The Ultimate Guide to Baby Position in the Womb
Your baby's position in the womb can make a difference in your labor and birth experience. Figuring out fetal position for yourself is also fun and can help you bond with your baby. Read on for a complete guide to positions, how to discover which on your baby is in, and how to help baby get in the best position for a natural birth.
Understanding Fetal Position in the Womb
There's a complete vocabulary used by midwives and doctors to describe baby position - but it can be really confusing if you've never heard it before. Here's a breakdown on common terminology and what it really means:
Vertex and Breech (Head Up or Head Down?)
You're probably familiar with the term "breech" because breech babies are a hot topic today (mostly due to the controversy on the safety of vaginal birth with a breech baby). But you might not know the corresponding "vertex" term. Both are pretty simple:
Vertex = baby is head down in the womb (the head is in your pelvis and the bum is by your ribs)
Breech = baby is head up the womb (the head is by your ribs and the bum is in your pelvis)
Having his or her bum down creates a few additional position factors for a breech baby. If your baby is breech, it's a good idea to know what kind of breech position he or she is in.
Complete and footling breeches are good candidates for a vaginal breech birth with a skilled provider. A cesarean section may be safer for a footling breech or incomplete breech.
Complete breech = your baby's bum is down and his or her legs are crossed over each other (similar to "tailor sitting" or "Indian-style" sitting)
Frank breech = your baby's bum is down and his or her legs are fully extended and the feet are up beside baby's face (similar to the "pike position" used in competitive diving)
Footling breech = Your baby has one or both feet down - during birth, the feet (rather than the bum) would come through the cervix and birth canal first
Incomplete breech = Your baby may be in a combination of the above, with one foot up, one down, or one crossed. In this situation, it's highly likely that one foot or leg would come first down the birth canal
Transverse or Lateral Position
I am 22 weeks pregnant and my baby is laying transverse with her head by my belly button and her legs to my left side.
At about what week should she move to get in position to deliver and am I getting too far along for her to run out of room laying transverse?
Transverse position = baby is lying side-to-side in the womb, with head to either your right or left and the bum on the opposite side
In some countries (such as the United Kingdom, Australia, and New Zealand), transverse is called the lateral position.
Early in pregnancy, it's very normal for babies to move a lot, and many babies are transverse during mid-pregnancy ultrasounds. Babies usually move into a vertex (or breech) position by early in the 3rd trimester.
What is an External Version?
I'm 39 weeks and my baby is in the ROL position. What are my options?
"ROL" means "right occiput lateral" - this mom's baby is lying sideways with head to the mom's right side.
When a baby is transverse/lateral or breech an external version may be attempted. Usually, this is done around 37 weeks and should be done by a skilled provider. It can be done gently but is often done with ultrasound guidance in the hospital. With a breech baby, it's a little easier if the baby is a complete breech.
Anterior and Posterior (Which Way is Baby Facing?)
Another important marker for your baby's position in the womb is the direction he or she is facing.
Anterior = your baby is facing your spine, with his or her back angled more towards your belly button
Posterior = your baby is facing your belly button, with his or her back angled more towards your spine
If your baby is looking directly to the right or left, this is (confusingly) called transverse - it means your baby is looking transverse (directly right or left) and his or her back is directly to the opposite side. The baby in the anterior picture above is almost left occiput transverse - keep reading for more on what all that means!
What About All the Acronyms?
You may have heard your midwife or doctor use acronyms, or see them written on your chart. The most common are ROA, ROP, LOP, and LOA.
The "O" in each of these stands for "occiput," which is the back of your baby's head. The position of the back of baby's head is used to note position. If your baby is breech, you'll see an "S" instead of an "O" because the baby's sacrum (the bony plate of at the back of the pelvis) is used to determine position. The part of baby used to determine position is called the "denominator" in medical terminology.
ROA = Right Occiput Anterior - this means your baby's back is angled facing to the right of your belly button
ROP = Right Occiput Posterior - this means your baby's back is angled facing to the right of your spine
LOP = Left Occiput Posterior - this means your baby's back is angled facing to the left of your spine
LOA = Left Occiput Anterior - this means your baby's back is angled facing to the left of your belly button
ROT or LOT mean that your baby's back is facing directly to your right side, or facing directly to your left side, respectively. OP means your baby's back is directly to your back, just in front of your spine. OA means your baby's back is directly to the front, just behind your belly button.
