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Cephalic Position: Getting Baby in the Right Position for Birth
You know your busy bean is exploring their digs because sometimes you can feel those little feet kick you in the ribs (ouch!) to help propel them along. Just think of them as a little astronaut attached to you — the mother ship — with their oxygen (umbilical) cord.
Your baby may start moving around before you’re barely 14 weeks pregnant. However, you probably won’t feel anything until about the 20 th week of pregnancy.
If your baby is bouncing around or turning in your womb, it’s a good sign. A moving baby is a healthy baby. There are even cute names for when you first feel your baby moving, like “fluttering” and “quickening.” Your baby’s movement is most important in the third trimester .
By this time, your growing baby may not be moving that much because the womb isn’t as roomy as it used to be. But your baby can probably still do acrobatic flips and turn himself upside down. Your doctor will closely monitor where your baby’s head is as your due date nears.
Your baby’s position inside you can make all the difference in how you give birth. Most babies automatically get into the head-first cephalic position just before they are born.
What is cephalic position?
If you’re getting closer to your exciting due date, you might have heard your doctor or midwife mention the term cephalic position or cephalic presentation. This is the medical way of saying that baby is bottom and feet up with their head down near the exit, or birth canal.
It’s difficult to know which way is up when you’re floating in a warm bubble, but most babies (up to 96 percent) are ready to go in the head-first position before birth. The safest delivery for you and your baby is for them to squeeze through the birth canal and into the world headfirst.
Your doctor will start checking your baby’s position at week 34 to 36 of your pregnancy. If your baby is not head down by week 36, your doctor might try to gently nudge them into position.
Keep in mind, though, that positions can continue to change, and your baby’s position really doesn’t come into play until you’re ready to deliver.
There are two kinds of cephalic (head-down) positions that your little one might assume:
- Cephalic occiput anterior . Your baby is head down and facing your back. Almost 95 percent of babies in the head-first position face this way. This position is considered to be the best for delivery because its easiest for the head to “crown” or come out smoothly as you give birth.
- Cephalic occiput posterior . Your baby is head down with their face turned toward your belly. This can make delivery a bit harder because the head is wider this way and more likely to get stuck. Only about 5 percent of cephalic babies face this way. This position is sometimes called a “ sunny side up baby .”
Some babies in the head-first cephalic position might even have their heads tilted back so they move through the birth canal and enter the world face first. But this is very rare and most common in preterm (early) deliveries.
What are the other positions?
Your baby might settle into a breech (bottom-down) position or even a transverse (sideways) position.
A breech baby can cause complications for both mom and baby. This is because the birth canal has to open wider if your baby decides to come out bottom first. It’s also easier for their legs or arms to get tangled up a bit as they slide out. However, only about four percent of babies are in the bottom-first position when it’s time for delivery.
There are also different kinds of breech positions your baby could be in:
- Frank breech. This is when your baby’s bottom is down and their legs are straight up (like a pretzel) so their feet are close to their face. Babies are definitely flexible!
- Complete breech . This is when your baby is settled into an almost legs crossed position with their bottom down.
- Incomplete breech . If one of your baby’s legs are bent (like sitting cross-legged) while the other one is trying to kick toward their head or another direction, they’re in an incomplete breech position.
- Footling breech . Just like it sounds, this is one when or both of baby’s feet are down in the birth canal so they would exit foot first.
A sideways position where your baby is lying horizontally across your stomach is also called a transverse lie. Some babies start like this close to your due date but then decide to shift all the way into the head-first cephalic position.
So if your baby is settled across your stomach like they’re swinging in a hammock, they may just be tired and taking a break from all the moving before another shift.
In rare cases, a baby can get wedged sideways in the womb (and not because the poor thing didn’t try moving). In these cases, your doctor might recommend a cesarean section (C-section) for your delivery.
How do you know what position your baby is in?
Your doctor can find out exactly where your baby is by:
- A physical exam: feeling and pressing over your belly to get an outline of your baby
- An ultrasound scan: provides an exact image of your baby and even which way they’re facing
- Listening to your baby’s heartbeat: honing in on the heart gives your doctor a good estimate of where your baby is settled inside your womb
If you’re already in labor and your baby is not turning into a cephalic presentation — or suddenly decides to acrobat into a different position — your doctor might be concerned about your delivery.
