At some point during pregnancy you’ll probably reach a moment where you wonder whether what you just felt was hunger, gas, or the baby moving. Feeling your baby move or kick for the first time is an exciting time for expecting parents.
In the early days, around the time of your first ultrasound picture, your tiny bean can float around in any position they want. There’s plenty of space in their digs. But as your baby gets bigger, it takes more effort — and kicking — to change positions in the womb (uterus).
Fetal positioning is the fancy term for how your baby — the fetus — is positioned in the womb, whether that’s on their back, head down, or some other combination. Fetal position usually refers to the classic curled up baby position.
Fetal position looks a bit like making a C-shape, with a curved spine, head down, and arms and legs pulled in close to the body. While your baby will stretch, kick, and move around often in the womb, this is typically the go-to position they’ll hang out in most of the time.
Fetal position is generally the most comfortable position for your baby in the womb and even after birth. As you get closer to your due date, this position is also important because it helps your baby get into the best position for birth and helps to lower the risk of complications during delivery.
In your uterus, the fetal position usually means your baby is hanging upside down. However, babies can be in the fetal position but have their head pointing upward or be completely sideways.
The fetal position isn’t limited to little ones in the womb. Once your baby is born you’ll often see them curled up in this shape. Babies, children, and — sometimes even adults — will also use the fetal position for comfort and self-soothing. It’s also the go-to for most people for getting a good night’s sleep.
Babies somehow magically know when it’s almost time for the birth. By 36 weeks most babies manage to arrange themselves into a head down position for the fastest exit possible. Others decide that they’re quite comfortable and have no plans to leave.
Occiput anterior (OA)
The best fetal position for your baby to be shortly before birth is feet up, head down, facing your back, with their back resting against your belly. This means that they can exit the birth canal with the back of their head, closest to your pubic bone.
The medical name for this position is occiput anterior or OA. You may also hear the terms vertex position and cephalic position, which refer to any position where the baby’s head is in the pelvis and is the presenting part.
This baby position is the easiest way for your baby to move downward and for you to give birth — not that there is an easy way! The downward fetal position helps the baby fit through the birth canal in the best way.
However, sometimes your baby has other plans and may decide they don’t want to be in that position no matter how many hours you’ve been in labor for. Or they might get into position and then decide to acrobat into another one and refuse to budge.
Other kinds of fetal positioning your baby might be in, that can make for a more challenging labor or the need for cesarean delivery (C-section), include:
Occiput posterior (OP)
This is almost like the ideal upside-down fetal position for birth, except that instead of facing your back, baby is facing your belly. It’s also called the back-to-back position and sunny-side-up position.
In the OP position your baby can’t tuck their chin down to go through the birth canal more easily. If your baby is in this position and can’t turn themselves over, labor might be longer. Your doctor may decide that it’s best to have a C-section.
About 3 to 4 percent of full-term babies decide to stay head up and bottom down in a breech position. There are different kinds of breech positions, and they all increase the chance you may need a cesarean delivery.
- Complete breech: Bottom is down near the birth canal, baby has their knees bent and feet near their bottom.
- Frank breech: Baby is in a V-shape, with bottom near the birth canal, legs up and feet near the head.
- Footling breech: Exactly what it sounds like, baby has one or both legs near or in the birth canal.
Oblique means that your baby is in a diagonal (or slanted) position across the womb. This fetal positioning is rare, but it can happen.
This position is more risky during birth because the head isn’t correctly aligned with the birth canal, which can lead to umbilical cord compression. If the umbilical cord enters the birth canal first, pressure from the head during labor can compress the cord, obstructing blood flow and causing an emergency situation.
You may need a C-section if your stubborn little one can’t be turned into a head-down position.
In transverse position, your baby might be curled up in the fetal position, but they are laying sideways across the womb. Your baby may have their back, shoulder, or hands and feet closest to the birth canal.
The main risk for this position is that the placenta can get damaged during birth or trying to turn the baby. Your doctor will decide if a C-section is the safest way to go.
In the weeks and days leading up to your due date, your doctor will check on your baby’s position in the womb. If your baby hasn’t dropped into the best position for birth, your doctor might use a few techniques to gently nudge them into place.
This can help make it possible for you to have a vaginal birth. Fetal version or changing baby’s position in the womb is most commonly done if:
- You’re about 36 to 42 weeks pregnant.
- Labor hasn’t started yet.
- You’re in labor but your water has not yet broken.
- Your baby is swimming in plenty of amniotic fluid.
- Your baby isn’t touching the entrance to the birth canal, and no part of them is in the birth canal.
- You’re having a single baby (not twins or other multiples).
- You’ve had a baby before (stomach muscles are — understandably — less tight).
- You’re delivering in a hospital — so you can be taken in for a C-section quickly if needed.
The medical name for the technique used to coax a baby into place inside the womb is called external cephalic version (ECV):
- external — because it’s mostly from the outside of your stomach
- cephalic — meaning into the head down position
- version — otherwise known as turning the baby
Your doctor will use gentle massaging and firm pressure to get your baby to move into the OA cephalic position. If it works, it can help you avoid having an unplanned cesarean delivery.
Your health and the health of your stubborn bundle of joy will be checked carefully before your doctor tries to roll your baby into place. During the procedure, your baby is closely monitored to make sure it’s not making them too grumpy.
During the ECV procedure:
- You might be given an injection of medicine that helps to relax your womb.
- You may be given a numbing (epidural) medication to keep you comfortable.
- Your heart rate and other vitals will be checked.
- Your doctor will make sure there’s plenty of fluid around your baby to make it easier for them to move.
- Your provider will use baby heart monitoring to make sure your baby’s heart rate stays normal during the procedure
- Fetal ultrasound can be used to see exactly where your baby is and if nudging is working to turn them
- Your doctor will massage and press on your stomach with both hands
The ECV procedure can be uncomfortable for you and make your baby get a bit upset. If your contractions get stronger, your water breaks or your baby is already near or partly in the birth canal, ECV won’t work. Your doctor will recommend a C-section as the safest option for your baby’s birth.
Your baby’s position in the womb is very important as your due date gets closer. Most babies get into the best fetal positioning a few weeks before birth. If your baby hasn’t moved into the head down cephalic position by about week 36, your doctor might try to nudge them into place.
Being in an awkward fetal position, such as breech, face-to-mama’s-belly, sideways, or diagonal may mean that you’ll need a cesarean delivery. Other fetal positioning can make it harder for your baby to slide out and can increase the risk of complications during birth.
While you can’t control the position your baby is in while they’re in the womb, they’ll soon be cuddled up on your chest in the same comfortable, curled up way!