“Transverse Lie” means a sideways position. The baby has his head to one of his mother’s sides and the bottom across her abdomen at her other side. This is normal before, and at, 26 weeks, but by 29-30 weeks we expect babies to be head down, or at least breech. If not, this article outlines what to do, easy ways to fix it, and what to do if they don't - read the stories, too.
Here are some images to help you understand the lie of a baby in relation to the pelvis.
In a Transverse Lie (right) the baby is lying sideways. The head is on one of the mother’s sides and the bottom is on the other. For instance, a transverse baby might have his head on mother's left and the bottom on her right. Hands and feet may be kicking and waving towards her cervix (in the lower part of the uterus). Another transverse baby may have the head on the right and kick towards the front, etc.
The baby on the left is in an ideal position - left occiput transverse. The head, not the body, is transverse. The head is down, facing the mother's hip. Both the head down (cephalic) and head up (breech) babies are in a "vertical lie" (up and down).
The two head down positions that are occiput (a part of the skull in back) transverse are: Left occiput transverse (an ideal starting position) and right occiput transverse (not so ideal, but with a little balance and time often fine). These head down positions means baby is facing mother's hip.
Thanks, Rae! You are a dear and more, a great doula! Thanks for all you do and thanks for this video testimony. I hope it helps women facing the situation you faced and overcame.
Techniques to correct a transverse lie
Please check with your primary care provider, birth care providers, to see if there is any medical reason for you not to be upside down for the inversions (risk of stroke because your blood pressure is so high, etc.)
Things a healthy woman can do for her self to help a transverse, oblique, or breech baby flip (see more in About Breech):
• Use the Forward-leaning Inversion off the couch, as shown in the video, for 30 seconds, 2-3 x a day,
• the Breech Tilt for 5-10 minutes, 2-3 times a day. (The two inversions accomplish two different things, so doing both may be important.)
Other helpful things
• Stand on your head in a pool of warm water, such as a backyard swimming pool or a therapeutic pool at a hospital or rehabilitation center. Some hotels will let you join a swimmer’s club.
- Stablize and strengthen your pelvis.
- Wear a pregnancy belt AFTER baby is head down if you suspect your uterine ligaments are too soft.
When you are using the Breech Tilt, an inversion by laying on your back, you can place a very cold item, like frozen veggies wrapped in a thin dish towel (don't freeze your skin!) on your abdomen in the place that is BEHIND and ABOVE the baby's head. At the same time, place a very warm item, like a toasty rice sock, BELOW and IN FRONT OF baby's face.
We are hoping that the baby moves towards the warmth.So the warmth must also be between the baby's face and the pubic bone. The warm object can be right over the pubic bone if the baby's head is down by the hip socket, almost to the brim. This is a helpful addition to other techniques and is not likely to work just by itself. Inversions are recommended unless your bodyworker or care giver says specifically that you have medical reasons not to do an inversion.
Release your psoas muscles.
- You can help by taking brisk walks. Swing the weight of your legs from the thigh. Each day, lay on the floor on your back for no more than ten minutes with your ankles resting on a chair. Your knees are bent to a 90-degree angle. Breath slow and deep from your belly. See your belly rise and fall like a sleeping toddler.
There are several yoga extensions of the legs that help.
- Massaging your own psoas is quite effective. Also, a myofascial massage person, or a chiropractor who includes hands on massage, pressure point release, etc. can accelerate your psoas release with their skills.
Wear a pregnancy belt to actually give a slight pressure that may relax the abdomen. The "slope" of the abdomen with a belt, supports the baby dropping down into the pelvic brim.
These techniques will relax your psoas muscles over time.
30-34 weeks Daily and weekly activities and sitting on the front of your sitz bones may help some. Most women need specific balancing exercises to bring a twist out of their lower uterine segment. Body work is recommended if you can get good care where you live.
34-36 weeks: Spend the week working with moxibustion on your little toes and doing the balancing activities. Seek professional myofascial release from a chiropractor, osteopath, therapuetic massage therapist or craniosacral therapist who may have the training for myofascial release.
