihood of a transverse lie.
The second pregnancy (or third, or more!)
After having your first child, your abdominal muscles can remain more pliable, stretchable, and loose, especially if you have diastasis recti which can weaken the abdominal muscles even more.
Looser abdominal muscles mean that your baby has more room to get comfortable in a less than optimal position.
Before 34 weeks
Up until your mid-trimester, it is common for your baby to move into a variety of positions, even several times a day. If your baby is transverse, there is no need to worry or try to maneuver them into a good position until you reach 32-34 weeks gestation.
Too much amniotic fluid (polyhydramnios)
It is common for a parent’s fundal height to measure a few weeks ahead or behind of their due date, and it can vary based on the baby’s position and even how hydrated the mother is. However, if you are measuring ten or more weeks ahead, medical providers typically want to do an ultrasound to check for polyhydramnios or too much amniotic fluid.
Too much fluid can make it very easy for a baby to swim into a transverse lie and stay there, among other potential complications.
Carrying multiples can mean these babies have to puzzle together in different ways to both grow and fit in the uterus. One baby may be head-down or breech, and the other transverse. Typically when baby A is head-down, transverse baby B will turn head-down or breech and then can be born vaginally.
Low-lying placenta/placenta previa
A placenta that is low lying or covering the cervix may take up room that the baby needs to get and stay head-down. With placenta previa, a Cesarean is necessary but, with a low-lying placenta, a transverse baby can still get into a head-down position.
Uterine abnormalities such as uterine fibroids, a bicornuate or unicornuate uterus, a didelphic womb, septate womb, and arcuate womb, all increase the likelihood of having a transverse baby due to the shape of the uterus.
While having a pelvis too small to birth a baby is incredibly rare, in the case of a misshapen or malformed pelvis, a baby may be forced into a transverse lie.
When a transverse lie position is a concern
It’s perfectly normal for babies to be lying in a transverse (or any other) position in the first and second trimesters of pregnancy. However, midway through the last trimester, especially after 34 weeks gestation, if your baby is still transverse, it is time to get them ready for birth.
Simply put, a transverse baby will not fit into the birth canal and out of the vagina. It is very important to work on getting a transverse baby in a better position before labor starts or your water breaks.
If your water breaks while the baby is still lying sideways the baby’s arm, shoulder, or even more severe, the umbilical cord can prolapse, or come out of, the birth canal. This is very dangerous and can be life-threatening to the baby as blood flow and oxygen flow become restricted. If cord prolapse happens, your baby needs to be delivered as quickly as possible by Cesarean.
You will find that as you approach your due date if your baby is transverse, most medical providers will advocate for a scheduled Cesarean ‘just in case’ your waters rupture prematurely.
A transverse lie presentation can cause very serious complications during labor and birth. Some of the complications are:
- Obstructed labor/labor dystocia — where labor does not move the baby through the pelvis because it is physically blocked in
- Umbilical cord or hand prolapse
- Postpartum hemorrhage
- Birth trauma to the baby
- Increased risk of rupture of the uterus, of particular concern for VBAC parents
How to tell if a baby is transverse
There are several ways you or your medical provider can determine whether your baby is transverse. The most certain way to confirm a baby’s position is by ultrasound. However, a skilled midwife or practitioner should be able to tell by palpating the abdomen to feel for the baby’s position. A vaginal exam may also be able to determine a baby’s position.
Do you want to find out for yourself?
We highly recommend all parents learn belly mapping by Spinning Babies. This is a great way to get comfortable with knowing where your baby is positioned in the womb and determine if additional steps are necessary.
After learning belly mapping, keep practicing so you can get more familiar and confident with it.
Transverse lie baby symptoms:
- Baby’s back is down, facing the birth canal
- Baby’s back is facing up with the hands and feet resting on the birth canal
- Baby has one shoulder down or pressing against the birth canal
In each of these positions, you will be able to distinguish your baby’s head on one side of your belly and bottom on the other side. After that, pay attention to where you feel kicks and wiggles. These movements will tell you where the baby’s hands and feet are to determine which transverse lie your baby is in.
How to turn a transverse baby
If your baby is not in a head-down position by 32 weeks, there are some things you can do to encourage them to flip into a head-down position. As always, make sure to check with your medical provider before doing anything that requires you to be head-down or upside down.
Spinning Babies is a great resource for getting transverse babies to turn, and we encourage you to do the recommended daily activities:
- Forward Leaning Inversion
- Breech Tilt
- Side-Lying Release
- Regular chiropractic care
- The Miles Circuit
- ECV (External Cephalic Version) only with a skilled practitioner in a hospital setting
- Myofascial Release
- Pregnancy Belt
If the baby is transverse when you go into labor
If you are in early labor, an external cephalic version (ECV) is a great option to discuss with your provider. Using this technique, the caregiver will attempt to manually turn the baby by pressing on your abdomen and slowly pushing in an attempt to turn the baby head-down.
If successful, and labor is starting, your contractions are likely to both push and keep your baby’s head in this position until the birth. If they can easily be turned into a head-down position, then the waters may be broken by the caregiver to remove some of the fluid that is helping your baby move about. If the baby is still high in your pelvis, breaking the waters can still cause prolapse and is something to consider when making that decision.
Sometimes, an ECV is not successful, or the baby will turn again after the ECV. If they have been transverse for long, keeping them head-down can be tricky. Your provider may suggest induction right away if it is successful and you are at term. Unfortunately, If your baby continues to remain in a transverse position, they will need to be born by Cesarean.
There is only so much space in the uterus, so if you are having twins the second can be transverse because the first twin is engaged in the pelvis. Your transverse lying baby will often turn once the first twin is born as there is more space for your baby to move. If this doesn’t occur naturally, the second twin will generally be able to be turned, so that it can be born vaginally, in either a head-first or breech position.
If a parent goes into labor while the baby is still transverse, it can negatively impact the shoulder of the baby. This is because they are in a folded position that is under pressure to move down the birth canal.
An immediate C-section would be carried out if this happens.
Fortunately, there are many resources available to assist you in encouraging your baby to engage in a head-down position. We highly encourage you to use the resources at Spinning Babies, linked above. We have seen great success using these methods with both our doula clients and in our Facebook Community.
It is always ok to keep trying and ask for more time if your intuition is telling you so.
If you are preparing for labor after Cesarean and your baby is transverse, having a repeat C-section can be devastating, no matter how necessary. Not achieving a VBAC when you have prepared SO much for it is filled with so many emotions. Find out how to cope with and process those emotions and then join our strong and thriving Facebook community to find lots of love and support.
Ready to take your VBAC preparation to the next level? Enroll in our course How to VBAC: The Ultimate Prep Course for parents today.