Fetal Positions

What are Fetal Positions

In the final weeks of your pregnancy, your baby usually moves into a head-down (vertex) position to get ready for birth. As a normal delivery proceeds through the stages of labor, the baby tucks in the chin and turns to face your back.

In this position, the back of your baby’s head starts to show (crown) first through your open cervix. Sometimes your baby may be in a different, abnormal position just before birth. These positions are called malpositions or malpresentations. Giving birth can be more difficult if your baby is in an abnormal position.

What are abnormal fetal positions?

There are five main abnormal fetal positions:

  • Occiput posterior presentation. This is the most common abnormal fetal position. It is sometimes called the “sunny-side up” position because your baby’s face points toward your front instead of your back.
  • Breech presentation. This is also common. In this position, your baby’s bottom or feet are in position to come out first.
  • Face or brow presentation. In this position, your baby is head down, but the face or the front of the head crowns first.
  • Compound presentation. In this position, your baby’s hand or leg comes out along with the head or bottom.
  • Transverse presentation. In this position, your baby is lying sideways across your birth canal. Your baby’s shoulder may come out first.

Your health care provider can diagnose an abnormal fetal position during a physical exam as your due date approaches. An abnormal fetal position may be found by feeling your belly and by doing an internal (pelvic) exam. A sound wave imaging study (fetal ultrasound) can be done to confirm the abnormal position.

What causes an abnormal fetal position?

In many cases, the cause for an abnormal fetal position is not known. You may be at higher risk of having a baby in an abnormal fetal position if:

  • You have an abnormally shaped womb (uterus) or pelvis.
  • You have growths in your uterus, such as fibroids.
  • Your placenta is large or in an abnormal position.
  • You are having twins or multiples.
  • You have too much amniotic fluid.
  • Your baby has some type of developmental abnormality.
  • You go into early (premature) labor.

How does this affect me?

In some cases, your baby may move into a vertex position just before or during labor. However, an abnormal fetal position increases your risk for a long labor or the need for steps to be taken to help ensure a safe delivery. Your health care provider may need to:

  • Turn the baby manually by pushing on your belly (external cephalic version).
    • Use instruments, such as forceps or a suctioning device, to help get your baby through the birth canal (assisted delivery).
    • Deliver your baby by cesarean delivery, also called a C-section.

The exact effects on your delivery will depend on the position your baby is in right before birth.

If your baby has an occiput posterior presentation:

  • You may have to push harder and may have a longer labor.
  • You may have more back pain.
  • You may deliver vaginally, but you are more likely to need an assisted delivery.
  • You may need a cesarean delivery.

If your baby is breech:

  • Your health care provider may try a vaginal delivery, but there is a risk that your baby’s umbilical cord will be stretched or compressed and your baby will not get enough oxygen.
  • In most cases, you will need a cesarean delivery.

If your baby is in a face or brow presentation:

  • Your labor may be longer.
  • You may be able to have a vaginal or assisted vaginal delivery.
  • There is a higher-than-normal risk that you will need a cesarean delivery.

If your baby is in a compound presentation:

  • Your health care provider may be able to change your baby’s position manually.
  • In most cases, this position requires a cesarean delivery.

If your baby is in a transverse presentation:

  • Your health care provider may be able to turn your baby manually.
  • In most cases, this position requires a cesarean delivery.

How does this affect my baby?

Most babies are not affected by an abnormal fetal position, but there is a higher risk of some complications, including:

  • Swelling and bruising.
  • Birth injuries.
  • Not getting enough oxygen during birth.

Summary

  • The normal fetal position for birth is head down and facing toward your back (vertex position).
  • Abnormal fetal positions include occiput posterior, breech, face or brow presentation, compound presentation, and transverse position.
  • In some cases, your baby may move into a normal position before birth, or your health care provider may be able to change your baby’s position manually.
  • If your baby is in an abnormal fetal position at the time of birth, you have a greater risk of a longer labor, assisted delivery, and cesarean delivery.
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