When the child is born, its head is usually in the direction of the birth canal. It assumes this position between the 34th and 36th week of pregnancy. In a transverse position, the child lies with its back at a right angle to the mother’s back. So it shows no body part to the exit of the uterus. In this case, a normal, vaginal birth is not possible, so the baby has to be delivered by caesarean section.
What is a cross position?
The most common and healthiest position of the child before birth is the skull position. The head is aligned with the birth canal so that it goes ahead during delivery. However, there may be times when the unborn child has not fully completed the rotation into position, which usually occurs in the middle or late ninth month. See sportingology for Meaning of API in English.
The transverse position describes the right angle at which the child’s spine is aligned with that of the mother-to-be. Unlike a head birth, or even a breech birth, no part of the body finds its way towards the birth canal. Therefore, the child cannot get outside by pressing, suction cups or tongs.
A transverse position occurs in only about 0.5 to 1 percent of births. The probability increases with multiple pregnancies, premature births or women who have already given birth to more than four children.
Two main causes can cause the fetus to lie transversely before delivery. Firstly, it is possible that the correct alignment of the head and buttocks is prevented. One type of disability occurs as a result of abnormalities in the uterus.
This can be, for example, a uterine septum, also called uterus septus, where the uterus is divided into two separate areas by a kind of partition. The placenta can also be an obstacle if it is in an incorrect position in front of the cervix, as is the case with placenta previa. In some cases, the transverse position is also due to a tumor in the small pelvis.
If there is too much space in the uterus for the child to adjust, this is often due to a distended uterus. Excessive stretching occurs as a result of multiple pregnancies, making multiple mothers at increased risk. Polyhydramnios, i.e. the increased formation of amniotic fluid, and malformations of the fetus are also possible causes.
Symptoms, Ailments & Signs
The position of the baby, with the head and buttocks at the same level in the uterus, makes a natural birth impossible. The position in which the main axis of the child’s body forms a right angle with the line of the birth canal is to be distinguished from the inclined position. The two main axes of the body form an acute angle.
Even the shape of the abdomen indicates the wrong position of the fetus and sometimes differs significantly from that of regular pregnancies. The transverse position of the child often causes pain in the mother-to-be during pregnancy. At this point, and if there are no further complications, the unborn child will not suffer from any painful symptoms.
However, a transverse position can have life-threatening consequences for mother and child, especially if the birth is unexpected. In the event of a ruptured membrane, the cervix is not properly sealed by the child. There is a risk of a prolapsed umbilical cord, which will constrict it and the child’s oxygen supply can no longer be guaranteed.
In a protracted transverse position, an arm of the unborn child can protrude into the birth canal. During labor, the baby’s shoulder presses into the mother’s pelvis, which in the worst case can rupture the uterus.
Diagnosis & course of disease
In many cases, the transverse position can already be recognized by the characteristic shape of the abdomen. The detailed palpation of the situation is usually carried out as part of the obligatory prenatal check-ups from the outside. The so-called Leopold maneuvers are used here.
If the examination is carried out by touching the vagina, it can be felt that the patient’s small pelvis is empty. In any case, an ultrasound examination is always used to secure the findings and to be able to make precise statements about the position of the child. If the unborn child does not move into the cranial position between the 34th and 36th week of pregnancy, it can be assumed that a normal vaginal delivery cannot take place.
As a result of the transverse position, premature rupture of membranes or umbilical cord prolapse can occur. A feared complication is the so-called complete arm prolapse. One of the child’s arms enters the birth canal and the shoulder becomes wedged in the pelvis, causing the birth to stop. The uterus is overstretched and there is a risk of uterine rupture.
In general, a cesarean section is almost always required in a transverse or oblique position. Although this is a routine procedure, there are still risks: risk of infection, tissue damage, wound healing disorders, risk of thrombosis and complications from anesthetics. In addition, the mother often feels severe pain days to weeks after the birth. A cesarean section also increases the risk of mishaps in another pregnancy.
After a section delivery, the child often has breathing problems or suffers from small abrasions or cuts as a result of the operation. Occasionally lung problems persist for a longer period of time. Finally, the painkillers and sedatives administered can also cause complications. In addition to the typical side effects and interactions, the child may experience temporary drowsiness and breathing problems. In rare cases, severe allergic reactions occur.