Other things that your doctor has to check include where the placenta and umbilical cord are inside your womb. A moving baby can sometimes get their foot or hand caught in their umbilical cord. Your doctor might have to decide on the spot whether a C-section is better for you and your baby.
How can you tell your baby’s position?
You might be able to tell what position your baby is in by where you feel their little feet practice their soccer kick. If your baby is in a breech (bottom-first) position, you might feel kicking in your lower stomach or groin area. If your baby is in the cephalic (head-down) position, they might score a goal in your ribs or upper stomach.
If you rub your belly, you might be able to feel your baby well enough to figure out what position they’re in. A long smooth area is likely your little one’s back, a round hard area is their head, while bumpy parts are legs and arms. Other curved areas are probably a shoulder, hand, or foot. You might even see the impression of a heel or hand against the inside of your belly!
What is lightening?
Your baby will likely naturally drop into a cephalic (head-down) position sometime between weeks 37 to 40 of your pregnancy. This strategic positional change by your brilliant little one is called “lightening.” You might feel a heavy or full sense in your lower stomach — that’s baby’s head!
You might also notice that your belly button is now more of an “outie” than an “innie.” That’s also your baby’s head and upper body pushing against your stomach.
As your baby gets into cephalic position, you might suddenly notice that you can breathe more deeply because they’re not pushing up any longer. However, you might have to pee even more often because your baby is pushing against your bladder.
Can your baby be turned?
Stroking your belly helps you feel your baby, and your baby feels you right back. Sometimes stroking or tapping your stomach over the baby will get them to move . There are also some at-home methods for turning a baby, like inversions or yoga positions.
Doctors use a technique called external cephalic version (ECV) to get a breech baby into cephalic position. This involves massaging and pushing on your belly to help nudge your baby in the right direction. In some cases, medications that help you and your muscles relax can help turn your baby.
If your baby is already in cephalic position but not quite facing the right way, a doctor can sometimes reach through the vagina during labor to help gently turn baby the other way.
Of course, turning a baby also depends on how large they are — and how petite you are. And if you’re pregnant with multiples, your babies can be changing positions even during birth as the space in your womb opens up.
About 95 percent of babies drop down into the head-first position a few weeks or days before their due date. This is called the cephalic position, and it’s safest for mom and baby when it comes to giving birth.
There are different kinds of cephalic positions. The most common and safest one is where baby is facing your back. If your little one decides to change positions or refuses to float head down in your womb, your doctor might be able to coax him into the cephalic position.
Other baby positions like breech (bottom first) and transverse (sideways) might mean that you must have a C-section delivery. Your doctor will help you decide what’s best for you and your little one when it’s time for delivery.
Last medically reviewed on May 19, 2020
- 3rd Trimester
How we reviewed this article:
- BirthPlace. (n.d.) stmarysregional.com/services/women/birthplace
- Glezerman M. (2014). Planned vaginal breech delivery: Current status and the need to reconsider. DOI: 10.1586/eog.12.2
- Horsager-Boehrer R. (2015). Feeling your baby move during pregnancy. utswmed.org/medblog/fetal-movements/
- Mayo Clinic Staff. (2017). Fetal presentation before birth. mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/multimedia/fetal-positions/sls-20076615
- Your baby’s movement and position. (2019). wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2FhealthAndWellness%2Fpregnancy%2Fpregnancy%2FthirdMove.html
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Fetal Positions for Birth
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What does fetal positioning mean?
The presentation of the fetus is how it's positioned in the uterus. Throughout your pregnancy, the fetus will move around in your uterus. It’s normal for the fetus to be in a variety of positions during most of your pregnancy. Early on, the fetus is small enough to move freely. You may have even felt this movement over the last few months. The larger the fetus becomes, however, the more limited the movement becomes. As the end of the pregnancy approaches, the fetus will start to move into position for birth. This typically involves flipping over so that it's head down in your uterus. Then, it starts to move down in your uterus, preparing to go through your birth canal during childbirth.
The birth canal is made up of your cervix (immediately outside of your uterus), vagina and vulva. Think of the birth canal as an expandable tunnel. During labor, your contractions work to stretch this space so that the baby can pass through it during childbirth.
What is the most common position for childbirth?
Ideally for labor, the baby is positioned head-down, facing the mother’s back with the chin tucked to its chest and the back of the head ready to enter the pelvis. This position is called cephalic presentation. Most babies settle into this position within the 32nd to 36th weeks of pregnancy.
