Is That A Knee Or An Elbow? Is Your Baby's Head Down?

Is that a knee or an elbow? Is your baby's head down? It can be very hard to tell! But a trained caregiver usually can tell which end is up. Here's how.
Jane Forester, D.O.

It seems that every pregnant woman challenges herself to determine the exact position of her baby in her uterus and be the one to tell her caregiver. But believe me, it's hard to do yourself. I've tried! If only we could be standing next to ourselves to palpate our pregnant bodies, then I'm sure we would have the same success rate as our examining caregivers.

Physicians and nurse-midwives use a technique called the Leopold maneuvers to determine a baby's position.

In the four steps that this procedure involves, the examiner:

  • Feels the top (fundus) of the uterus to determine if it's hard and round, like the head, or irregular and soft, like hands, feet and elbows.

  • Puts her hands on both sides of the abdomen to determine on which side the baby's back lies. The back is smooth and convex, whereas the extremities have multiple parts. Discerning the location of the back helps considerably in determining the baby's position.

  • Places a single hand just above the pelvic bone to feel for the head (round and hard) versus little feet, ankles and knees (irregular and nodular).

  • Determines the exact position of the head and neck within the mother's pelvis (if the head is down there) and which way the baby is facing for delivery.
Maneuvers 1 through 3 can be tried at home, while the fourth is best left for the experts (it's quite difficult). Remember also that the caregiver will use Doppler ultrasound on each visit not only to listen to the heart, but also to look for big clues as to the baby's position. At the end, if there is any doubt, a sonogram will be used as the final determinant of position.PregnancyAndBaby.com

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