When the baby is born, its head normally lies in the direction of the birth canal. It assumes this position between the 34th and 36th week of pregnancy. In a transverse position, the baby lies with its back at a right angle to the mother’s back. Thus, no part of the body points to the exit of the uterus. In this case, a normal, vaginal birth is not possible, so the baby must be delivered with the help of a cesarean section.
What is a transverse position?
The most common and healthiest position of the baby before birth is the cranial position. In this position, the head is aligned with the birth canal so that it is forward during delivery. However, the unborn child may not have fully completed the rotation into the correct position, which usually occurs in the middle or toward the end of the ninth month. Transverse position describes the right angle at which the baby’s spine is aligned with that of the expectant mother. Unlike head birth, or even breech birth, no part of the body finds its way toward the birth canal as a result. Therefore, the baby cannot get out by pushing or by suction cups or forceps. Transverse presentation occurs in only about 0.5 to 1 percent of births. The likelihood increases in multiple pregnancies, premature births or women who have already given birth to more than four children.
Causes
Two main causes can lead to the fetus being transverse before delivery. One is the possibility that the correct alignment of the head and buttocks is prevented. One type of obstruction occurs as a result of malformations of 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. Furthermore, the placenta can also be an obstruction if it is in a malposition in front of the cervix, as in placenta praevia. In some cases, the transverse position is also due to a tumor in the lesser pelvis. If there is too much space in the uterus for the baby to align, this is often due to an expansive uterus. Excessive dilation occurs as a result of many pregnancies, which is why multiple mothers are at increased risk. Polyhydramnios, or increased amniotic fluid formation, and malformations of the fetus are also possible causes.
Symptoms, complaints, and signs
The position of the baby, with the head and buttocks at the same height each side of the uterus, makes natural birth impossible. The position in which the baby’s main body axis forms a right angle with the leading line of the birth canal is different from the oblique position. In this case, the two main body axes form an acute angle. Even the shape of the abdomen indicates the wrong position of the fetus and sometimes differs significantly from that in regular pregnancies. The transverse position of the child often causes pain to the expectant mother while she is still pregnant. The unborn child does not suffer from painful symptoms at this time, and in the absence of further complications. However, a transverse position can have life-threatening consequences for both mother and child, especially if the birth begins unexpectedly. In the event of a rupture of the membranes, the cervix is not properly sealed by the baby. There is a risk of umbilical cord prolapse, causing it to be cut off and unable to provide oxygen to the baby. If the transverse position is protracted, an arm of the unborn child may prolapse into the birth canal. During labor, the baby’s shoulder thus presses into the mother’s pelvis, which in the worst case can cause the uterus to rupture.
Diagnosis and course of the disease
In many cases, the transverse position can already be recognized by the characteristic shape of the abdomen. Detailed palpation of the position is usually performed externally as part of the mandatory prenatal care examinations. Here, the so-called Leopold handles are used. If the examination is performed by palpation through the vagina, it can be felt that the patient’s pelvis is empty. In any case, however, an ultrasound examination is always used to confirm 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 regular vaginal delivery cannot take place.
Complications
Premature rupture of the membranes or prolapse of the umbilical cord may occur as a result of the transverse position. A feared complication is the so-called complete arm prolapse. In this case, one of the baby’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 transverse or oblique delivery almost always requires a cesarean section. Although this is a routine procedure, there are still risks: Risk of infection, tissue injury, wound healing problems, risk of thrombosis, and complications from anesthetics. In addition, the mother often feels severe pain for days to weeks after delivery. A cesarean section also increases the risk for adverse events in another pregnancy. The baby often has trouble breathing after an incisional delivery or suffers minor abrasions or cuts because of the surgery. Occasionally, lung problems persist longer term. Lastly, 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 see a doctor?
If the baby is transverse, medical treatment should always be sought. In this case, vaginal birth is hardly possible, so the patient is dependent on a cesarean section. This is the only way for the child to survive. In most cases, transverse presentation is already detected during 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 detect the transverse position at an early stage and to initiate a Caesarean section accordingly during birth. Further complications will no longer occur if the irregularity is detected early. In the worst case, the woman’s uterus can completely rupture during delivery due to the transverse position. In some cases, affected women also suffer from pain, although this is rare. Appropriate treatment in the hospital during childbirth prevents complications, so that the life expectancy of the mother and child is also not negatively affected.
Treatment and therapy
Early delivery, that is, before the onset of labor, by cesarean section offers a safe way out of the life-threatening situation. If the transverse position is due to too much free space in the womb, the procedure can still be delayed until labor begins. In some cases, the baby does align itself in the cranial position, which is why a regular head birth becomes possible. In any case, however, 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 an extended uterus are responsible for the transverse position, an experienced obstetrician can attempt an external reversal. This involves grasping the baby through the abdominal wall with the aim of inducing it to roll. However, the prerequisite for this is that the 37th week of pregnancy has been completed and the child is in good health. In addition, there must be no malposition of the placenta and a cesarean section must still be possible. In the case of twin births, an attempt can be made to grasp the second twin by the foot and turn it immediately after the delivery of the first, in order to make a vaginal birth possible after all.
Prevention
Gynecologic examinations prior to pregnancy can already determine if there are any malformations of the uterus or placenta that may become risk factors. Early detection and removal of pelvic tumors also reduces the risk of transverse presentation. If a woman has already given birth to several children, the risk of uterine dilation should also be considered. However, even women who are likely to have complications do not necessarily have to give up their desire to have children. Due to the professional application of a cesarean section, there is no longer any acute danger to the life of mother and child today.
Aftercare
After a transverse position and delivery, the need for and extent of follow-up care depends on the delivery itself. If the position could be corrected and the child was born naturally, appropriate follow-up appointments with the attending gynecologist should be made. If a cesarean section was necessary because there was no possibility of correcting the position, the surgical scar must be checked and proper healing of this must be ensured. This is done in cooperation with the home midwife and the gynecologist. Special features such as scar pain or poor healing can be detected in time and treated accordingly. Which treatment is deemed necessary in an individual case varies greatly. Ideally, the aftercare for a transverse position is the same as after a natural or a cesarean birth and no special measures are required. In the case of a special cesarean section, there may be a longer follow-up and monitoring period. In addition, it may be necessary to perform a cesarean section again for subsequent births. No special postpartum care is also required for the baby if the birth is normal and the transverse position is known, except for the usual checkups and possibly care by a midwife who cares for the woman in labor and the baby at home after the birth.
Here’s what you can do yourself
If ultrasound examinations from the 35th week of pregnancy reveal a transverse position of the baby, there is still a chance that its position will return to normal on its own. If this is not the case, an external turn can be attempted with the assistance of a professional team consisting of a physician and obstetrician. However, the expectant mother must want this, otherwise such a turn will not succeed. However, the pregnant woman must also be prepared for a birth by cesarean section at any time. For first-time births, it is standard in Germany to perform a cesarean section under these conditions. For the expectant mother, however, there are other possibilities beforehand to possibly encourage the baby to change position. This is done by taking advantage of the fact 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 it. Furthermore, the light beam of a flashlight can be directed downward 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 decreases tension in the abdomen and allows the baby to move more easily.
