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Knowing what position your baby is in can be really comforting to expectant parents. Baby will most likely need to be head down in order to facilitate a vaginal delivery. But, what are the signs that baby has turned head down (also called cephalic) and what can you do if they’re not?
But, how do I know so much about breech babies?
Hi — I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have seen hundreds of breech babies, and have talked with countless patients about how to get baby to turn and what they can do to help (or what to watch for), so I’m a good resource on this one.
What are the signs that baby has turned head down?
The biggest indicator is where you feel fetal movement. If you tend to feel kicks up more towards your rib cage and smaller movements (arms and hands) in the bottom half of your uterus, it is likely baby is in the head-down position.
Some people may able to feel the baby’s head engaged into their pelvis this is another potential sign of them being in the cephalic position. When providers feel for the baby’s position is called Leopold’s maneuvers, and while not 100% can be very accurate by a skilled practitioner. As a note, this is a difficult job, even after 20 years of doing it I didn’t feel amazing at it, so I would leave that type of work to a professional who’s felt a LOT of babies.
Your doctor or midwife may also be able to use ultrasound imaging to tell if your baby is in the cephalic position (this is the best way — anything else can be confusing and sometimes we are wrong). And, while I don’t recommend it I do have a whole post on at-home ultrasound machines. I also have a post on 32-week ultrasounds and what they’ll check for.
Furthermore, when performing a pelvic exam near the end of your pregnancy, your doctor may also be able to tell from the positioning of the baby’s head and body whether they are in the cephalic position or not (they will feel a hard head vs a softer bum).
Paying attention to all these signs may help you determine if your baby is in a head-down (cephalic) position and give you peace of mind as you prepare for childbirth.
If you have any questions at all about baby’s positioning once you’re into your third trimester, be sure to ask at your next prenatal appointment, so your provider can assess the position using their skills (and maybe an ultrasound if they have one handy).
BTW if you’re close enough to your due date that you are worried about if baby is cephalic, you need to be SURE to get one of these in!
What are the signs my baby may be in a bottom-down (breech) position?
If your baby may be in a bottom-down or breech position, there are some signs to look for.
Your healthcare provider can help you determine if your baby is in this position by feeling your abdomen and performing an ultrasound. Some of the most common signs that your baby may be in a breech position include the presence of what feels like the baby’s head above your bellybutton, a head that can be felt very low down in the pelvis, and an irregular shape to your uterus.
Many people also complain about the very hard head bumping into their ribs and causing rib pain.
Other signs include feeling less movement on one side than the other as well as hearing fewer heart tones on one side than the other. If you suspect that your baby is in a breech position, it is important to let your healthcare provider know right away so they can take any necessary steps to ensure their safe delivery.
Experienced practitioners can often look at a belly, and just noticing it looks different can know that baby is breech. Also, where we assess the fetal heart rate can be different in a breech baby as well. If I found the heart rate on your tummy above your belly button I’d often ask the doctor for an ultrasound to see if baby is breech. If there isn’t time for an ultrasound, a vaginal exam can often tell an experienced practitioner if baby is breech (because you’d feel buttock, not head when you check their cervix).
What are the signs my baby may be in a transverse position?
A transverse position means that the baby is neither head or bottom down. They are laying across your abdomen with the head and bum on the sides of your uterus (although most often they aren’t directly across, usually one appendage is pointing down, more like a 45 degree angle).
It is more difficult to ascertain that your baby is transverse — most often you’ll feel the symptoms of whichever side is “down” — and again, an ultrasound is the best way to tell how baby is positioned in the womb.
Most often “transverse lie” babies are easier to to do a version to put them in the right place — and we’ll talk more about those, so keep reading!
What about the other positions? LOA — ROA?
These positions refer to the way your baby is facing in the womb. LOA (left occiput anterior) and ROA (right occiput anterior) mean which side of the baby’s face is facing the top of your pelvis. They would be used for a cephalic (baby head is down) presentation. Most often they refer to LOA or LOA instead of talking about which side of the baby is posterior.
This is easy to get confused with two things that also talk about:
- Anterior placenta — means the placenta is on the front of your uterus (anterior position means front) rather than on the back closer to your spine
- Posterior cervix — means the cervix is further back in your birth canal
Neither of those things have anything to do with if baby is head up or head down.
What about Footling or Frank Positioning?
There are 3 different types of breech presentation (although a transverse lie can also be considered a breech presentation, but we already covered that).
- Frank breech — when baby’s legs are straight up and near their head — baby’s bum is directly pointed out the vagina
- Complete breech — baby’s legs are folded up (so the thighs and calves are together — like the “Fetal position” normally is — but baby is bum first, instead of head first)
- Footling breech — baby’s feet are the first things next to the birth canal. Baby is sort of sitting on their feet cris-crossed.
All of these are breech presentations, and change what type of delivery you might be able to have and how easy it might be to do a version.
What does it feel like when your baby turns head down?
Obviously, it really depends on how far along you are and how big baby is. However, people that are well into their 3rd trimester say they feel like a “tidal wave” of baby movement happens and they “know” baby has switched.
As the uterus at that point doesn’t really accommodate baby to be perpendicular to the womb, it may shift slowly at first, but then normally moves quite quickly into the new position.
This can also be true if a baby switches from cephalic or breech though.
That being said, I have patients who have no idea that baby has changed position. It may have happened while they were sleeping, or perhaps they just didn’t have that “tidal-wave” experience — but, either way I have seen baby changing position without the mother knowing (even later in pregnancy).
