“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.

The word transverse is also used in phrases describing two of the normal head down positions. Left occiput transverse (the ideal starting position) and right occiput transverse. These head down babies facing the mother's hip. The side of the mother’s body that the back of the baby’s head is on is indicated by the first word, left or right. The baby faces the opposite hip. To see several different fetal positions go to Belly Mapping.

 Here are some images to help you understand the lie of a baby in relation to the pelvis.

      

 Left: The baby on the left is in the ideal start position - left occiput transverse. The head is transverse but the head is down. This baby is in a vertical lie, meaning the baby lies up and down. One end or the other points towards the pelvis.
Right: The baby on the right is lying sideways in the womb - transverse lie.

In a Transverse Lie the baby's head is on one of the mother’s sides and the baby's bottom is on the other side. For instance, one mom with a transverse baby will have the head on her left side and the baby's bottom on her right. The hands and feet may be kicking and waving towards her cervix (in the lower part of the uterus) when the baby's belly is down. Another transverse baby may have the head on her mother's right and kick upwards or towards the front.

What’s the problem with a transverse lie?

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. Or the shoulder might block the opening. We can try to help this baby move to a head down, or cephalic, 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 considered normal when found between 26 and 31 weeks gestation. Most babies are head down by 28-30 weeks gestation; a few babies wait to settle head down until 31-34 weeks. And only a few babies who aren't head down after 36 weeks can get there 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 is more difficult to help the side ways baby to become head down.
When the baby has been transverse in the last trimester, the womb becomes shaped for a transverse baby. Conversely, 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 a leisurely process of flipping to head down. The breech to head down process shouldn't take more than 3 days (when it doesn't happen instantly).

 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 confusing variation: One woman had weak uterine ligaments. She was a strong woman, athletic. Perhaps the jolting stops of sports effected her uterine ligaments in this way. Her first baby was head down, but with her little bottom resting on her mother's right hip. The baby was folded over at her 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. 

Techniques to correct a transverse lie when the belly seems tight

Things you can do yourself:

•    Use the Inversion off the couch, as shown in the video, for 30 seconds, 2-3 x a day,
or
•    Do the Breech Tilt for 5-10 minutes, 2-3 times a day. (Dr. Carol Phillips says the ironing board technique is not as effective as the forward leaning inversion.)
•    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.

When you are using an inversion by laying on your back, the Breech Tilt,  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.

Adjust the placement of the warm and cold items according to your individual situation. For instance, you might know from an ultrasound where the placenta is. Putting warm or cold items on top of the placenta may not be effective. Don't worry if you don't know where your placenta is.

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.

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.

If the womb seems tight around the baby (chronically, not just during Braxton-Hicks contractions) in pregnancy, then professional help is needed.

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

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?