See this experienced person for three visits right in a row. Reschedule remaining visits to weekly, if you like, when baby drops head down, but don't spread your visits out until you have success.
36 weeks or more:
If these things don't work in three days, please make an appointment with a chiropractor who is specially trained in the Webster Technique and other pregnancy and pelvic issues, AND is regularly adjusting pregnant women. If the Chiropractor's adjustments don't work within 2-3 times [try and get your appointments all within a week or two] then add 2 visits with a myofascial release person who works with pregnant women. Keep doing the inversion and Pelvic Floor Release on your own, unless told not to by your Chiropractor (but I think its worthwhile in general to do both, so see if they have a specific reason not to in your case.)
Why have a cesarean now?
(Warning, opinion coming.) The reason may be for your surgical teams convenience. Why should your baby miss a few brain cells so health care providers can schedule their health care providing time? If you are healthy in other ways, give your baby another week or even two. There are risks to early cesareans (I count 39 weeks early) and risks to waiting, so choose carefully. Early surgery has unavoidable side effects and waiting has theoretical side effects that may occur and probably won't. But they could. So choose carefully.
Techniques to correct a Transverse Lie when the belly seems loose
For women who have given birth before, and a very few first time moms, the trouble may not be with tightness, but rather with looseness. The techniques then have to adapt to the mother.
The idea is that once the baby is head down, support the abdomen with a pregnancy belt and perhaps a rolled hand towel (Brust pad) so that the baby stays head down and in a vertical lie.
A manual version may also be successful in helping baby get head down. The looser the mama, the more likely the success. Anterior placenta may be a reason not to do a manual version.
Using a pregnancy belt for transverse lie
When the lower abdomen is loose, as with a pendulous uterus, add a pregnancy belt to create an improved slope to the lower uterine segment.
A pregnancy belt helps the uterine ligaments hold the uterus upright so the baby can get into an upright position.
For the mom with loose ligaments, I would suggest wearing a pregnancy belt in the fifth month through to labor, and for very loose moms with a pendulous womb, then wearing the belt through pushing the baby out is safest.
Women with tight ligaments can wear a pregnancy belt too for the support is actually relaxing.
Professional help for a Transverse Lie
If the womb seems tight around the baby (chronically, not just during Braxton-Hicks contractions) in pregnancy, then professional help is needed.
Bodywork can correct the length of the uterine ligaments so that they are all symmetrical. Chiropractic adjustments align the pelvic bones so the joints are symmetrical and this, in turn, helps the uterine ligaments become symmetrical. Doing both the bony adjustments and the soft tissue work is the most time efficient and successful, if the mother’s Inversions don’t work in 3-4 days.
Some chiropractors and craniosacral therapists know how to do myofascial release of the round and broad ligaments. Certainly, a myofascial massage worker can do this.
Maya abdominal massage is another excellent choice for symmetry.
- Acupuncture, effective for fetal positioning, especially when done by an experienced professional.
- Moxibustion, heating the acupuncture points with a stick of mugwort incense, can be done at home inexpensively. Best results from 20 minutes a day during the 34 and 35th week.
- Chiropractic, neck and pelvis, including SI, Symphysis Pubis, Webster and other areas as individually needed.
- Myofascial, buckled sacral release and diaphragmatic release
- Homeopathy, Pulsatilla or other remedies can help with malposition. See a professional for best results.
This work is specifically for you pelvis, neck and soft tissues (sacral fascia, round and broad ligaments of the uterus, cervical ligaments and sacrotuberous ligament).
Remember the time to hire bodywork for transverse babies would be between 32 weeks and birth. The sooner the better! Begin at or after the middle of the seventh month. If you want to try things at home in weeks 32 to 34 that seems reasonable, though if baby is big, and/or mom is tight I would start getting professional help earlier. Starting in mid pregnancy isn't too early.
Next year at this time, would you like to look back and feel satisfied that you did all that you could do at this time in your life?
What’s the problem with a transverse lie?
