When to Expect a Baby to Turn Head-Down During Pregnancy

The position of your baby at the time of birth is important for safe and low-risk delivery. The head-down position, also known as vertex positioning, is when the baby comes out head first.

Key takeaways:
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    Around 95% of babies will naturally turn head-down by the 37th week of pregnancy.
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    If a baby remains in a breech position after 37 weeks gestation, the doctor will likely discuss options to attempt to turn the baby through ECV (external cephalic version) or plan for a cesarean section.
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    Techniques for turning the baby naturally may include positioning oneself with the hips above the head, performing water aerobics, going to a chiropractor, or using acupuncture.
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    For a breech delivery, having a planned cesarean section poses fewer risks than having a planned breech vaginal delivery.

This is the most common fetal positioning, accounting for over 95% of births. This article will discuss when babies should turn head-first and what parents can expect if they do not move into the proper position.

Why fetal positioning matters

When a baby is in a head-down position at birth, their head, one of the widest parts of its body, will push open the mother’s pelvis, making way for the shoulders and the rest of the body. When a baby does not turn into a vertex position before delivery, and their feet or bottom comes out first (breech position), it poses the risk of the baby’s head or shoulders getting stuck in the birth canal.

If a baby gets stuck during a breech delivery, it creates an emergency as the baby may suffer injuries, like broken bones, trauma to internal organs, or decreased oxygen levels if the umbilical cord becomes compressed. In addition, decreased fetal oxygen levels can lead to severe brain damage or death. For this reason, your baby's position at the time of birth is vital.

When do babies turn head-down?

Most babies turn head-down during the 36th or 37th week of pregnancy. However, some babies turn downward much earlier in the pregnancy, while others wait until later. In addition, the larger the baby, the more difficult it is for them to move freely in the womb, making it harder for them to reposition itself fully.

Most babies are born in a head-down position, facing their mother’s back. This position is called cephalic presentation. Less than 5% of births are in the feet/bottom first breech position.

What if babies don't turn head-down?

If your baby does not turn head-down by 37 weeks, your doctor may discuss performing an external cephalic version (ECV) procedure. During the procedure, the doctor pushes on the mother’s abdomen to attempt to reposition the baby. There may be mild to moderate discomfort during the procedure, so your doctor might offer pain-relieving medication. As a precaution, the procedure is usually performed at a hospital.

Though ECV procedures are generally safe, they do involve some risks to consider, including the following:

  • Premature rupture of membranes (water breaking too soon).
  • Placental abruption (the placenta separates from the uterus).
  • Preterm labor (going into labor too soon).

The ECV procedures are successful over half of the time. However, in rare cases, a baby may turn back to breech after an ECV. As a result, most breech babies are delivered by a planned cesarean section, although, in some cases, the doctor may consider a breech vaginal birth. However, the risks of planned breech vaginal births are higher than cesarean sections.

Helping babies turn head-down

Your doctor may suggest some techniques that can be done at home to encourage the baby to get into a head-down position. By positioning your hips above heart level, gravity assists the baby in moving away from the pelvic region, increasing its chance of flipping over. Some of the techniques used to turn a breech baby include the following:

  • Lying on your back with your legs elevated above your head by placing them on a higher surface or using pillows to prop them up (breech tilt position).
  • Positioning yourself on your hands and feet with your hips high in the air.
  • Rocking yourself back and forth while on your hands and knees.
  • A study has shown that water aerobics has been helpful in repositioning breech babies.
  • A chiropractor performing the Webster technique to adjust and align the pelvis.
  • Acupuncture with Moxibustion is a Chinese technique that uses heat therapy from burning herbs near acupuncture points of the body.

If these other techniques do not work, your doctor will likely recommend an ECV if you are a candidate. Women who are pregnant with multiples, have low amniotic fluid, or have any known complication of their uterus or placenta will not be able to attempt ECV and will likely require a planned cesarean section.

Around 95% of the time, babies naturally turn into a head-down position before the 37th week of pregnancy. If they remain in a breech position after that time, your doctor might encourage at-home techniques to try before considering an ECV procedure. If an ECV is not an option or does not correct the positioning, a planned cesarean section poses less risk than attempting to deliver a breech baby vaginally.

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