It is also even possible (although very rare) for baby to change position during labor.
I know all of this can seem super complicated, but this can really simplify it!
Do you feel pain when baby turns head down?
I haven’t heard patients say it is painful, just more of a big movement that they aren’t initiating. Again, all of that is when baby is closer to your due date. If you’re earlier on you likely won’t notice anything when baby turns head down.
Baby can engage more into your pelvis when they are head down, so some people feel some cervical or clitoral pressure in that instance. But, that’s more due to the engagement rather than just the head being down.
How often will my baby’s position change?
Early in pregnancy (first and second trimesters) baby may change position frequently. They have lots of room and as they grow and stretch they will float and move throughout the uterus.
As you progress into your third trimester baby usually picks a spot as the womb begins to tighten into them. However, I have still seen babies who switch position frequently, so it is still possible for babies to turn well into your pregnancy.
At what week does baby turn head down?
I have a whole post about when baby will turn head down — but the cliff notes is that most babies will be head down by around 34-36 weeks of pregnancy. If you are prior to that point, there is no need to worry about baby being breech still.
Many people see that baby is breech at their 20 weeks ultrasound and initiate a lot of worry around that, but baby may change position several times after that — no need to worry!
Remember, that constant worry (vs small stressful events in life) isn’t good for you or the baby, so try to decrease your anxiety!
What if my baby is breech towards my due date?
If the baby remains breech (meaning their head is up and either the bum or the legs are positioned to come out first) after 36 weeks, there are techniques available such as external cephalic version (ECV) which can help turn the baby so that they are head down before labor begins. If this does not work, then your doctor may recommend a Cesarean section which will help ensure both mom and baby remain safe and healthy during delivery.
In the US most doctor’s medical malpractice insurance cautions them on doing a breech vaginal delivery. I have only seen them in very few small circumstances in the hospital, and your provider will likely recommend a cesarean birth if your baby remains breech.
Will I need a c-section if my baby is breech?
Most likely, yes. Most doctor’s medical malpractice insurance cautions them on doing a breech vaginal delivery. I have only seen them in very few small circumstances in the hospital, and your provider will likely recommend a cesarean birth if your baby remains breech.
I know this can seem super scary, but I love what Rachel had to share on this podcast episode (listen right here) — her baby was breech and she needed a cesarean, and ended-up being really happy with it!
And getting prepared for a c-section is smart for any expecting parent, you never know how your delivery will turn-out! That’s why you need a birth class from someone experienced with them too!
What can I do to help my baby to turn?
I have a few tips if your baby is breech:
Go see a chiropractor. I’ve actually seen the most luck from this. While I wish I’d seen a chiropractor for all of my pregnancies, if I was past 32 weeks and my baby was breech I would definitely find a chiropractor trained in the Webster Technique (very important to find one trained in that vs a regular chiropractor). They manipulate your pelvis to help baby find their best way out. Ask your provider if they know of one to start (if not, just head to the internet to start searching for one in your area with good reviews).
I have a podcast episode with a chiropractor that explained it super well!
Try Spinning Babies: While waiting for that chiropractor appointment, I would try the techniques in spinning babies.
Ask for a Version: Ask your provider to do a version. As long as baby is growing well and you and baby are healthy most often they will do this for you. We’ll talk more about those in the next section.
Resign myself to mother nature: If your baby has been in one position for a long time, there is a good chance there is a reason they are that way. Be it your pelvis, your uterus, the placenta, the cord or something…. mother nature has that baby breech for a reason, and a cesarean section may be your best way to deliver.
Remember that cesarean sections, while major surgery, are one of the most frequently-done surgeries in the hospital had have a high success rate. And we have a whole chapter about them in here (any birth class you take should have information on cesarean sections).
What is a Version?
In the version they will use their hands and forearms to try to push baby into the right position.
If you are a good candidate, I’d ask them their success rate with versions because as an assistant to many versions I’ve seen some doctors not very good at versions. If you go to a large practice, feel free to ask for the provider that is the best at versions.
Are versions painful?
I think most people describe them as a LOT of pressure. As you can imagine, that doesn’t feel great. They do give you anti-contraction medications (called tocolytics) to help your uterus relax for the procedure.
There is a study that proves that having anesthesia for the version can increase the success rate. Some doctors seem hesitant to have an epidural on board because the patient won’t be able to say if they feel their uterus tearing, but with proper monitoring, it seems like that isn’t as much of an issue.
Most often they also have an ultrasound on baby at the same time too (to be sure of how baby’s positioned), and an RN is there to try to get fetal monitoring as much as possible.
Sometimes people are induced right after a version, and sometimes they let you go home to let baby “settle in” first — seems to be doctor’s preference.
How long after baby turns head down does labor start?
Baby’s position isn’t normally one of the signs of labor. Some babies are head down the entire pregnancy, so that obviously wouldn’t want to start labor.
What happens if I go into labor and baby is breech?
If you start to have contractions and baby is breech they will either stop the contractions if you’re before 35’ish weeks, or you will need a caesarean section. They really don’t perform breech vaginal births routinely in the hospital at this point. While your provider will feel to see how baby is positioned, if there is any question they need to do an ultrasound to check to see if baby is still breech.
They do not do versions on people who are currently contracting, so that won’t be an option at that point.
Ok, that’s baby head down. I hope you found this information pretty simple to understand and helped you feel more calm about the progress of your pregnancy. Come join me in The Online Prenatal Class for Couples — the simple way to get prepared for your birth.
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.