Though normal in early to mid pregnancy, the baby needs to stop being sideways in the last trimester of pregnancy to get ready to travel the pelvis. The baby who is lying sideways cannot be born vaginally. The baby has to get vertical to fit through the pelvis. A breech or vertex (head down) baby can usually fit. The baby in a transverse lie can not fit. Labor contractions cannot bring this baby through the pelvis. Perhaps the arm or umbilical cord would come through the pelvis, but the shoulder would block the opening. We will try to help this baby move to a head down position so that a cesarean can be avoided.
When is transverse lie a problem?
It is normal for a baby to be transverse in the first and second trimester. We hope that the baby is in a vertical position between 26 and 31 weeks gestation. The breech position is quite normal when found between 26 and 31 weeks gestation.
I am 26 weeks pregnant with my 3rd child. I has my 1st child via c-section, (normal postioning, distressed baby) and my 2nd via VBAC. I was told yesterday that my baby is currently transverse and I am very concerned that I will not be able to have another VBAC due to this....
Most babies are head down by 28-30 weeks gestation while a few babies wait to settle head down until 31-34 weeks. Fewer babies still transverse at 34-36 weeks can get head down on their own. After 30 weeks, it may be good to do some exercises to help your baby get head down.
Late in pregnancy it becomes more difficult to help the transverse baby to become head down.
"Why is my baby transverse?"
At Spinning Babies, the basic idea is that babies get into the best position they can given the space they are in. Sometimes a placenta is below the baby blocking the baby from getting head down at the end of pregnancy. The second twin sometimes waits in a transverse position until after the first twin is born; then the second twin drops into place, head down, and is born soon afterwards. But often, there is a simple need for Balance, Spinning Babies 1st Principle.
Not every uterus is lined up vertically-usually because an accident or even a habit has tipped or twisted the uterus. This may have happened many years ago. But until a series of exercises or body work has "lifted" the uterus back into place, the uterus remains where it "fell."
This might be the reason gravity hasn't been able to bring the baby head down is either that the lower uterus is tight with a twist or too loose to support the baby vertically.
When the baby has been transverse in the last trimester, it may be because uterine ligaments or pelvic floor muscles have a twist. The womb seems shaped for a transverse baby. The baby will stay transverse when the pelvic inlet (brim) is not symmetrical or the lower uterine segment (the lower part of the womb where the head would normally settle) is not symmetrical. Crossing our legs, holding toddlers on our favorite hip, a fall, etc. can put a twist in the lower uterine segment.
Gravity helps, but there is less room to navigate the womb. First time mothers and women with tight, sturdy musculature, spasming ligaments or tight fascia can do exercises or have body work or both to loosen these soft tissues and allow more fetal movement. Women who have birthed before, and who have loose soft tissues (this includes a few first time mothers, but mostly experienced mothers) may actually need to prop their wombs and abdomens up to let the baby get head down!
After 32-34 weeks, I am quite concerned to find a transverse baby – except when the baby was breech recently and is now in process of flipping to head down. The breech-to-head-down process may take 3 days (but is often 3 minutes!) and a mother or provider may notice the baby in a transverse position in the midst of the change. Usually, the mother knows the baby is "on the move."
Breech lie or transverse lie?
The transverse lie position is sometimes loosely called breech. This seems more common among ultrasound technicians. Midwives and doctors do not use these terms interchangeably. They are not the same.
The breech baby lies vertically, the transverse lie baby lies horizontally.
The breech baby has an easier time getting head down than the baby who has been transverse into the third trimester. An interesting point is that a breech baby may move to the transverse lie for a couple days before finishing the flip to head down. If your transverse baby was just recently breech wait a couple days before worrying, and keep up the techniques you are using to help baby into a head down position.