As we'll discuss further on in this article, LOA, LOT, or OA are considered the optimal positions for birthing. Watch the video below to see me demonstrate the positions with a baby doll!
Watch the video below to see me demonstrate each position with a baby doll:
What Are Station and Engagement?
I recently went to my doctor for my 36-week appointment and she said my cervix is a -1, what does that mean?
While I don't recommend vaginal exams at 36 weeks (!), you may hear comments about baby's station when you're in labor.
Station = where your baby's head (or bum for a breech baby) is in the pelvis. The lower the number, the higher your baby is in the pelvis.
Your baby's head drops lower into the pelvis and through the deep pelvis during birth. A baby's head that's moved deep down into the pelvis is engaged. First-time babies usually engage a couple of weeks before labor. Subsequent babies often don't engage until labor.
Sometimes engagement is called lightening.
Here are the stations (measured in centimeters):
- -3 Baby is still high and floating within the pelvic brim (your hip bones)
- -2 Baby has dropped down into the narrower "true pelvis"
- -1 Baby is moving deeper into the pelvis
- 0 Station: Baby's head is at the level of the ischial spines, bony points deep inside your pelvis. Your baby is fully engaged at 0 station
- +1 Baby is starting to move out of the pelvis
- +2 Baby nearly through the pelvis
- +3 Baby's head is moving past your "sit bones" and out of the bony pelvis
Sometimes +4 and +5 stations are used to indicate baby's head is moving through the birth canal to the perineum for birth.
What Does Flexion Mean?
You probably won't hear the terms flexion, extension, or attitude very often, but if you plan a vaginal birth with a breech baby or twins, providers may carefully assess this. It's also important if you're trying to reposition baby during labor.
Flexion = your baby's head is tucked into the chest. This is the ideal for babies in any and all positions
Extension = baby's head is tilted up as if baby is sniffing at something or even looking up at the sky (full extension)
You may occasionally hear the term military attitude as well, which means your baby is looking straight ahead (no tucked chin or extended neck).
How to Tell the Position of Your Baby
My baby was breech at 24 weeks and I am now 32 weeks. I don't know if my baby is still in the breech position or not. How can I find out other than having an ultrasound scan done? Everybody in my due date club posts that they feel their baby is down! - Padma
Okay - you have a clearer understanding of baby position now - but of course, you want to know what position your baby is in!
4 Steps to Discover Baby's Position!
Care providers have been feeling the position of babies in the womb for ages. This is called "palpating" and you can do it for yourself. You may have heard of "Belly Mapping (SM)" - a technique created by Gail Tully, creator of Spinning Babies which actually helps you draw out your baby's position!
Below I'll outline 4 steps I find helpful to find out what position baby's in - I've used this with my last two babies and really enjoyed the bonding experience. After the video, I'll give more information on Belly Mapping (SM), which gives more detailed instructions (and even the chance to paint/draw baby's position onto your belly!).
Feel with the pads of your fingers, not the tips - watch the video for my demonstration (written instructions below the video):
1. Think About Baby's Movements
Your baby's movements in the womb can give you a good clue about positioning.
Pay attention for a few hours or a couple of days - try and decide if the movements you feel are big or small.
Small movements are likely to be your baby's hands. Babies like having their hands near their faces, so you'll probably be able to find the head near where you usually feel lighter movements.
Strong kicks and stronger, longer sliding movements are probably your baby's legs and feet. If you're farther along in your pregnancy, you may actually be able to feel your baby's little feet poking to one side or another - try feeling up and over from where you feel feet and strong kicks to find baby's bum.
2. Feel for Hardness
Start by feeling around for hardness. You want to feel something that feels like baseball or tennis ball (or a softball if you're close to the end of pregnancy)- round hardness.
This is likely baby's head or bum. If you push against this part and it moves alone, you've probably found the head. If the whole baby seems to shift, that's likely the bum. Both can feel pretty hard, but baby's head will be harder.