What other positions can the baby be in for childbirth?
Sometimes the baby doesn’t get into the perfect position before birth. There are several positions that the baby can be in and each of these positions could come with complications during childbirth. These fetal positions can include:
- Occiput or cephalic posterior position : Sometimes the baby is positioned head down as it should be, but other times it is facing your abdomen. With the head in this position, the baby is looking at the ceiling. You may hear this position nicknamed sunny-side-up. This increases the chance of a painful and prolonged delivery.
- Frank breech : In a frank breech, the baby's buttocks lead the way into the birth canal. The hips are flexed, the knees extended (in front of the abdomen). This position increases the chance of forming an umbilical cord loop that could precede the head through your cervix and cause the baby to be injured during a vaginal delivery.
- Complete breech : In this position, the baby is positioned with the buttocks first and both the hips and the knees are flexed (folded under themselves). Like other breech presentations, this position increases the risk of forming an umbilical cord loop that could precede the head through the cervix and injure the baby if delivered vaginally.
- Transverse lie : The baby lies crosswise in the uterus, making it likely that the shoulder will enter your pelvis first. Most babies in this position are delivered by cesarean (C-section) .
- Footling breech : Sometimes, one or both of the baby's feet are pointed down toward the birth canal. This increases the chances of the umbilical cord slithering down into the mouth of your uterus, cutting off blood supply to the baby.
Is my baby at risk if it’s in a breech position?
A breech birth is when the baby is positioned with its feet down in the birth canal. While in the uterus, the fetus isn’t in any danger. However, in this position, the baby would be born foot first. A vaginal delivery is often a very safe form of childbirth, however, when the baby is breech, a vaginal delivery can be complicated. Because the baby’s head is larger than the bottom, there is a risk of head entrapment where the baby’s head becomes stuck in your uterus. In this situation, the baby can be difficult to deliver. Some babies in the breech position may want to come in a hurry during labor. Some providers are comfortable performing a vaginal birth as long as the baby is doing well. In many cases, your healthcare provider may recommend a cesarean birth (C-section) instead of a vaginal birth. This is a surgical procedure where an incision is made in your abdomen and the baby is removed in an operating room. There’s a lot less risk to the baby during this procedure compared to a breech vaginal birth.
Why does the position of the baby at birth matter?
During childbirth, your healthcare provider’s goal is to safely deliver your baby and ensure your well-being. If the baby is in a different position (not a cephalic presentation), this job becomes more challenging. Different fetal positions have a range of difficulties and the risks can vary depending on the position of your child.
When should my baby move into position for birth?
Typically, your baby will drop down in the uterus and move into position for birth in the third trimester. This happens in the last few weeks of your pregnancy (often between weeks 32 and 36). Your healthcare provider will check the position of the baby by touching your abdomen during your regular appointments. This will happen during most of your appointments in the third trimester. In some cases, your provider may also do an ultrasound to check the baby’s position.
Can my healthcare provider turn or reposition my baby before birth?
There are several ways that your healthcare provider can try and turn the fetus before you go into labor. These methods don’t always work and sometimes, the fetus can actually turn back into the wrong position again. You can actually try some of these techniques at home and they won’t harm you or the fetus. They might encourage the fetus to turn on its own, but there’s also a chance that nothing will happen. Even though there isn’t a guaranteed success rate, these methods are still recommended because they’re usually worth a try and could help you avoid a C-section delivery.
Methods for turning your baby can include:
- External cephalic version (ECV) : ECV is one non-invasive way to turn the fetus and improve your chance of having a vaginal birth. This procedure is performed on the labor and delivery unit. This procedure requires two providers where one lifts the baby’s buttocks in an upward position and the second provider applies pressure through the abdominal wall to your uterus to rotate the fetal head forward or backward. The best time to perform this procedure is between 36 to 38 weeks of pregnancy. Afterward, the baby’s heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after ECV.
- Getting on your hands and knees and gently rocking back and forth.
- Pushing your hips up in the air while lying on your back with your knees bent and feet flat on the floor (bridge pose).
- Using stimulating sounds to encourage movement : Another thing you can try to get the fetus to change position is stimulation. Music, talking, temperature changes and light could interest the fetus. While in your uterus, the fetus can hear music, see light changes through your skin and even hear your voice as you talk. You can try placing headphones on your belly, toward the bottom, to see if this attracts the fetus. Applying cool temperatures to the top of your abdomen where the baby’s head is could also prompt the fetus to move away and downward. Similar to changing your position, there is no guarantee that stimulation will make the fetus move, but it’s often worth a try.
