Parenting: Pregnancy

The only thing a woman in the last couple of weeks of pregnancy wants to hear is "everything is fine." To hear anything else is disturbing and just adds to the general discomfort of the home stretch.

Johanna Zumallen from Nixa, Mo., was in the 8th month of her pregnancy when she first heard the words "transverse lie," which refers to the way the baby lies in the womb. It isn't the way they are supposed to be lying, either!

"My uterus apparently is in the shape of a heart, thus allowing her to go sideways," Zumallen says. "She also was 10 pounds, 3 ounces at birth, so her sheer size made her not want to go head down. I was really nervous only because I was scared of having a C-section. They tried to turn her, but that didn't work. Within two hours she had moved right back."

The baby wouldn't budge and Zumallen ended up having a C-section that went very well, which isn't unusual for a transverse lie pregnancy.

"A fetus in head-down position, the most desirable position, is called a vertex or cephalic lie," Dr. Anderson says. "When the fetus has either bottom down or feet down, this is referred to as a breech lie. Transverse lie means that the head is to one side and the feet or bottom are to the other so that neither the head nor the feet or bottom are presenting to the cervix. The fetus is lying sideways."

Fetuses cannot deliver safely in a transverse lie. They either need to turn such that they are facing head down or need to be delivered by C-section.

Can mothers notice their baby is in an abnormal lie before the doctor diagnoses the condition? Sometimes, but not often. "Mothers occasionally notice that they feel the fetus' head on one side of their abdomen and the bottom on the other side," Dr. Anderson says. "Generally mothers whose fetus is in either breech or transverse position feel pressure of the presenting part in their pelvis and may feel a firm structure in the upper part of their abdomen."

"In this country, however, a transverse lie could be fatal to the fetus if the woman goes into labor and breaks her water, allowing the fetal [umbilical] cord to come out and be compressed," Dr. Anderson says. "In general, women are able to make it to the hospital so that the fetus can either be turned or be delivered by Cesarean section."

Dr. Moustafa M. Hassan, medical director of Maternal Fetal Associates of the Mid-Atlantic in Washington, D.C., agrees that transverse fetal lies should not be fatal to either mother or child in this day and age.

"In modern obstetrics, a fatal outcome should not happen," Dr. Hassan says. "However, if labor continues, this can result in obstructed labor, which can have serious complications for the mother and baby. In regards to the baby, the cord can protrude first and become occluded, which can result in oxygen deprivation and brain damage, and possible death to the baby. This is usually only seen in third world countries."

"Sometimes the baby can be turned by a manipulation called an external cephalic version," Dr. Hassan says. "This is where the baby is moved from transverse to head first by gently pushing on the mother's abdomen to literally push the baby into a better position. This has a better than 50 percent chance of success if done by an experienced provider. If the external cephalic version is unsuccessful, a Cesarean section needs to be performed."

Though most women don't want to hear anything except good news during the last month of pregnancy, there are many things worse than hearing that your baby is lying in the wrong position. Having the infant turn on its own or turning them manually is very possible. All and all, there are many worse conditions than the transverse fetal lie.

Transverse Tips If diagnosed with a fetal lie position don't panic; most babies turn themselves before delivery. If Baby doesn't turn spontaneously, experts may be able to turn him manually. Do not attempt to do this at home or have a non expert try it, as this may lead to complications. This very rarely has any serious complications, though a C-section may be needed if the infant stubbornly refuses to move.