3. Find Your Baby's Back
If you're feeling an area that's long, smooth, and firm, that's probably your baby's back. Keep sliding your finger pads along until you find baby's bum or head.
*As your baby gets bigger it's probably easiest to find your baby's bum or back first, then use your finger pads to explore the rest of baby's body.
When I'm palpating bellies in the office, I usually find the bum and back pretty quickly (if the baby is head down) and then try to find feet and feel the head in the pelvis. Remember, other factors like how much padding you have around baby or tight abdominal muscles are can make it a little harder to feel baby, so give it time and practice.
Don't be afraid to press in - as long as it's not uncomfortable for you, you're just giving the baby a nice massage!
4. Heartbeat Can Be Helpful
The location of your baby's heartbeat can give you clues about your baby's position. It's usually easiest to hear fetal heartbeat high on baby's back (around the shoulder blade).
If you hear the baby's heartbeat high in your belly, it's likely that your baby is breech. If the heartbeat is below your belly button and close to your pelvis, your baby is likely vertex (head down).
Your baby's back is probably on the same side of your body as the heartbeat - so if you hear the heartbeat on the left side of your body, your baby's back is probably on the left.
This also means that you often feel the most movement on the opposite side you hear your baby's heartbeat. Baby's back (and heartbeat) are on one side, and the feet are kicking out to the other side.
Remember, feeling your baby's position and hearing the heartbeat gets easier as you get farther along in your pregnancy.
As mentioned above, Gail Tully teaches the Belly Mapping method - where you can actually draw out baby's position (on your belly or paper)! She has a free handout on belly mapping - click here to download. Gail also teaches you how to use a baby doll to help visualize baby's position - this can be really helpful, especially at first. We actually keep a baby doll in the office to help show mamas baby position during prenatal appointments 😉
What's the Best Position for My Baby?
Okay, you've figured out your baby's position - now you might be wondering why it all matters.
Early in pregnancy it really doesn't. In fact, up to about the 3rd trimester, your baby is relatively small and can flip, flop, and somersault in your womb!
But as you start to get closer to birth, it's a good idea to get baby lined up. When a baby is aligned to the left - either in LOT or LOA position or with his/her back directly against your belly button in the OA position, labor is often shorter.
Posterior positions (ROA, LOA, or with the back directly against your spine in the OP position) add time to labor because the baby has to rotate into a better position for birth. Occasionally a posterior baby doesn't rotate and is born face up, or "sunny side up" but this generally doesn't happen.
Many babies positioned to the right in the ROT position (back directly to your right) will turn posterior and need to rotate all the way around to the left. Some will turn ROA and come down that way (or OA).
Again, the best positions for baby are LOT, LOA, and OA. Most babies will turn into these positions naturally - and you can take steps to encourage good positions.
How to Position Baby for Labor
Now that we've talked about how to find a position and which positions are the best for baby, let's cover how to get your baby lined up. It's best to start focusing on this around the start of your 3rd trimester, as your baby is getting bigger and settling in for labor and birth.
It's important to remember that your baby can turn right up to labor - and even during labor (read below for some helpful techniques). It's not good to get really stressed out about baby positioning - but there is a lot you can do to be proactive in your 3rd trimester - and help line baby up!
Posture in Pregnancy
Good pregnancy posture may be different than you think (in fact, good posture is probably different than you think).
Fortunately there have been researchers pioneering posture research that goes past what you were told when you were a kid, and their information really makes a difference back health - even during pregnancy. Esther Gokhale and Katy Bowman are two woman leading in the field of back (and foot) health for everyone - and especially for women.
Katy has written articles especially for pregnant women (check out her article over at Fit Pregnancy - opens in a new tab for your convenience). She notes that you need to think with your heels. When you're stranding, your weight should be firmly on your heels. Your pelvis will be flared out slightly in the back - not tucked under as you were probably taught as a girl. It's not an exaggerated posture, but you shouldn't try to hold or tuck your pelvis in under your body.
Esther Gokhale has many photos showing people with this good posture (click here to see some of them, also opens in a new tab). Though they're not generally pregnant women, this posture is appropriate for you, too. The baby in this picture shows good posture - straight back, pelvis out slightly (not tucked under).
