If you have already started to do the research into labor and delivery, you have probably heard that it is best that your baby is born “head first.” In medical terms, this position is called the vertex position or the cephalic position with your little one’s head being considered the “vertex” of their body. This is the safest way for your baby to be born, and many women do whatever they can to help ensure that their baby is “head down” when they are getting close to their due date.

All three of my children were born in the vertex position, but my second one (typical middle child!) gave me a run for my money for a few weeks leading up to her birth. My oldest daughter was almost three, and when I was 36 weeks pregnant with my second daughter my oldest was hospitalized for a week for seizures of an unknown origin. It was a terrifying experience and needless to say I was extremely stressed.

Although she was previously in the vertex position, my high levels of stress and uncomfortable sleeping positions on tiny hospital cots and recliners caused her to do a complete 180-degree flip at some point in my belly. But to be quite honest, getting her to flip back to the vertex position was the last thing on my mind. My only goal was to stay pregnant long enough to make sure my oldest daughter was back to her normal, healthy self and home safely again.

By the time I hit 38 weeks, my second daughter had somehow flipped herself back again. She was born a whopping 2 days later after a stunned OB-GYN had told me I didn’t have to go through with the terrible pain of manually flipping her.

How do you know if your baby is in the vertex position?

Most babies put themselves into the vertex position between 33 and 36 weeks. Babies can continue to flip themselves until they are low enough to reach the pelvic canal. After they have reached that position and are head down, they cannot turn anymore. But don’t fret if your baby isn’t head down by 36 weeks. There is still time for them to turn!

According to Medical News Today, “The best way of finding out which position the fetus is in is by talking to a doctor or midwife. At each appointment during the second and third trimesters of pregnancy, a doctor or midwife should feel the woman’s abdomen to check the position of the fetus.If the doctor is unsure about whether the fetus is in the correct position after a physical examination, they may request an ultrasound scan."

If you are worried about your baby’s position, consult your doctor or midwife. They should be able to tell you easily if your baby is head down or not. If your baby is not head down and it is getting close to your due date, your doctor or midwife may try to do an external cephalic version (ECV) in which they manually turn the baby to face head down. There is more information on that procedure below.

What are the other positions a baby can be born in?

There are several other ways a baby can be positioned in the uterus prior to birth. As mentioned before (and probably as you have experienced) babies will continue to twist and turn inside the uterus throughout pregnancy. As you get closer to labor, babies will usually go into the vertex position with their head’s down, but they could also go into the following positions:

  • Breech which includes frank breech, complete breech, and footling breech
  • Frank breech means that the baby’s legs are straight up in front of their body so that the feet are near the face.
  • Complete breech means that baby is sitting with their legs crossed in front of their body so that their feet are near their bottoms
  • Footling breech means that the baby has one or both feet hanging below their bottom. If a woman gives birth in this position, the baby’s feet would come out first.
  • Transverse position in which your baby is sideways, with their bottom facing your vaginal canal.

There are several reasons why a baby may end up in the breech or transverse position. These reasons include: too much or too little amniotic fluid surrounding the baby, uterine fibroids, an irregularly shaped uterus, or multiple fetuses in the womb. In some breech positions the baby can be born vaginally with an experienced midwife or doctor. However, in the case of a transverse position many doctors will require a cesarean section.

Things you can do to make sure your baby is in the vertex position

There are several different things you can do to help get your baby in the vertex position if you do not think they are head down or your doctor tells you that they are in one of the breech or transverse positions. Although these exercises can help, it doesn’t mean they are a definitive way to get your baby head down. If you are getting extremely close to your due date and your baby is still in a breech or the transverse position, your doctor or midwife may request to do an external cephalic version (ECV) which is described below.

Here are a few exercises that can help get your baby into the head down, or vertex position as recommended by Medical News Today:

  • While you are sitting down, use a cushion or a pillow so your bottom is higher than the knees.
  • Once in a while, you can do some front tilts by sitting on a big exercising ball.
  • Get on your knees on the floor. Lower your chest down slowly to make sure that the hips are at their highest point for around 15 minutes.
  • Keeping your hips higher than the knees will help the baby settle easier. However, do not stay in a position for too long, and make sure you move regularly.
  • Taking herbal medicines is sometimes recommended by those who like to use natural methods. Moxibustion (moxa) is a form of traditional Chinese medicine used to try to turn breech babies. It involves burning a moxa stick, which looks like a big cigar and is usually made from a herb called mugwort. When burned, the stick smolders, a bit like incense. It's then placed on or near an acupressure point on your little toe as it burns. The theory is that it affects the flow of energy in your body, encouraging your baby to turn. Moxibustion hasn’t been found to be effective on its own, but many say that combined with acupuncture it can often help a baby turn on its own. We know many women for whom this was a major game-changer!

What if my baby won’t switch to the vertex position?

If your baby is content sitting breech or transverse even after you try the above exercises or other exercises recommended by your doctor or midwife, your doctor or midwife may recommend an external cephalic version or ECV.

An ECV is a procedure where a doctor or midwife will try to turn the baby manually.

According to Medical News Today, for this procedure, they will first insert a small needle into the woman’s hand to relax the uterus.

Using their hands on the outside of the pregnant woman’s belly, a doctor or midwife will then gently manipulate the baby from a breech position into a transverse lie position, then into a head-down position.

Some babies turn by themselves after 36 weeks, and some even turn during labor which can be dangerous.

Can you baby turn out of the vertex position during birth?

The short answer is yes. Even if your baby is in the vertex position when you go into labor, they can still flip until their head is fully in the pelvic canal. Babies can turn out of the vertex position if mom has a surplus of amniotic fluid, also known as polyhydramnios.

If your baby does turn out of the vertex position, your doctor can still perform an ECV unless your water is broken. They will also not do an ECV if your baby has an abnormal heartbeat or if you had any recent bleeding. In these cases, and if you are pregnant with multiples, your doctor will probably request an emergency c-section.

In most births, however, babies are born in the vertex position. They can be “upside down” where their face is facing up instead of down or sideways during birth, but those positions are still considered vertex even if they aren’t ideal. Only 4% of vaginal births have the baby born in a breech position in which their bottoms or feet come first. All transverse positions are born via c-section however.

If you are worried about your baby not being in the vertex position, contact your doctor or midwife. They will be able to evaluate your baby’s position and give you tips and exercises to do at home to help the baby turn.

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