A chiropractic technique, called the Webster technique, can also be used to move your hips. This is meant to allow your uterus to relax. Some providers even recommend acupuncture to help your body relax. Both of these techniques need to be done by a professional that your healthcare provider has recommended. Relaxation could promote movement in the baby and help get the fetus into the best possible position for birth.
Can my baby change position on its own?
It’s always possible that your baby will reposition all on its own. In the weeks leading up to birth, the baby still has time to make adjustments and change position. Most find their own way into the correct position before birth.
How is the baby delivered when it’s breech or in another position?
Most birth plans begin with the idea of having a vaginal birth. Your provider will look at your medical history, the scans of your baby throughout your pregnancy and the position of the fetus to pick the safest form of delivery. When the fetus is in a breech position or another abnormal position, your healthcare provider may suggest a cesarean section (C-section) delivery. This is a surgical procedure where an incision is made in your lower abdomen. The baby is delivered through this opening instead of through the birth canal.
It is possible to deliver a breech baby vaginally. However, this type of birth can be much more dangerous for the baby and the risk of injury from the umbilical cord is much higher. If the cord is compressed during birth, the baby could be deprived of oxygen and this could harm the brain and nerves. The cord could also slip around the baby’s neck or arms, causing injury. Different healthcare providers have various levels of comfort with vaginal deliveries of breech babies. Talk to your provider about the risks and benefits of different types of birth for a breech baby.
Does anything increase my risk of having a dangerous fetal position?
There are several factors that could increase the risk of a fetal position like a breech presentation. These can include:
- Going into labor too early and having a premature baby . In this case, the baby may not have had time to turn in preparation for birth yet.
- Having issues with the placenta. If the placenta is either attached too low in your uterus (a condition called placenta previa) or disconnects from your uterus before birth, it could prevent the fetus from turning and getting into the right position for birth.
- Having a multiple pregnancy. When there’s more than one fetus in your uterus, it can be difficult for each baby to get into position. The limited space creates problems as the babies develop throughout your pregnancy.
- Having a uterus that is shaped differently than normal. The uterus is typically shaped like an upside-down pear. When it’s shaped abnormally or has fibroids (growths that can vary in size), there might not be enough shape for a full-grown baby to move into position for birth.
A note from Cleveland Clinic
Learning that the fetus is in a breech or other complicated position before birth can add to the anxiety that often surrounds childbirth. It’s alright to have concerns and questions about what this means for your birth experience. You may have developed a birth plan during your pregnancy. A birth plan is an ideal plan for your labor and delivery. These plans can be very helpful as a tool. Take your birth plan to an appointment and talk to your healthcare provider about what you are picturing for your labor and delivery. Your provider can help guide you through not only the ideal plan, but an emergency plan. Remember, things can change quickly during childbirth. Having a C-section may not be a part of your birth plan. However, the goal is to safely deliver your child and protect your health. Talk to your healthcare provider about questions and any concerns you might have about your baby’s position.
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Abnormal Position and Presentation of the Fetus
, MD, Children's Hospital of Philadelphia
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Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up).
Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks or a shoulder leads the way.
The most common and safest combination consists of the following:
Head first (called vertex or cephalic presentation)
Face and body angled toward the right or left
Neck bent forward
Chin tucked in
Arms folded across the chest
If the fetus is in a different position or presentation, labor may be more difficult, and delivery through the vagina may not be possible.
Position and Presentation of the Fetus
There are several abnormal presentations.
Occiput posterior presentation
In occiput posterior presentation (also called sunny-side up), the fetus is head first but is facing up (toward the mother's abdomen). It is the most common abnormal position or presentation.
In breech presentation, the buttocks or sometimes the feet present first. Breech presentation occurs in 3 to 4% of full-term deliveries. It is the second most common type of abnormal presentation.
When delivered vaginally, babies that present buttocks first are more likely to be injured than those that present head first. Such injuries may occur before, during, or after birth. The baby may even die. Complications are less likely when breech presentation is detected before labor or delivery.
