How each baby’s position influences the type of delivery

Have you ever heard that the baby can be in the wrong position to be born? Although there is in fact no “wrong” position, there are postures that can make normal delivery more complicated or even positions in which a cesarean section is necessary. However, the most common is that most pregnant women are able to have a normal birth, since babies often adopt the best posture for this until the moment of birth.

Even so, Brazil has a very high rate of births by cesarean section, exceeding 40%. The WHO recommendation, however, is that this rate does not exceed 15%. According to the Birth in Brazil survey, 28% of women already want to have a cesarean section in early pregnancy. However, the cesarean section motivated by the baby’s position is a decision that should only happen at the time of delivery.

“The baby moves and can, during pregnancy, assume several positions. At the time of birth, if the baby is in an unfavorable position for normal delivery, a cesarean section will be indicated”, explains obstetrician and gynecologist Domingos Mantelli (CRM-SP: 107.997).

What will determine the influence on the type of delivery is the position the baby is in at the time of birth, regardless of others that he may have assumed during pregnancy. The most indicated, considering only the position of the fetus, is to wait until the beginning of labor to decide if a cesarean section will be necessary. After all, the probability is that the baby will position itself favoring normal delivery.

Baby’s positions at birth

“Positions do influence the time of birth”, explains Domingos Mantelli. “Usually, the baby positions itself of its own free will. It moves throughout the pregnancy.”

Check out what the most common baby positions are and how each of them influences the time of delivery.

cephalic position

The cephalic position is the one in which the baby is upside down. According to Dr. Domingos, this is the best position for normal delivery. In addition, it is the most common position: statistics show that in more than 90% of cases the baby naturally assumes the head position.

As the baby’s head is flexed, the cephalic position can be flexed or deflected by 1st, 2nd (front) or 3rd degree (face). “In the flexed, 1st degree deflected and 3rd degree deflected cephalic position, the baby is also born by normal delivery”, emphasizes the doctor.

However, in the 2nd degree deflected position, a cesarean is necessary. In addition, although the 3rd degree deflection can be conducted for a vaginal delivery, it is an atypical posture and it is not so common for obstetricians to be able to perform a normal delivery in this case.

pelvic position

When the baby is sitting up – that is, head up – he is in a breech position. Although much is speculated about the impossibility of normal delivery when the baby is sitting, this is a possible alternative. “In the pelvic position, it can also be born from normal birth, but it is a little more difficult”, says the obstetrician.

transverse position

In this position the baby is lying across the uterus. In many cases, the doctor may be able to help the baby turn from this position to a cephalad. When this does not happen and the pregnant woman is already in labor, it is not possible for the child to be born through normal delivery. “In the transverse position, a cesarean section is mandatory”, points out Dr. Sundays.

3 myths about baby posture and childbirth

1. Mandatory cesarean section in the case of a sitting baby

“One of the biggest myths about the position of the baby is that when the baby is sitting, it must be a cesarean section. Pelvic babies, that is, babies who are sitting, can also be born through normal delivery”, explains Domingos Mantelli.

2. Mandatory cesarean section when the cord is wrapped around the baby

The umbilical cord being tangled in some part of the fetus is not in itself a determining reason for the need for a cesarean section. Even if the cord goes around the baby, it is possible that the delivery is normal without presenting risks to the child.

3. Inability to turn the baby over

When the baby is in a position other than the head, it is possible to do some exercises to change the position. For this, however, you need to consult your obstetrician. “There are some maneuvers that doctors can do to try to turn the baby. For example, there is a maneuver called the external cephalic version, where the doctor can often turn babies that are transverse or pelvic to the cephalic position”, comments Dr. Sundays.

When is cesarean section really necessary?

It’s not just the baby’s position at birth that can make a cesarean section necessary. Even so, the cases in which this happens are uncommon: the most frequent is that the woman can have a normal delivery without any problem.

Check out the main factors that make a cesarean section necessary:

• When the baby is in the transverse position and has not turned around at birth;
• When there is placental abruption;
• When the mother is HIV positive and does not have a viral load count or a high viral load;
• When, after the onset of labor, the umbilical cord appears before the baby in the canal;
• When the mother has heart disease, only in some cases.

Babies “too big” or the pregnant woman being over 35 years old are not decisive reasons for indicating a cesarean section. Other cases, such as the mother having high blood pressure, should be studied with the doctor.

It is always important to discuss the situation with the obstetrician, seek information and check all aspects of the pregnancy before making a decision. A conscious choice can provide a healthy birth – for both the woman and the child!