When should you go to the doctor?
If the child is in a transverse position, medical treatment should always take place. A vaginal birth is hardly possible, so that the patient is dependent on a caesarean section. This is the only way the child can survive. In most cases, the transverse position is already recognized during the regular examinations by the gynecologist, so that an additional visit to the doctor for diagnosis is no longer necessary.
For this reason, such examinations should always be carried out during birth in order to recognize the transverse position at an early stage and to initiate a caesarean section at birth. There are no further complications if the irregularity is recognized early on. In the worst case, the woman’s uterus can rupture completely during childbirth due to the transverse position. In some cases, the affected women also suffer from pain, although this is rare.
Appropriate treatment in the hospital during birth avoids complications, so that the life expectancy of the mother and the child is not negatively affected.
Treatment & Therapy
An early delivery, i.e. before the onset of labor, by means of a caesarean section offers a safe way out of the life-threatening situation. If the transverse position is due to too much space in the womb, the procedure can be delayed until labor begins. In some cases, the child still aligns itself in the cranial position, which is why a regular head birth is possible.
In any case, however, a surgical intervention should be prepared in order to be able to react to developments as quickly as possible. If an increased amount of amniotic fluid or a distended uterus are responsible for the transverse position, an experienced obstetrician can try an external turn. Here the child is grasped through the abdominal wall with the aim of causing it to roll.
The prerequisite for this, however, is that the 37th week of pregnancy has ended and the child is in good health. In addition, the placenta must not be in the wrong position and a caesarean section must still be possible. In the case of twin births, an attempt can be made to grasp the foot of the second twin immediately after the birth of the first and to turn it in order to make a vaginal birth possible after all.
Even with gynecological examinations before pregnancy, it can be determined whether malformations of the uterus or placenta are present, which can become risk factors. The early detection and removal of pelvic tumors also reduces the risk of a transverse position.
If a woman has already given birth to several children, the risk of uterine distension should also be considered. But even women who are likely to have complications do not necessarily have to give up their desire to have children. Thanks to the professional use of a caesarean section, there is no longer an acute danger to life for mother and child.
After a transverse position and the birth, the need and the extent of the follow-up care depends on the birth itself. If the position could be corrected and the child was born naturally, the appropriate follow-up appointments with the treating gynecologist must be kept. If a caesarean section was necessary because it was not possible to correct the position, the surgical scar must be checked and the proper healing ensured.
This is done in cooperation with the home midwife and the gynaecologist. Special features such as scar pain or poor healing can be recognized in good time and treated accordingly. Which treatment appears necessary in the individual case varies greatly. Ideally, follow-up care for a transverse position is the same as after a natural or caesarean birth and no special measures are required.
In the case of a special caesarean section, a longer follow-up and check-up period may be required. In addition, subsequent births may require another caesarean section. If the birth is normal and the child is in a known transverse position, no special aftercare measures are required for the child either, apart from the usual check-ups and possibly care by a midwife who will look after the woman who has recently given birth and the baby at home.
You can do that yourself
If ultrasound examinations from the 35th week of pregnancy reveal that the child is in a transverse position, there is still a chance that the position will return to normal on its own. If this is not the case, an external turn can be attempted with the support of a professional team consisting of a doctor and an obstetrician. However, the mother-to-be must want that, otherwise such a twist will not succeed.
However, the pregnant woman must be prepared at all times for a birth with caesarean section. In the case of first births, it is standard in Germany under these conditions to perform a caesarean section. For the expectant mother, however, there are other ways to encourage the baby to change position.
For this purpose, the fact is used that the unborn child already reacts to external stimuli and moves its head in the direction of this stimulus. Therefore, a conscious contact with the child is necessary by, among other things, breathing towards the baby and communicating with him. Furthermore, the light beam of a flashlight can be guided downwards from the ribs and acoustic stimuli can be generated, for example, by sound balls in the trouser pockets. The unborn child turns to the external stimulus and may be encouraged to turn. Swimming can also help because it relieves tension in the abdomen and allows the baby to move around more easily.