Your baby kicks, squirms, and flips all day (and night!). But what exactly are they doing in there?
Well, toward the end of your pregnancy, your baby will likely get into a head-down position so that they can begin their descent into the birth canal. The exact timing of when your baby hits this position is individual. And some babies prefer other positions, like breech (head up) or transverse (side lying).
Regardless, some signs can serve as clues about how baby’s relaxing in there. Here’s more about when your baby will move head down, what the options are if they stay head up or in another position, and what to feel for when trying to determine your baby’s position at home.
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Your baby may move all over the place in the first and second trimesters. Their position may change wildly early on in the third trimester as well.
However, if you’re between 32 and 36 weeks, you may notice your baby staying put in a head-down position. Your uterus grows to accommodate their size — but there’s only so much room. As time passes, your baby gets bigger and starts to run out of space to move into different positions.
Being head down is just half of the equation when it comes to birth. There’s also the matter of which way your baby is facing.
Why does this make a difference? It comes down to geometry. Your baby’s head must fit through the pelvis on its way into the vaginal canal for delivery. Some positions make this journey easier than others, especially considering how different parts of your baby’s skull are wider and narrower than others.
- Occiput anterior: This position is the most common. It means that your baby is head down with their back against your stomach and their chin tucked into their chest.
- Occiput posterior: This position means that your baby is head down but facing the opposite direction. In this position, your baby’s back is at your back.
Anterior is the ideal position for an uncomplicated vaginal delivery. When your baby’s chin is tucked, it helps the narrowest part of their head go through the birth canal. Posterior presentation can mean a longer or potentially more difficult delivery, sometimes requiring a vacuum, forceps, or cesarean section.
If your baby is posterior even in early labor, they may still turn throughout the process as contractions move them around in the womb. Some babies completely spin to an anterior position during labor while others are born posterior.
You may not experience any signs that your baby has flipped into a head-down position. There’s really no easy way to tell just by looking at your bump. You need to get in there and feel around. But how?
Fortunately, your doctor or midwife is trained to feel for your baby’s position using what are called Leopold’s maneuvers.
With this technique, your provider will feel for what part of your baby is presenting in the pelvis, then for your baby’s back, and then for what part of your baby is in your fundus (up high, near your rib cage). They’ll also feel around for your baby’s cephalic prominence, which simply means which way your baby is facing.
With a head-down presentation:
- baby’s head would be in your pelvis
- baby’s back position would depend on whether baby is anterior/posterior, but generally baby will have either their back to your belly (anterior) or your back (posterior)
- baby’s bottom/legs would be in your fundus
All these findings can also be confirmed via ultrasound to give you the clearest picture.
But how can you figure out your baby’s position at home? Pay close attention to the shapes in your belly, as well as the different movements you feel.
Your baby may be head down if you can:
- feel their head low down in your belly
- feel their bottom or legs above your belly button
- feel larger movements — bottom or legs — higher up toward your rib cage
- feel smaller movements — hands or elbows — low down in your pelvis
- feel hiccups on the lower part of your belly, meaning that their chest is likely lower than their legs
- hear their heartbeat (using an at-home doppler or fetoscope) on the lower part of your belly, meaning that their chest is likely lower than their legs
It can be difficult to read the different lumps and bumps you feel on your stomach. With practice, you may start to understand what you’re feeling. You might even try belly mapping — a process to estimate baby’s position. It was created by Gaily Tully, certified professional midwife and author of SpinningBabies.com.
To use this technique, wait until you are at least 30 weeks pregnant. You may even want to try belly mapping following a prenatal appointment so your doctor can give you some guidance on baby’s position.
Lie down in bed or on the couch. Using a washable marker or finger paint, gently mark where you feel your baby’s head (it feels like a small bowling ball). The arms and hands are likely near the head, and their tiny movements give them away.
Then feel for the back, butt, and legs, as well as larger movements. You may find it helpful to use a baby doll to play with different possible positions. You can then lightly draw or paint your baby on your stomach to help you visualize how they’re lying.
If you’re in late pregnancy and have concerns about your baby’s positioning, ask your doctor about it at your next prenatal appointment. Chances are that your healthcare provider is making a note of your baby’s position as well.
If your baby is breech or in some other position besides head down, there are several options for delivery. Factors at play here include:
- whether your baby stays in a certain position as you reach term
- any other pregnancy complications you might have
- when you end up going into labor naturally
Again, your baby’s position isn’t usually a big concern until you reach between 32 and 36 weeks in your pregnancy. Before that point, the fluid in the uterus gives your baby plenty of space to move around. As you get closer to delivery and your baby hasn’t settled head down, they start to run out of room to make the switch.
Your doctor can monitor your baby’s position at your prenatal appointments by feeling your belly for where their head, back, and buttocks are. To confirm, you may also have an ultrasound or pelvic exam.
External cephalic version (ECV)
External cephalic version (ECV) is a procedure during which your doctor tries to move your baby into a head-down position to increase the chance you’ll have a vaginal birth. This is done in a setting in which baby can be monitored and you can have an emergency cesarean section (C-section) if needed.
Your provider uses their hands to manually turn the baby head down. If you’ve reached 36 weeks and your baby still isn’t head down, your doctor may suggest an ECV.
The success rate of this procedure is around
It’s also worth noting that some babies that are flipped return to a breech position. You can have a repeat ECV, but space runs out the closer you get to birth, so it may be more difficult the second time.
Cesarean delivery (C-section)
A C-section is another option for delivering babies who aren’t head down. It involves major surgery that you may schedule ahead of time (if you know your baby isn’t head down) or that can be performed in the event you go into labor naturally.
- postpartum hemorrhage
- blood clots
- issues with future pregnancies, like a risk of placenta previa or uterine rupture
The American College of Obstetricians and Gynecologists explains that some women may be candidates for a vaginal birth even if their babies are breech. This possibility is determined on a case-by-case basis and involves a review of your medical history and weighing the benefits of vaginal delivery versus the risks of C-section.
If you choose to go this route, you’ll need to follow any specific guidelines set up by your hospital or birth center.
Your baby moves a lot throughout your pregnancy. As you get closer to your due date, they’ll likely settle into a head-down position as they get ready for birth.
If you have concerns about your baby’s position, don’t hesitate to bring them up at your next prenatal appointment. Your healthcare provider is also keeping tabs on whether baby is head down and can help guide you with options for repositioning or an alternate birth plan, if necessary. You’ve got this, mama!