Breech presentation is more likely to occur in the following circumstances:
Labor starts too soon ( preterm labor Preterm Labor Labor that occurs before 37 weeks of pregnancy is considered preterm. Babies born prematurely can have serious health problems. The diagnosis of preterm labor is usually obvious. Measures such... read more ).
The fetus has a birth defect Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more .
Sometimes the doctor can turn the fetus to present head first by pressing on the woman’s abdomen before labor begins, usually after 37 weeks of pregnancy. Some women are given a drug (such as terbutaline ) to prevent labor from starting too soon. If labor begins and the fetus is in breech presentation, problems may occur.
The passageway made by the buttocks in the birth canal may not be large enough for the head (which is wider) to pass through. In addition, when the head follows the buttocks, it cannot be molded to fit through the birth canal, as it normally is. Thus, the baby’s body may be delivered and the head may be caught inside the woman. When the baby’s head is caught, it puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among babies presenting buttocks first than among those presenting head first.
In a first delivery, these problems may occur more frequently because the woman’s tissues have not been stretched by previous deliveries. Because the baby could be injured or die, cesarean delivery is preferred when the fetus is in breech presentation unless the doctor is very experienced with and skilled at delivering breech babies.
In face presentation , the neck arches back so that the face presents first.
In brow presentation , the neck is moderately arched so that the brow presents first.
Usually, fetuses do not stay in a face or brow presentation. They often correct themselves. If they do not, forceps, vacuum extractor, or cesarean delivery may be used.
In transverse lie , the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.
Shoulder dystocia occurs when one shoulder of the fetus lodges against the woman’s pubic bone, and the baby is therefore caught in the birth canal.
In shoulder dystocia, the fetus is positioned normally Abnormal Position and Presentation of the Fetus Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). It’s important to check the baby’s... read more (head first) for delivery, but the fetus’s shoulder becomes lodged against the woman’s pubic bone as the fetus’s head comes out. (The two pubic bones are part of the pelvic bone. They are joined together by cartilage at the bottom of the pelvis, behind the vaginal opening.) Consequently, the head is pulled back tightly against the vaginal opening. The baby cannot breathe because the chest and umbilical cord are compressed by the birth canal. As a result, oxygen levels in the baby’s blood decrease.
Shoulder dystocia is not common, but it is more common when any of the following is present:
A large fetus Large-for-Gestational-Age (LGA) Newborns A newborn who weighs more than 90% of newborns of the same gestational age at birth (above the 90th percentile) is considered large for gestational age. Newborns may be large because the parents... read more is present.
Labor is difficult, long, or rapid.
A vacuum extractor or forceps Operative Vaginal Delivery Operative vaginal delivery is delivery using a vacuum extractor or forceps. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted... read more is used because the fetus’s head has not fully moved down (descended) in the pelvis.
Women are obese.
Women have diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more .
Women have had a previous baby with shoulder dystocia.
Shoulder dystocia increases the risk of problems and of death in the newborn. The newborn's bones may be broken during delivery, and the brachial plexus Plexus Disorders Plexuses (networks of interwoven nerve fibers from different spinal nerves) may be damaged by injury, tumors, pockets of blood (hematomas), or autoimmune reactions. Pain, weakness, and loss... read more (the network of nerves that sends signals from the spinal cord to the shoulders, arms, and hands) may be injured. The woman is also more likely to have problems such as
Excessive bleeding at delivery (postpartum hemorrhage)
Tears in the area between the vaginal opening and the anus
Injury of muscles in the genital area and nerves in the groin
Separation of the pubic bones.
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While babies twist, stretch and tumble during pregnancy, before labor begins they usually settle in a way that allows them to be delivered headfirst (cephalic presentation) through the birth canal. That doesn't always happen, though.
Check out some of the possible fetal presentations and positions at the end of pregnancy and find out how they can affect delivery.
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- Strauss RA. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed July 24, 2017.
- Frequently asked questions. Pregnancy FAQ079. If your baby is breech. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech. Accessed July 24, 2017.
- Gabbe SG, et al. Normal labor and delivery. In: Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2017. https://www.clinicalkey.com. Accessed July 31, 2017.
- Frequently asked questions. Pregnancy FAQ188. Multiple pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Multiple-Pregnancy. Accessed July 24, 2017.
- Cunningham FG, et al. Williams Obstetrics. 24th ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.mhmedical.com. Accessed July 24, 2017.
- Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed July 24, 2017.
