Transverse Baby Position in Pregnancy

A diagram showing an external cephalic version, turning a breech baby

Dorling Kindersley / Getty Images

A transverse lie position in pregnancy means that the baby is horizontal in your belly. The position of the baby becomes an issue as your due date approaches. The optimal position for vaginal delivery is the head down or vertex position. Approximately 2% to 13% of babies are in malposition in the third trimester, some of which will turn to the vertex position before delivery.

Transverse lie position is uncommon, even among non-vertex presentations. In fact, by 37 to 40 weeks gestation, only 2% of babies are in malposition, with approximately only 20% of those in the transverse lie position.

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What Is a Transverse Baby Position?

Baby position is the way the baby faces in the uterus—if the baby is facing your bottom, they are anterior, and if they face your belly, it's called posterior. (This is based on the position of the back of your baby's head.) The transverse lie position is where the baby's head is on one side of the mother's body and the feet on the other, rather than having the head closer to the cervix or the heart. The baby can also be slightly at an angle, but still more sideways than up or down.

Before birth, your baby is in many different positions in the uterus. When talking about where the baby's head is, doctors use the terms cephalic (head down) and vertex (crown of the head down), which as noted above, means the head is towards your feet, and breech, which means the head is up towards your heart.

The sideways position in the uterus is more common earlier in pregnancy when the baby has space to move around freely. As noted above, very few babies remain in this position at term.

Checking Baby's Position

Your doctor or midwife will typically be able to tell the position of your baby by placing their hands on your abdomen in a series of movements known as Leopold's Maneuvers. They may also request an ultrasound exam be done to confirm the position of your baby.

Typically the position of the baby is not a concern until the last trimester of pregnancy. At this point, the doctor or midwife may check your baby's position at every visit. As noted above, the vast majority of babies will be head down at birth.

Why Babies May Be in a Transverse Lie

Sometimes, it is unknown why a baby is in a malposition, other times there are contributing factors, such as in the case of an atypically-shaped uterus or pelvis. Some of the more common reasons why a baby may be in the transverse lie position include the following:

  • Abnormality of the uterus
  • Having a cyst or fibroid blocking your cervix
  • Pelvic structure
  • Polyhydramnios (too much amniotic fluid) or low fluid levels
  • Position of the placenta
  • Second (or more) pregnancy
  • Twin or multiple pregnancy

The biggest factor in whether or not your baby is in a transverse lie position (and if they will turn to another position on their own) is why the baby is transverse in the first place. For example, having a bicornuate uterus, where the uterus has two sides, can mean that your baby fits better inside when in the transverse position. Sometimes, it is due to an issue like low amniotic fluid not giving your baby the room to turn head down or vertex.

Potential Complications With a Transverse Baby

A baby who is transverse will not fit in the pelvis, making a safe vaginal birth very difficult, if not impossible. A baby in the transverse position simply doesn't fit through the vaginal canal. Additionally, there is added risk of cord prolapse and other complications.

Often, the baby will move themselves into the correct position or they can be manually repositioned. A cesarean section may be needed if the baby cannot be turned.

Turning a Transverse Baby

There are things you can do to help your baby rotate into a more favorable position if they don't do so on their own. Your doctor or midwife may suggest exercises or positions you can do to promote repositioning. If your baby stays transverse, your doctor may do an external cephalic version (ECV), this is where they attempt to turn the baby from the outside using pressure on the baby's head and buttocks. This procedure can be painful for the mother, but pain relief may be used and complications are rare.

However, some babies are easier to turn than others. Plus, the procedure can not be done in certain circumstances, such as with twin or multiple pregnancies. That said, this procedure is often successful, particularly if the doctor is experienced in the technique. Typically, it is performed anywhere from around 36 weeks until delivery as long as the water has not broken and other conditions are favorable. However, it's easier to turn a smaller baby than a full or post-term one.

One 2013 study, whose authors advocate for practitioners to learn and use repositioning methods more often, reported a 100% success rate in turning babies in the transverse lie position. However, generally, success rates for ECV are around 65%, with even higher positive outcomes for women who've given birth before.

When the Baby Doesn't Turn

If your baby is in a transverse lie position at term, a cesarean section may be recommended if the baby doesn't turn or if other measures are not successful in turning the baby.

Know that even if interventions to get the baby to turn work, some babies will revert back to the transverse lie or breech positions.

A Word From Verywell

A transverse baby may turn (or be turned) into a head-down position before birth, but if not, a c-section will likely be necessary to ensure the safe birth of your child. Remember, the end goal is a safe delivery, and ultimately, all that matters is ending up with a healthy baby in your arms.

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5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Van der Kaay DC, Horsch S, Duvekot JJ. Severe neonatal complication of transverse lie after preterm premature rupture of membranesBMJ Case Rep. 2013;2013:bcr2012008399. doi:10.1136/bcr-2012-008399

  3. Oyinloye OI, Okoyomo AA. Longitudinal evaluation of foetal transverse lie using ultrasonography. Afr J Reprod Health. 2010;14(1):129-33.

  4. Cruceyra M, Iglesias C, De la calle M, Sancha M, Magallón SL, González A. Successful delivery of a twin pregnancy in a bicornuate uterus (uterus bicornis unicollis) by bilateral Caesarean section. J Obstet Gynaecol Can. 2011;33(2):142-144. doi:10.1016/S1701-2163(16)34800-9

  5. Tan JM, Macario A, Carvalho B, Druzin ML, El-Sayed YY. Cost-effectiveness of external cephalic version for term breech presentation. BMC Pregnancy Childbirth. 2010;10:3. doi:10.1186/1471-2393-10-3

Additional Reading
  • Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Sixth Edition.

  • Spinning Babies. Gail Tully. Boston, 2013.