This is the "natural" posture of all humans, and it's the way our pregnant foremothers walked up until around the 1920's. At that point it became unfashionable to walk and sit like peasants and the slouch was born. Thankfully you can go with what not only preserves your back and hips - but it lines babies up.
We were naturally meant to stand with our shoulders rolled back, head back, and pelvis flared slightly behind so that our heels ground our body. Because that's our natural posture, it's what babies expect and encourages your baby to take a naturally optimal position.
Sitting on a birth ball (rather than a chair), helps align your pelvis well. It's almost impossible to slouch and curl your pelvis under (you'll roll off the ball if you do!). It keeps your belly tilted slightly forward, which makes it into an appealing "hammock" for your baby to nestle down into. A birth ball is a great tool for optimal baby positioning.
You can also rotate your hips in circles on the birth ball, which encourages baby down into the pelvis if you know your baby is in a good position.
Getting up and getting going helps baby too. Walking is especially beneficial - and especially if you walk barefoot or in shoes that mimic barefoot walking as much as possible (even simple moccasins work). These shoes let your feet mold to the earth as they were meant to, therefore lining your hips and pelvis naturally, all of which helps line your baby up. Walk as much as you can.
Walking also really helps ease the aches and pains of pregnancy because the better alignment helps your entire body.
Swimming is another great pregnancy exercise that's famed for helping babies position correctly. Many moms with breech babies have found that swimming encourages baby to turn. While swimming your heavy baby belly is almost weightless and your body is able to align naturally and simply.
Belly Dancing feels great - it's a nice way to get your heart rate up a little while pregnant, and prenatal belly dance has a lovely focus on bonding with baby. It's also very good for encouraging your baby to rotate down into an optimal positioning. Once baby is well positioned and you're close to your due date, deep spiraling movements can help to "lock" baby down into your pelvis.
Other activities help in similar ways - for instance, walking up and down stairs can encourage a baby to turn and descend into a good position. Prenatal yoga helps you feel good, understand how your body stretches (and get a feel for tension and relaxation). You can choose poses that encourage your baby to turn the way you want him or her to and build your routine from those.
Remember to Relax
Relaxing and enjoying your pregnancy - while being mindful of good posture - really does help your baby to turn. Baby needs soft, relaxed muscles to turn and to move through during birth. If your stomach muscles are very weak from a previous pregnancy, a rebozo worn daily can provide gentle support and alignment for baby - but understanding tension and relaxation is still beneficial to your baby.
Sometimes tension can hold baby in positions that aren't optimal. If that's the case for you, a chiropractor can really help make a difference. They can help gently align your spine so it's well-positioned, giving your muscles the chance to relax into their proper positions. Sometimes a massage therapist can compliment a chiropractor's work, so feel free to pamper yourself with a prenatal massage.
Getting baby lined up is a matter of creating good habits throughout your pregnancy - and a little aid from some proven techniques or experienced helpers can often encourage the most determined babies to turn around and line right up!
Techniques to Position Your Baby DURING Labor
As a student midwife, I've seen labors where working to re-position baby in labor can help move past "stalls" or get a slower labor moving. I believe that working on positioning through your third trimester (like I outlined above), is the best option.
Sometimes babies will turn at the last minute, however - or maybe you're in labor now and didn't realize that positioning baby beforehand was important!
There are several different techniques you can use. Gail Tully from Spinning Babies recommends the 3 Sisters of Balance - a trio of techniques:
- Rebozo sifting
- Forward-leaning inversion
- Sidelying release
You need a helper to do these techniques, but they're not difficult and Gail gives step-by-step instructions on her site. She notes that things often slow down for a bit after doing the trio, giving you the opportunity to rest while baby gets lined up. You can also help baby reposition into a better place when he/she resettles.
Another technique is called The Miles Circuit. This trio includes:
- One Knee Chest Position
- Exaggerated SIMS
- Get up and get moving
The Miles Circuit also gives you a chance to rest during the first two positions. You don't need a helper for these techniques but having someone help you get positioned, track time, and possibly offer support for the knee-chest position is helpful.
If you're experiencing a slow labor or a "stop-start" labor and baby seems to be posterior, it's a good idea to work towards repositioning baby.