Pregnancy comes with many questions and big decisions: Are you going to have a water birth or a land birth? Will you co-sleep? Baby-wear? But one question that many women don’t consider—or even realize they have any control over—is baby’s fetal position in utero.
In this post, we’ll explain exactly what fetal position is, why it matters, and how to coax baby into the best fetal position.
What is Fetal Position? And Why Does it Matter?
This well-known term refers to baby’s position in the womb.
When you hear the words “fetal position,” you may envision someone sleeping soundly while curled up in a ball. But baby’s positioning in utero isn’t quite that simple. There are several different fetal positions that your baby can be in, and some are better for birth than others. If your baby is in a less-than-ideal position, it can cause painful and prolonged labor, fetal distress, and possibly even interventions like a C-section.
Fetal Position vs. Fetal Presentation
The way baby is situated in utero is often referred to as fetal position, but that’s not entirely accurate. Technically, there are important distinctions:
Fetal position: whether the fetus is facing rearward (face down towards the woman’s back when she lies down) or forward (face up towards the woman’s stomach when she lies on her back).
Fetal presentation: what body part is leading the way out of the birth canal.
In the interest of simplicity, this article will refer to the way baby is situated in utero as fetal position.
How to Tell What Fetal Position Baby is In
If you feel your stomach and identify a wide, hard shape, this indicates that the baby’s back is facing forward. If however you feel a lot of small lumps and protrusions, this indicates that you’re feeling the baby’s limbs, and that baby is facing forward. (source)
If you feel a hard, round mass settling down in your pelvis, this is most likely baby’s head. (YAY!) It can also be her butt but the head will be harder and rounder. An experienced midwife or doctor can help distinguish the two.
Sometimes the position of the placenta, tone of the abdomen, abundance of amniotic fluid, or excess weight can make it difficult for a mama to figure out baby’s fetal position on her own. (Read more about belly mapping and identifying fetal position here.)
Of course, when all else fails, an ultrasound will confirm the baby’s fetal position.
Different Fetal Positions
Here’s where things get complicated! The terms used to identify fetal position and presentation are confusing and it’s easy to get turned around, but the definitions below will help clear things up.
Occiput – This refers to the back of baby’s head, or the nape of baby’s neck
Transverse – Sideways, or laying horizontally across
Left – The baby’s occiput (back of their head) is facing left
Right – The baby’s occiput (back of their head) is facing right
Anterior – The front of the mother
Posterior – The back of the mother
So for example, if your baby’s fetal position is left occiput posterior, it means that the back of hishead is facing to the left and baby is face up with his spine against your back.
Let’s put it all together now and unpack each possible fetal position:
Head-Down Fetal Positions
Towards the end of pregnancy, baby should situate herself into a head-down position. But it’s not quite that simple! Just because baby is head-down, doesn’t mean she’s is in an ideal position for delivery. Here, all the ways baby may be positioned:
Left Occiput Anterior (LOA)
This fetal position is when a baby is head-down, with the back of his head facing mama’s left side, and looking inward toward mama’s spine. Since the baby’s face is actually pointed to the right of the mother’s womb, this can be a little confusing at first. When dealing with fetal position, the directional term (left or right) is dependent upon which direction the back of the neck—not the face—is pointing.
Right Occiput Anterior (ROA)
In this fetal position, baby’s head is down, her back is facing mama’s right side, and she is looking inward toward mama’s spine.
Left Occiput Posterior (LOP)
Here baby is head-down, the back of his neck is facing mama’s left side, and his spine is up against mama’s spine. In this fetal position, the back of baby’s head lines up with mama’s spine.
Right Occiput Posterior (ROP)
In this position, baby’s head is down, the back of her neck is facing the right side, and her spine is up against mama’s spine.
Transverse Fetal Positions
Transverse positions are rare during delivery, since babies in this position generally turn head down before delivery. When babies remain in transverse positions, however, delivery can be difficult—baby is more likely to get stuck in the birth canal, which can cause emergencies like umbilical cord prolapse. (source)
Rather than head up or head down, baby is sideways in the womb, almost as if he is relaxing in a hammock.
Right Occiput Transverse (ROT)
In this position, baby’s back is lined up with mama’s right side and isn’t angled toward her front (anterior) or back (posterior). In other countries, this position is called right occiput lateral. Babies in this position will typically rotate to a posterior position during labor. (source)
Left Occiput Transverse (LOT)
Here, baby’s back is lined up with mama’s left side and isn’t angled toward her front (anterior) or back (posterior).
A baby is considered to be breech when her head is facing up, instead of down towards the birth canal. This happens in about 1 of every 25 births. Certain factors, like having multiples or subsequent pregnancies, can put you at a higher risk for having a breech birth. You can certainly have a natural, unmedicated birth with a breech baby if your provider and/or state allows. You can also try certain things to flip your breech baby.
This is a true butt-first position, as baby’s hips are flexed, and his knees and feet are up by his ears. The majority of breech babies (around 65 to 70 percent) fit this category. This fetal position increases the chance of an umbilical cord loop coming through the cervix first and can cause injury.
Baby is butt-first, but she appears to be sitting cross-legged in the womb; her knees are bent, and her feet are lower in the pelvis. Like other breech positions, the risk of damage from an umbilical cord loop is higher for a vaginal birth with a complete breech.
Instead of leading with his bottom, a footling baby leads with his feet—either one (called a single footling) or both (a double). Footling presentations are rare in general, but are more common among premature babies. The umbilical cord can fall down into the mouth of the womb and cut off the baby’s blood supply. (source)
Baby is positioned butt-first, with one leg straight (like a Frank breech) and the other bent (like a Complete breech). This awkward position is also known as an incomplete breech. (source)
This one’s pretty much what it sounds like: baby is essentially kneeling in the pelvis. Kneeling breech is an extremely rare form of breech. Both kneeling and footling breech positions are riskier than a frank breech to deliver vaginally. (source)
Which Fetal Position Is Best for Normal Delivery?
The occiput anterior—left or right—position (remember, that’s when baby is head-down looking inward toward mama’s spine) is the ideal fetal position for birth. (source)
When baby is occiput posterior (that’s head-down looking outward toward mama’s belly), it’s often more difficult for baby to pass through the birth canal and can result in back labor. This is because baby’s neck is often straightened (rubbing against mama’s spine… ouch!) rather than bent, requiring more space to pass through the birth canal. (source)
How to Get Baby in the Best Fetal Position
If your baby isn’t in an optimal position, don’t worry. Babies are always moving, and some babies change position at the very last minute. And you have options! There are a few techniques—like chiropractic care, exercises, and eternal cephalic versions—that mamas can use to try to turn their babies. Read more about these methods here.
If Baby Doesn’t Turn, Will You Need a C-section?
Many U.S. hospitals require breech babies to be delivered via C-section to avoid the risks associated with vaginal delivery.
But as mentioned above, many babies will settle into a good fetal position right before or during delivery on their own. A well-trained midwife or doctor will be able to monitor and help turn a baby into the right position. You also want to be sure to do as many things as possible to open, balanced and align your pelvis to encourage a head-down position.
Try not to worry if things aren’t perfect—just do what you can to encourage the best birth for you. Always remember you can incorporate many things into your c-section to make it feel more natural, too. You got this, mama.
How About You?
What position was your baby in? How did it affect your birth plan?
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