A head-down variation: One woman may have had weak uterine ligaments in spite of being a strong, athletic woman. Perhaps the jolting stops during soccer effected her uterine ligaments in this way. Her first baby was head down, but with the little bottom resting on her right hip. The baby was folded at the baby's waist in this way for the entire third trimester. I wondered how it would effect birth. I suggested a pregnancy belt but the mother wasn't concerned. Her labor advanced beautifully and the baby came down through the pelvis perfectly. I was happy to see how well birth works in a fetal position variation that I had never noted before in a first time mother. The baby had seemed somewhat in a transverse lie, but since the head was in the pelvis, wasn't. The mother used active labor positions and free movement, instinctively moving with her labor and the baby came down well.
A breech variation: Another woman's second baby was breech with the bottom at the entrance to her pelvis. Her uterus leaned far to the left, visible from behind her. Labor began on its own, and she hoped for a vaginal breech birth. However, labor contractions didn't stay consistent and the uterus continued leaning to the left. The uterus couldn't aim the baby into the pelvis. The baby never descended and a cesarean was the only safe option when labor wasn't able to progress. Could exercises and body work have helped her to have a natural birth. Perhaps they could have. These techniques might work in labor, but in this case would have been needed weeks before. Her baby might have even gotten head down. Her chiropractor didn't know the full myofascial/craniosacral release protocol for pregnant women (www.dynamicbodybalancing.com)
What has worked for others:
From a comment on the Forward-leaning inversion video on Gail's blog post:
Thank you SO much for posting this! for the past couple i've been alot of pain but i didn't know that all the pain was coming from my son being transverse. i knew he was lying like that but i never knew it could cause all the pain it was causing. i was even sent to L&D to see if i was in preterm labor. at my follow-up OB appt she told me that if he didn't move that A.) i'd be in pain until i went into labor and B.) it'd be a mandatory c-section. i'm only 36 weeks along and was missing tons of work along with sleep and just turning into a nasty woman to be around in general. after leaving the OB's office and learning that this was the reason for all my pain, i texted my doula who told me to look up your website. after learning that our son was in a "transverse lying position" i found the video of the lady doing the modified headstand off the couch and decided to try it off a bed. i was able to hold the pose for (30) seconds but i didn't think anything had happened. my hubby checked the babies position and sure enough he was in the perfect occipital posterior position! it's been over (4) days now and he hasn't moved back so I'm praying we are safe.
Thank you SO much for saving me all the pain of carrying him sideways and avoiding a c-section!! - The McGuire's, December 28, 2009 12:45 PM
Inversion is an excellent thing to do, but may not be enough on its own. If using the inversion doesn't work after 3-4 days, when you are 32 or more weeks pregnant, then I would suggest getting professional body work. See more about this lower down in this article, and see more fun things to help baby flip head down under the Breech category.
Here is my answer to a woman writing who is 34 weeks along with a transverse baby.
"Do you know how long your little girl has been lying transverse?
You are doing the forward-leaning inversions for 30-seconds ?
You may also do the breech tilt inversion for 5-20 minutes, longer as you get used to them. After about 3-6 times (in 2-3 days), you might start putting a lightly wrapped cold pac on your upper uterus, above the baby's head (not directly over it, just above it). At the same time, putting a warm pac behind your baby's head and towards your pubic bone. Close enough for the heat to radiate to the baby's head.
I don't know which way your little one is facing, but I suppose it doesn't matter. The idea is that the baby feels that it is warmer towards your pubic bone.
Moxibustion is so helpful in weeks 34-35 and beyond, but particularly these two weeks are more successful to get baby head down. Use in addition to other methods of helping baby get head down.
Add myofascial release to the Chiropractor's adjustments. Ask the chiropractor to add Websters to both sides in one visit, if they would please.
Craniosacral work can make chiropractic more effective and visa versa.
Head stands in a warm pool of water. Hanging from a yoga sling (1 minute) or inversion table (1 minute).
Learn to release your psoas. CoreAwareness.com with Liz Koch. A tight psoas my hold the baby's head back above the brim to the side.
Talking to your baby, too. Whether out loud or by journaling. See what you can learn about your self this way, too.
If your daughter has been transverse all along do everything you can, all of the above you can. If she was breech last week and transverse this week, she is likely to get head down with less to do. But it sounds like she's been transverse a while.