- Hofmeyr GJ. Overview of issues related to breech presentation. https://www.updtodate.com/contents/search. Accessed July 24, 2017.
- Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed July 24, 2017.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 161: External cephalic version. Obstetrics & Gynecology. 2016;127:e54.
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October 14, 2016
A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part (the part that first enters the birth canal). All other presentations are abnormal (malpresentations) which are either more difficult to deliver or not deliverable by natural means.
The movement of the fetus to cephalic presentation is called head engagement. It occurs in the third trimester. In head engagement, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perineum and cervix are further flattened and the head may be felt vaginally. Head engagement is known colloquially as the baby drop, and in natural medicine as the lightening because of the release of pressure on the upper abdomen and renewed ease in breathing. However, it severely reduces bladder capacity, increases pressure on the pelvic floor and the rectum, and the mother may experience the perpetual sensation that the fetus will “fall out” at any moment.
The vertex is the area of the vault bounded anteriorly by the anterior fontanelle and the coronal suture, posteriorly by the posterior fontanelle and the lambdoid suture and laterally by 2 lines passing through the parietal eminences.
In the vertex presentation the occiput typically is anterior and thus in an optimal position to negotiate the pelvic curve by extending the head. In an occiput posterior position, labor becomes prolonged and more operative interventions are deemed necessary. The prevalence of the persistent occiput posterior is given as 4.7 %
The vertex presentations are further classified according to the position of the occiput, it being right, left, or transverse, and anterior or posterior:
Left Occipito-Anterior (LOA), Left Occipito-Posterior (LOP), Left Occipito-Transverse (LOT); Right Occipito-Anterior (ROA), Right Occipito-Posterior (ROP), Right Occipito-Transverse (ROT);
By Mikael Häggström – Own work, Public Domain
Cephalic presentation. (2016, September 17). In Wikipedia, The Free Encyclopedia . Retrieved 05:18, September 17, 2016, from https://en.wikipedia.org/w/index.php?title=Cephalic_presentation&oldid=739815165
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Important Terms Used to Describe the Fetal Relationship to the Maternal Pelvis
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What Is Cephalic Position?
The ideal fetal position for labor and delivery
Cherie Berkley is an award-winning journalist and multimedia storyteller covering health features for Verywell.
Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.
- Why It's Best
Risks of Other Positions
- Determining Position
- Turning a Fetus
The cephalic position is when a fetus is head down, facing back, with the chin tucked and the back of the head ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery.
About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy . Your healthcare provider will monitor the fetus's position during the last weeks of gestation to ensure this has happened by week 36.
If the fetus is not in the cephalic position at that point, the provider may try to turn it. If this doesn't work, some—but not all—practitioners will attempt to deliver vaginally, while others will recommend a Cesarean (C-section).
Why Is the Cephalic Position Best?
During labor, contractions stretch the birth canal so the fetus has adequate room to come through at birth. The cephalic position is the easiest and safest way for the baby to pass through the birth canal.
If the fetus is in a noncephalic position, delivery becomes more challenging. Different fetal positions have a range of difficulties and varying risks.
A small percentage of babies present in noncephalic positions. This can pose risks both to the fetus and the mother, and make labor and delivery more challenging. It can also influence the way in which someone can deliver.
A fetus may actually find itself in any of these positions throughout pregnancy, as the move about the uterus. But as they grow, there will be less room to tumble around and they will settle into a final position.
It is at this point that noncephalic positions can pose significant risks.
A fetus may also present in an occiput or cephalic posterior position. This means they are positioned head down, but they are facing the abdomen instead of the back.
This position is also nicknamed "sunny-side up."
Presenting this way increases the chance of a painful and prolonged delivery.
There are three different types of breech fetal positioning:
- Frank breech: The legs are up with the feet near the head.
- Footling breech: One or both legs is lowered over the cervix.
- Complete breech: The fetus is bottom-first with knees bent.
A vaginal delivery is most times a safe way to deliver. But with breech positions, a vaginal delivery can be complicated.
When a baby is born in the breech position, the largest part—its head—is delivered last. This can result in them getting stuck in the birth canal (entrapped). This can cause injury or death.
The umbilical cord may also be damaged or slide down into the mouth of the womb, which can reduce or cut off the baby's oxygen supply.
Some providers are still comfortable performing a vaginal birth as long as the fetus is doing well. But breech is always a riskier delivery position compared with the cephalic position, and most cases require a C-section.
