Fetal Position & Presentation

Throughout pregnancy, the baby moves and changes position. However, as delivery nears, the position of the baby becomes an important part of a safe vaginal delivery. Depending on the position, obstetricians will have to take specific steps to ensure that safe delivery.

Types of presentation and physician reactions

• Vertex:  head down
• Breech:  buttocks down
• Transverse:  neither head nor buttocks down

There are any number of variations, and obstetricians may need to know the rotation and angle of head relative to the mother’s pelvis.

Position may be determined from the Leopold maneuvers (a system of feeling the belly to determine how the baby is positioned), but can be confirmed when the doctor performs a cervical examination. When in doubt, an ultrasound can provide the specific position.

A breech is particularly problematic, and there are three types of breech: Frank (legs straight and feet near the head); complete (one or both knees folded up near head); and incomplete/footling (one knee or foot below the breech in the birth canal). There are three options for delivery

• Manipulation: the doctor attempts to rotate the baby into a standard vertex position
• Trial of labor: not as common, the doctor may allow labor to proceed to see if delivery is possible.  Complications include cord prolapse and entrapment of the head.
• Elective cesarean: if manipulation doesn’t work, a cesarean delivery is a common and safer option

Complications of positioning

When the baby’s position causes complications with delivery, the child is at risk for other physical and mental complications. These may include:

• Umbilical cord prolapse
• Entrapment of the head causing lack of oxygen
• Shoulder dystocia
• Problems associated with cesarean delivery

Contact Us

A breech birth or other malpresentation can provide many challenges for your labor and delivery team, but they should have the tools and resources to deliver your child. If you have questions about whether your doctors and nurses acted appropriately, contact our birth injury lawyers at (440) 252-4399 or send us a message online.