Very often this is from a soft tissue issue in the lower uterine segment which can be caused by torsion in the pelvis and the surround soft tissues (ligaments, fascia, muscles etc.) Addressing these issues will likely allow the baby to move into a head down position.
Exceptions, if the placenta is below the baby covering the access to the cervical area. An unusual uterine shape, a partial septum or a fibroid blocks the baby's attempts to get head down. Ultrasound would reveal something as obvious as these. Ultrasound is unlikely to reveal a twist in the lower segment of the uterus which is one of the soft tissue issues I mean.
Please let me know if any of these or another suggestion helps you. I will hope for the best and expect the best for you and your baby, - Gail"
A-K posted on the website,
I am 40 weeks pregnant with my 2d child (first one born naturally) and was told today by my OB that baby is now transverse. This was also confirmed by an ultrasound (at my last visit a week ago, baby was in the heads-down position and had been so for several weeks).
I have been given three more days to see if the baby will turn before my doctor wants to schedule at C-section (at 40+3). I have already visited a trained acupuncturist and am doing the inversions on your site to try to prevent this. I would just like to know:
- How common is it for a transverse position to appear so late in the pregnancy, and what are the odds of turning the baby back down?
- Which of the inversions tend to be the most effective at 40 weeks, given the more limited room for the baby to move? The dr tried to externally manipulate the baby to move down today but failed.
Thanks so much for a lovely website!
Gail wrote back something like this, but this is better:
A-K, I hear the surprise you are suddenly faced with. I will try and answer your questions.
Why now, in late pregnancy? A baby will move from a good or reasonable position to a posterior, breech, oblique or transverse position in late pregnancy when there is,
A.) An existing reason, usually a twist in the lower uterus or other reason the area of the pelvic inlet is compressed or twisted. Balance the area with body work and forward-leaning inversions and baby will return to a head down position.
B.) The baby will pull away from the pelvis (tailbone, sacrum) if something happened such as a fall, twist, impact, or a significant emotional stress about parenting. It can happen to any of us.
C.) Some event may trigger an old injury. A long car ride can be the culprit. If this is the case, addressing the trigger is likely to allow the baby to settle back head down quickly.
How many times do you need to do the inversion? How quick can baby get head down again? You see the range of success in the comments to the Feb. 9th 2007 blog post from one inversion, to three, to several. It doesn’t always work, but it seems to work often.
I’d add what else can I do?
Professional help: Myofascial release, chiropractic, and craniosacral therapy along with your acupuncture may increase chances of success. I can’t promise, of course. But these are efficient ways to address the cause.
Self help: Begin with the Rebozo sifting, go to the forward-leaning inversion and follow it with the breech tilt using hot and cold pacs. Then I’d add a pelvic floor release.
How often does a baby go transverse at the end of pregnancy? It is uncommon.
Still you are likely to get the baby head down even in three days with several short, forward-leaning inversions and addressing the soft tissue cause, assuming that something was, or became, twisted near your cervix or brim.
A twist in the cervical ligaments will twist the lower uterine segment where the baby would like to put his or her head. Depending on the amount of twist the baby may back up and go transverse or breech. This is fixable with the right body work for you.
Be kind to yourself as you try to take on this challenge. You are doing the best you can with a suddenly complex situation. Keep breathing and talking to your baby. Together you will find your way to the other side of the transverse lie.
Hi Tijitha, It may be that your belly is loose, Jean Sutton suggests laying on your left side and while lying down, bind your belly tightly, then wear that belt for 24 hours.
Could you comment on this?
Hi Tijitha, In my opinion, breech is better than transverse and easier for the baby to flip head down from breech than from a long time in the transverse. If the baby moved that much with just one inversion, i think she will flip head down with a few more... unless there is quite a twist somewhere, sacrum or pelvic floor, or something, and more work may be needed.
Peace is an action, Gail Tully
Just two days later, January 14, I received Tajitha's happy news:
This is such a blessing! And unusual for 38+ weeks.
Could you please mention that after I had done the inversion, I prayed earnestly with faith that God can turn the baby, and He did. When we pray with faith, God can work wonders!