Likelihood of a Breech Baby
You are more likely to have a breech baby if you:
- Go into early labor before you're full term
- Have an abnormally shaped uterus, fibroids , or too much amniotic fluid
- Are pregnant with multiples
- Have placenta previa (when the placenta covers the cervix)
In transverse lie position, the fetus is presenting sideways across the uterus rather than vertically. They may be:
- Down, with the back facing the birth canal
- With one shoulder pointing toward the birth canal
- Up, with the hands and feet facing the birth canal
If a transverse lie is not corrected before labor, a C-section will be required. This is typically the case.
Determining Fetal Position
Your healthcare provider can determine if your baby is in cephalic presentation by performing a physical exam and ultrasound.
In the final weeks of pregnancy, your healthcare provider will feel your lower abdomen with their hands to assess the positioning of the baby. This includes where the head, back, and buttocks lie
If your healthcare provider senses that the fetus is in a breech position, they can use ultrasound to confirm their suspicion.
Turning a Fetus So They Are in Cephalic Position
External cephalic version (ECV) is a common, noninvasive procedure to turn a breech baby into cephalic position while it's still in the uterus.
This is only considered if a healthcare provider monitors presentation progress in the last trimester and notices that a fetus is maintaining a noncephalic position as your delivery date approaches.
They may also recommended several other ways to encourage a head-down position.
None of these options are sure to work or have long-lasting results, however.
External Cephalic Version (ECV)
ECV involves the healthcare provider applying pressure to your stomach to turn the fetus from the outside. They will attempt to rotate the head forward or backward and lift the buttocks in an upward position. Sometimes, they use ultrasound to help guide the process.
The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the fetal heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after having ECV done.
ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the fetus will return to the breech position before birth.
Natural Methods For Turning a Fetus
There are also natural methods that can help turn a fetus into cephalic position. There is no medical research that confirms their efficacy, however.
- Changing your position: Sometimes a fetus will move when you get into certain positions. Two specific movements that your provider may recommend include: Getting on your hands and knees and gently rocking back and forth. Another you could try is pushing your hips up in the air while laying on your back with your knees bent and feet flat on the floor (bridge pose).
- Playing stimulating sounds: Fetuses gravitate to sound. You may be successful at luring a fetus out of breech position by playing music or a recording of your voice near your lower abdomen.
- Chiropractic care: A chiropractor can try the Webster technique. This is a specific chiropractic analysis and adjustment which enables chiropractors to establish balance in the pregnant person's pelvis and reduce undue stress to the uterus and supporting ligaments.
- Acupuncture: This is a considerably safe way someone can try to turn a fetus. Some practitioners incorporate moxibustion—the burning of dried mugwort on certain areas of the body—because they believe it will enhance the chances of success.
A Word From Verywell
While most babies are born in cephalic position at delivery, this is not always the case. And while some fetuses can be turned, others may be more stubborn.
This may affect your labor and delivery wishes. Try to remember that having a healthy baby, and staying well yourself, are your ultimate priorities. That may mean diverting from your best laid plans.
Speaking to your healthcare provider about turning options and the safest route of delivery may help you adjust to this twist and feel better about how you will move ahead.
Glezerman M. Planned vaginal breech delivery: current status and the need to reconsider . Expert Rev Obstet Gynecol. 2012;7(2):159-166. doi:10.1586/eog.12.2
Cleveland Clinic. Fetal positions for birth .
MedlinePlus. Breech birth .
UT Southwestern Medical Center. Can you turn a breech baby around?
The American College of Obstetricians and Gynecologists. If your baby is breech .
Roecker CB. Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios . Journal of Chiropractic Medicine . 2013;12(2):74-78. doi:10.1016/j.jcm.2013.06.003
By Cherie Berkley, MS Cherie Berkley is an award-winning journalist and multimedia storyteller covering health features for Verywell.
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Which Way is Up? What Your Baby’s Position Means for Your Delivery
- Which Way is Up? What…
Are you going to be able to have a vaginal delivery? Will your labor pains be more in your pelvis or your back? The answers to these questions depend in large part of the position of your baby in your uterus as you go into labor. Medical professionals call this position the fetal presentation .
