Transverse Lie or Presentation

The position called the 'transverse lie' in a full-term pregnancy is very rare. A baby in the transverse position is sideways, often with a shoulder or arm presenting first. Most transverse babies will turn before or during labour to be birthed head down or breech. However, if the baby does not budge at all they won't be able to be born vaginally and this usually results in a casearean section.

There is a 1998 study in the Journal of the American Medical Association that found that moxibustion treatment for 1-2 weeks increases fetal activity during the treatment period and 75% of breech positions ended up cephalic after treatment and at birth. This is an alternative possibility for getting transverse babies to move before birth.

Deep Transverse Arrest

Sometimes during birth a transverse baby stays in its original position and engages as they are, causing themselves to get stuck. Because of how they are presenting, the greater diameter of the head presents and is prevented from moving down by the ischial spines (two bony protrusions inside the pelvis). This also can result in an emergency or unplanned caesarean section.

Posterior babies are more likely to get stuck in deep transverse arrest than an anterior baby since when they turn during the birthing, the position they are in makes turning difficult for some of them - they get stuck behing the ischial spines as well, with the greater part of their head presenting.

Babies in deep transverse arrest can still get themselves unstuck with the help of an medical professional or with the help of their mother. Vaginal birth is still possible for some! If at hospital, the doctor pushes the baby back slightly to turn the baby (usually done with forceps). Then a breech or cephalic birth occurs.

If at home, the ability to move around intuitively is the best way to assist a transverse baby to move. Do not break your waters.

A word of warning however, if birthing with a midwife, it is possible the midwife will suggest positions to move labour along that will just cause the transverse arrested baby to get more deeply stuck in the pelvis. It is best if the woman is able to go with her instincts without any outside suggestion.

Following are some quotes from women on this topic:

"My baby moved into Deep Transverse Arrest when I was labouring upright, at home and in a birth pool. My MW told me my only option was c-sec so we transferred. By the time I got there I now know he moved OA and repositioned himself and I could have pushed him out.

Sometimes lying on your left and just taking things easy normally moves them and if they're not in distress I see no reason to interfere. I think in our case, I was feeling overwhelmed by how low he was and my bones moving apart and so he put the brakes on to give me time to catch up emotionally.

I was also moving (I now know!) in a way which would have moved him in the pool, it was instinctive and I heard my MW say she'd never seen a woman move like that.

Shame she didn't trust me to move him, hey? Shame I didn't know other than to trust me careprovider and do what was suggested too. I've learnt! I think Nancy Wainer Cohen's article "Bakers' Dozen" has info in it on Deep Transverse Arrest. Basically I believe that if a baby can be tilted in your pelvis on your hands and knees, they can be moved. Once I was stuck on my back with EFM strapped to me (Hospital Policy and truly excruciating!!!) and AROM done without my consent, he was probably going to be stuck for real."

Janet Fraser, Joyous Birth

"The ability to be Moving about instinctually is the best way to move a transverse baby. Case in point: a friend of mine was in labor and the baby was trans. When she had the urge to push she found herself arching her back (upright), sticking her tummy way out. The nurse scolded her, saying she was doing it "wrong" and had to lay back and "curl forward". My friend ignored her - and later found out that pushing like she did for a while was what turned the baby!"

"Transverse arrest doesn't mean the same thing as transverse presentation. I have attended a few cesareans for this reason. In my experience it has been another "failure to wait" situation.

It refers to the baby's head descending rapidly enough for whoever is making the decision. You see it often with inductions because usually women are induced before the baby has moved into its optimal positioning and come down into the pelvis.

When women are induced they usually have an epidural which restricts their movements and there is little they can do to bring the baby down. If there was no infection she might have been able to have antibiotics and wait longer, but there is no way to know after the fact whether the cesarean was necessary or not."

"Deep transverse arrest is more common with posterior babies. With posterior babies, because their heads are not well-applied to the cervix, we typically see early rupture of membranes with no labor for awhile. It's like the bag of waters can fill up under the head and there's more pressure with the late braxton-hicks, early labor contractions to break it."

"It's totally difficult to second-guess this sort of outcome. Surely, in a hospital, they could have tried forceps to rotate the baby when it became stuck. However, there is a risk of trauma to the baby applying the forceps in that position."

"Yes, this can often be corrected with positioning techniques by changing the mother's position (knee chest for example) by encouraging the baby to rotate as it decends."

"Personally, I think the transverse arrest is over diagnosed. I have seen women push their babies down in a transverse position and have them rotate on the perineum. I've also seem women (mostly multips with a generous, loose pelvis) deliver them OT. My guess would be that pitocin probably didn't help your situation (and of course I am Monday Morning quarterbacking here), b/c it continued to force the baby into the pelvis in an OT position rather than encouraging rotation."

Other Resources

http://www.radmid.demon.co.uk/presentation.htm#trans

A planned unassisted birth story, csect for deep transverse arrest

And here is a recommended reading article from a midwife & childbirth educator who co-authored the book "Silent Knife: Caesarean Prevention and VBAC", Nancy Wainer-Cohen; A Butcher's Dozen which appeared in Midwifery Today, Issue 57.

Here are some relevant quotes from the article.

On posterior babies: (bold emphasis in quote mine):

"If the woman is in the hospital, the obstetrician will most likely suggest Pitocin, which often causes other problems: maternal and/or fetal distress; stronger, but still ineffective contractions which are more difficult for the mother and so she needs-begs for-drugs or an epidural; and then we get into that whole CASCADE of interventions, and, most importantly/ominously, forcing the baby down in-and thus actually committing the baby to-the unfavorable position. Others suggest that the woman squat if she is not making progress-this may also encourage the baby to come down in the unfavorable position, causing a deep transverse arrest. Doctors often break the bag of waters, hoping to get things going-this is not generally recommended either, as this, too, often commits the baby to the unfavorable position."

On turning posterior babies:

"The position that we find most always rotates posterior babies is called the Polar Bear Position. This term was coined from a magnificent picture in National Geographic magazine of a polar bear who is birthing her baby.

Her front paws are down as low as they can go, as are her shoulders, and she has a big arch in her back with her knees apart and her butt way up in the air. (It has also been called the Playful Puppy Position, or Sleeping Baby). Women assume the position in early labor, when the contractions are established. If after 45 minutes or so the baby has not turned on its own, it is easy to go in (with the woman still in that position) and reposition the baby by gently but firmly pushing the baby back in.

Many obstetricians tell women that the baby's position cannot be adjusted until the woman is at least seven or eight centimeters or more, and unless the baby's head is quite low in the pelvis. The problem, of course, is that many women never get to seven or eight with a posterior or asynclitic baby, and if they do, it has usually taken hours and hours. Adjusting the baby's head position in early labor is imperative: it saves the mother from exhaustion, saves the baby from distress and eliminates the problem of a baby that is unable to turn. It is not unusual to have a mother who has been "stuck" at four or five centimeters for a while to automatically progress very quickly, because the head is now well applied to a cervix which has very much wanted to cooperate but has been unable to do so due to unequal (or non-existent) pressure.