What You Need to Know If Your Baby Is in an Oblique Lie

Before we dive into the specifics of an oblique lie, it’s important to describe, in general, what we’re talking about when we say “fetal lie.”

When a doctor or midwife describes the lie of your baby, they’re technically describing the relationship between your long axis and the baby’s long axis. In other words, the baby’s position in your belly.

Fetal positions change throughout pregnancy, and it’s normal for your baby to present in a lot of different “lies.” But, as you get closer to your due date, the goal is to have the baby in a head-down position in preparation for birth. This often happens between weeks 32 and 36.

If your little one is presenting in an oblique lie, which often results in a shoulder or arm presentation, their head and feet will rest on your pelvis.

More specifically, Thomas Ruiz, MD, an OB-GYN at MemorialCare Orange Coast Medical Center, says an oblique lie is when the baby’s head is just to the side of the pelvic inlet.

To understand how close this position is to a traditional vertex presentation, Ruiz says if the baby’s head changes position slightly, centers itself over the inlet, and then drops into the pelvis, you get a head-down position.

However, oblique lies can just as easily become transverse if the head moves away from the pelvis.

Some of the more common causes of an oblique lie, according to Jamie Lipeles, DO, founder of Marina OB-GYN, include:

• an abnormally shaped uterus
• baby is too large for the pelvis
• presence of fibroids in the uterus
• excessive amniotic fluid

When a pregnancy isn’t textbook (and when is it ever?), we all want to know and understand the potential risks for baby. If your little one has decided to hang out in an oblique lie, there are some risks if they don’t get turned around before you go into labor.

The most threatening risk of an oblique lie, says Lipeles, is that this presentation doesn’t allow the head to obstruct the outlet where the baby is supposed to be delivered through.

“If you go into labor and the amniotic sac ruptures, there is nothing at the outlet to prevent the umbilical cord exiting the uterus through the cervix,” he explains. This is called cord prolapse, which is a surgical emergency and can be life threatening or result in permanent neurological damage to the baby’s brain.

Additionally, if the baby can’t fit through the pelvis and remains in an oblique lie, Lipeles says the doctor must perform an immediate caesarean delivery.

Now that you understand the predicament your little bean is in, it’s time to tackle the mechanics of how to get them headed in the right direction.

The solutions for an oblique lie are often similar to the ones used for a transverse lie. And the best part? There are several exercises that work.

Here are a few that Lipeles recommends:

• doing yoga poses such as downward dog
• sitting on a birthing ball and rolling your hips with an open leg stance (aka pelvic rocking)
• floating in a swimming pool to attempt to get the baby to move into a better position
• remaining in a squatting position to “open the pelvis” to give way to the baby changing their position

One 2019 study found that pelvic rocking on a stability or birthing ball while pregnant contributed to correcting the fetal lie and, more specifically, the oblique lie, in women at or more than 29 weeks pregnant. More than 49 percent of women in the intervention group indicated a longitudinal lie compared to 29.8 percent of those in the control group.

While all of those interventions can work, Lipeles says in his 14 years of practice, there’s one activity he finds the most effective with both an oblique lie and breech position that you can do at home.

He instructs his patients to take whatever frozen fruits or vegetables (or any other item) they have in the freezer and place them in a thin cloth and leave them on their belly in the area that the baby’s head is positioned.

“The unborn baby is sensitive to changes in temperature, and thus these frozen items near their head are uncomfortable, and will encourage them to move their head away from the cold item, which often leads to the baby moving into a more desirable position,” he explains.

Doctor-involved interventions are also a possibility. Because the head is so close to the pelvic inlet, Ruiz says these lies often respond to manual manipulation or external cephalic version.

To do this procedure, your doctor, with the help of an ultrasound, will manually guide the head into the pelvis. “If there’s adequate space within the pelvis, the head will usually drop down into a normal position,” he says.

Since uterine contractions can also force the baby’s head into the pelvis, Ruiz says at 39 weeks, a doctor can use external version cephalic techniques to push the baby’s head down into the pelvis and then start an induction.

“This usually works and can lead to a vaginal delivery, if you’ve had more than one pregnancy,” he says. But if this is your first pregnancy, Ruiz says the maneuver is more difficult, and not as successful, because the uterus and abdomen are more firm.

And finally, Kecia Gaither, MD, an OB-GYN and director of perinatal services at NYC Health + Hospitals, says there are some alternative methods like acupuncture and Spinning Babies classes. “Acupuncture, which has been utilized for fetal movement for years, relaxes the mother’s musculature, allowing the baby to turn head-first into the pelvis,” she says.

The classes Gaither is referring to are called “Spinning Babies,” which she says employ certain yoga positions to relax mom and encourage fetal movement into a head-first position.

If you’re nearing your due date, regular labor can also push the baby’s head down into the pelvis. “If this happens, you will get a chance at a vaginal delivery,” says Ruiz. Of course, if the head moves laterally, Ruiz says the baby will move into a transverse lie, and you’ll end up with a cesarean section.

In a normal shaped uterus, the forces of uterine contractions will force the baby’s head in the pelvis. Fortunately, the forces of uterine contractions can force the baby’s head into the pelvis.

But if the contractions don’t push the baby’s head into the pelvis, and you’re going into labor while still in an oblique lie, your doctor will most likely need to perform an expedited C-section.

Your baby will move into various positions before your due date. As you near the end of your pregnancy, your doctor will keep a close eye on the fetal position and recommend interventions if the baby is in an oblique lie.

Like other fetal positions, an oblique lie may require a cesarean delivery if the baby doesn’t move into a head-down position before you go into labor.