In the first months of pregnancy, the offspring enjoys the generous space in the womb. He has enough space to do gymnastics, to stretch and turn, for somersaults and other activities. However, the closer the calculated date of birth, the more importance is given to the location of the child.
Cozy babies often maintain their position throughout pregnancy, more active children still turn in the last weeks before delivery. The position that the fetus finally assumes is especially relevant with regard to birth. There are certain positions that make natural vaginal delivery difficult or even impossible. Whether the baby is already lying correctly is determined by the gynecologist during the last two mother-child pass examinations. At this time, parents will also be informed about possible consequences (e.g., the baby’s head may be pressed against the head).B. Registration for cesarean section in the respective maternity hospital) of a positional anomaly.
Determination of the infant position
The position of the child is assessed by ultrasound at every mother-child-pass examination. The attending gynecologist then indicates the position with an appropriate abbreviation (z.B. SEL or BEL) in the mother-child passport. The majority of unborn babies are very active in the womb, which means that they often change their position repeatedly during the pregnancy. Some babies like to press their head against the mother’s pelvis, others prefer to sit, still others lie crosswise in the uterus at all.
In addition to ultrasound, there is also the possibility to feel the position of the baby from the outside. For this purpose, midwives and doctors use the so-called Leopold hand grips. This is a defined sequence of examination steps that can be used to determine the position of the baby in the uterus without ultrasound. The position of the unborn baby plays a subordinate role during pregnancy, but towards the end it becomes increasingly important. Ultrasound examinations as part of the last two mother-child pass examinations (between the 30. and 34. Week of pregnancy and between the 35th week of pregnancy. and 38. The first week of pregnancy) can already provide the first important indications of the possible starting position for the birth.
Optimal starting position
Ideally, the baby is in the anterior occipital position before birth. This position is noted in the mother-child passport with the abbreviation SL. The abbreviation SL stands for cranial position, which in turn means that the baby’s head is already down in the mother’s pelvis. The back of the baby’s head faces the mother’s abdomen, the unborn baby’s face faces the mother’s back. This is the optimal starting position for a natural birth, as the baby’s head and the mother’s pelvic circumference meet at the most favorable position.
The anterior occipital position is also the position that children assume most frequently. Thus, about 95% of all babies move into this position in time before birth. Depending on the position of the baby’s back (on the left or right side), a distinction is made between SL I or SL II. However, this has no significance for the birth. Since the head does not turn properly into the pelvis until the birth is imminent anyway. Both positions are considered ideal for giving birth naturally.
Positional anomalies
Relatively rarely (in 5% of all cases), the position of the baby makes a natural delivery difficult or even impossible. This is referred to as a positional anomaly of the child. Babies can finally make themselves comfortable in the uterus in different ways. The type of positional anomaly determines the course of the birth and possible risks for mother and child.
Breech presentation
The breech presentation is abbreviated as BEL. In this case, the baby’s head is not pointing downwards, but upwards (it is located approximately under the mother’s ribs). Children in breech presentation sit in the womb, so to speak, with their backs facing forward. They can assume a total of 7 different positions, which are determined by how the child’s arms, legs and head relate to each other. Some babies have both legs extended, others crouch cross-legged. Natural birth from the final pelvic position is possible in principle, but is rarely performed or offered in only a few maternity wards. This is a complicated initial situation that requires a high level of skill and experience on the part of the delivery team. If you give birth naturally, the birth must proceed more quickly, mother and child must be monitored more closely, and more often an episiotomy is performed to make room for the baby. In the maternity practice, children in the breech position are usually born by Caesarean section.
Transverse position
As the name suggests, the baby lies across the mother’s abdomen. Although this is relatively rare, it is favored by too much amniotic fluid, too much space in the uterus, a present placenta or a yielding uterine wall. Some babies turn into the cranial position before birth. If this is not the case, delivery must be by cesarean section, as a natural birth carries too many risks (z.B. This would mean a prolapse of the umbilical cord, damage to the uterus) for mother and child.
Posterior occipital position
Here the unborn baby is lying head down, but the back of the head is not in the right position. The baby looks up at birth – that’s why it’s colloquially known as a "stargazer". Vaginal birth is possible taking into account individual factors. However, assistive devices such as a suction cup or forceps are used more frequently compared to regular births.
Deflexion postures
Only occur during natural birth when the baby is already entering the maternal pelvis. Deflection posture is when the baby’s head moves away from the breast. A distinction is then made between anterior, frontal, or facial position. This may result in birth complications that require medical intervention (z.B. Emergency cesarean section) may be required.
The external turn
Women who wish to have a natural birth have the option of using deflexion postures in the 36th week of pregnancy. or 37. To have an external turn performed during the first week of pregnancy, if the offspring is not yet in the correct starting position. This special reversal technique is offered only in hospitals or by experienced gynecologists and only under certain conditions. After a thorough ultrasound examination, the doctor will try to apply external pressure to the abdomen to encourage the baby to turn.