Another January exchange:
I was told yesterday at my 37 week appt that the baby was transverse with his head on my right side and bottom on my left. He seems to be lying with his head slightly lower then the butt. I have been doing inversion a few times since then hopefully it will work. How often does a baby turn without additional help ie. chiropractor or moxibustion?
I slipped on some ice and fell on my left side Monday afternoon, could that have actually caused him to move from head down?
thanks so much,
Ask your provider if there is any medical reason not to do an inversion (rather than an opinion) in your case.
Peace is an action,
Thank you for getting back to me. Yes the baby was head down and I noticed that my belly seemed lower the day after the fall.
I have an appointment tomorrow with a chiropractor who is trained in the Webster technique, so hopefully that will help.
I have been doing inversion with my knees on the couch and resting my forearms on the floor. I will have my husband check to make sure that my bottom is lined up with my knees. So it is okay to do both the inversion and the breech tilt? I thought you were supposed to do one or the other.
The doctor did suggest doing a version [external cephalic version], I have an ultrasound scheduled for tomorrow to check fluids. I wanted to try less invasive techniques first and then will do that if need be.
Again thanks so much for your reply,
I agree with you, [M], Do the body work first, Webster and some sacral release (myofascial, see if your Chiro is trained in it) etc. and that would help the
I did the 7 inversions and then the breech tilt this morning. I also went to the Chiro and at the ultrasound, he is head down :)
Now just to keep him that way for 3 more weeks. Will an inversion or two daily help keep him down?
Thank you so much for all your advice, I'll keep you updated as I am trying to have another VBAC for this one.
Yes, I do suggest keeping the inversions going, but can you also walk about 3 miles a day for 2-3 days before resuming the inversions? I'm so happy you found these techniques successful!
One more, July 12, 2011:
I got your email off of the spinningbabies.com website, so I hope you don't mind me emailing you asking advice. This is my 3rd baby, and I'm 35 weeks along. However, this is my first experience with the baby not being head down. He has been contently lying with his head in my right rib, and his feet in my LLQ for quite a long time now. I am terrified he wont turn for a natural delivery! I heard great things about your website, but the terminology confuses me to no end. I was wondering if you could possibly help me figure out some positions I could try to get him to flip! One I saw is with my legs on the couch and arms on the ground. How long do you stay in that position? I have 2 weeks left till my Dr. will do a [external cephalic] version
Anyways, sorry for rambling and taking up your time. I hope you can help me! [name with held]
Later, another email from the same mother:
I had one of my friends show me how the site worked ... and between the positions and the acupuncture, he flipped!!! Now hopefully he doesn't flip back. But thank you for your response! I really appreciate it:)
And no, I didn't do the [external cephalic] version. I opted out of it. I didn't like the risks. I just decided to try the acupuncture, all 4s, and the couch thing on your website.:) [forward-leaning inversion]
Questions I'd ask a woman who is scheduled for a cesarean for a transverse lie or breech presentation:
Is convenience the most important thing to schedule your baby's birth around? If not, you might ask for a postponement to 41-42 weeks gestation. You'd be taking additional responsibility for your birth. And giving additional benefits to you baby, if you and your baby are healthy that is. So this is something to research and then to discuss with your doctor. Waiting for spontaneous labor has benefits as well as risks. You should know about both to make an informed decision.
I do advocate for waiting for spontaneous labor in general. However, you are the Mama, and you get to decide. It's not wrong to schedule a cesarean for malposition especially after 41 weeks or at any appropriate time if mom or baby really are sick, or baby had InterUterine Growth Retardation (IUGR is not mental retardation, but small for dates due to poor placental circulation or other serious reason). Some women would face serious hardship or risk waiting for labor. But most women and babies would receive benefits when letting labor begin and then going right in and having the cesarean. There is a risk of prolapsed cord. There is a benefit of improved breathing and brain chemicals for life outside the womb. Its not an easy decision, so it can't be made for you.
Whatever you decide is the best decision for the situation at hand.