Almost all (95-97%) babies are delivered in head-first or cephalic presentation. Most babies move into the head down position by the third trimester. Cephalic presentation is further broken down by the position of the head; in the vast majority of cephalic deliveries, the crown or top of the head (called the vertex ), enters the birth canal first and is the first part of the baby to be delivered. This is why we say a baby is ‘crowning’.
In most cases of vertex presentation, the back of the baby’s head (called the occiput ) is toward the front ( anterior ) of the mother’s pelvis. This presentation is called occiput anterior , and is considered the best position for a vaginal delivery. Around 5% of babies are delivered in the occiput posterior position, where the back of the baby’s head is toward the mother’s backbone and tailbone. This is popularly believed to be the cause of painful ‘back labor’, although the scientific support for this is somewhat lacking. What is known is that the occiput posterior (OP) presentation can significantly prolong labor, and is three times more likely than occiput anterior (OA) presentation to result in cesarean section. This is because the position of the baby makes it harder to pass through the birth canal. Occiput presentation is more common in older and first-time mothers, as well as with larger or overdue babies. Surfing the internet will provide you with many different exercises which claim to prevent occiput posterior presentation, but none of these have been scientifically proven to be of benefit.
Rarely (around 1 in every 800 births), the baby will present face-first instead of with the top of the head. Around 70% of these babies can be delivered vaginally, although the labor may be mildly prolonged. The remainder tend to be delivered by cesarean section either because the labor is not progressing or because the doctor or midwife is concerned about the baby’s heart rate.
Breech presentation occurs when a baby enters the birth canal with the buttocks or feet first, rather than the head. This prevents the cervix (opening to the uterus) from dilating effectively, and can lead to problems with the umbilical cord becoming pinched/compressed. Breech presentations occur in approximately 3-4% of deliveries, and are more likely in premature births and with multiple babies (e.g. twins and triplets). While breech babies can be delivered vaginally, studies have found that vaginal deliveries are around three times more likely to result in serious harm to the baby than cesarean sections. Therefore, in most cases in the US, breech babies are delivered by c-section. Your midwife or doctor may diagnose a breech presentation by physical exam and/or ultrasound.
Shoulder presentation is uncommon, occurring in less than 1% of deliveries. This occurs when the baby is lying sideways in the uterus, rather than head down or buttocks/feet down. If labor starts with the baby in this position, the shoulder becomes wedged in the pelvis and the labor cannot progress. Almost all babies with shoulder presentation will need to be delivered by cesarean section. Shoulder presentation, like breech presentation, is more common in premature babies or in the setting of multiple gestations.
The chances are good that your baby will know which way is up; in the case of labor and delivery, this means head down. Attending your regular prenatal visits will allow your doctor or midwife to keep a close eye on your baby, and plan the safest delivery for the two of you.
Author: Physicians & Midwives
Physicians and Midwives is composed of a team of doctors , midwives , and nurse practitioners that practice in five centers spread out across Northern Virginia ( Alexandria , North Arlington , Kingstowne , Mt. Vernon and Woodbridge ). Telemedicine is also available. We understand that our patients are time sensitive and our office hours and locations are in place to stress convenience. In addition, our dedicated call center is in place during office hours to facilitate your requests for medication refills, lab results or questions about your treatment. Read more
All other presentations are abnormal (malpresentations) and are either more difficult to deliver or not deliverable by natural means. Cephalic presentation.
Breech · Frank breech. This is when your baby's bottom is down and their legs are straight up (like a pretzel) so their feet are close to their
Positions can include cephalic presentation (head down, facing your spine) and several types of breech (feet down).
This is the most common position for babies in-utero. In the cephalic presentation, the baby is head down, chin tucked to chest, facing their mother's back.
(head presentation, head-first presentation)A fetal position at childbirth where the fetus is in a longitudinal lie and the head enters the
Head first (called vertex or cephalic presentation) · Facing rearward · Face and body angled toward the right or left · Neck bent forward · Chin tucked in · Arms
While babies twist, stretch and tumble during pregnancy, before labor begins they usually settle in a way that allows them to be delivered headfirst (cephalic
A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal
When the fetus is in CEPHALIC presentation, most commonly the VERTEX, or occipital area of the fetal skull is presenting. Any other presentations may introduce
The cephalic position is when a fetus is head down, facing back, with the chin tucked and the back of the head ready to enter the birth
Cephalic presentation is further broken down by the position of the head; in the vast majority of cephalic deliveries, the crown or top of the