The baby’s position in the womb during pregnancy has a significant impact on how labor progresses. With the baby’s head pointed down toward the birth canal, this is known as the fetal cephalic presentation, and it is one of the most common and advantageous birth positions. Both the mother and the infant find it easier to deliver their child in this head-first position.
Depending on where the baby’s head is positioned, there are various cephalic presentations. These include variations such as brow or face presentation, and vertex presentation, in which the top of the head leads the way. Different positions are better suited for different methods of natural childbirth, and each type may have an impact on the delivery technique.
Knowing where your baby is in relation to you will help you be more prepared for labor. A head-first presentation usually results in a more seamless vaginal birth. But throughout your pregnancy, your healthcare provider will keep an eye on the baby’s position and help you decide which course of action is best for a safe and healthy delivery.
The ideal position for delivery is when a baby is positioned head-down in the womb, which is known as fetal cephalic presentation during pregnancy. Depending on how the baby’s head is angled, there are various cephalic presentations, including vertex (head fully down), face, and brow. While labor frequently advances more quickly when the baby is in this position, depending on the particular type of presentation, medical intervention may occasionally be required. This positioning helps the baby get ready for a more seamless delivery.
- What is it?
- Classification and causes of occurrence
- Diagnostics
- How labor occurs?
- Video on the topic
- FETAL POSITION DURING PREGNANCY | 10 questions about fetal presentation
- Is it possible for a baby to turn from breech to cephalic presentation?
- Cephalic presentation of the fetus
- CORRECT POSITION OF THE BABY DURING PREGNANCY | What is the difference between cephalic presentation of the fetus
- Cephalic Presentation of the Fetus. Fetal Position During Pregnancy
- LOW POSITION OF THE FETAL HEAD DURING PREGNANCY | When should the baby"s head drop into the pelvis
- BREECH PRESENTATION | how to turn the baby
- BREECH presentation of the fetus | childbirth | BIOMECHANISM | reasons | what you NEED to know
What is it?
Throughout pregnancy, the fetus in the mother’s womb shifts positions more than once or twice; in the first and second trimesters, the baby can roll over and flip around freely and spontaneously several times per hour. The size of the uterus and the volume of amniotic fluid allow it to do so to a certain extent.
But starting in the thirty-first week of pregnancy, the baby’s mobility decreases, its size reaches a point where it can perform gymnastic coups, and as the gestational period lengthens, its movements get increasingly restricted.
It is thought that by the 34th or 35th week of pregnancy, the baby’s position in relation to the exit into the small pelvis—from which its journey through the birth canal will commence during labor—is finally established. It is unlikely that the presentation will change after this time.
After the 23rd and 25th week of pregnancy, 80% of babies adopt the ideal, most comfortable head position, with the head presenting to the exit into the pelvis.
Pregnant women turn over 95% of their babies head down by week 34. The percentage of these children rises to 97% by the 38th week.
The fetus develops more harmoniously in the cephalic presentation, in line with the laws of nature and evolution. Cephalic presentation is thought to be ideal for childbirth.
During the final months of pregnancy, a baby that is breech, or sitting on a papa in the uterus, has an opportunity to turn into the proper position. Furthermore, there is almost no chance that a baby in the cephalic presentation will "sit down" or settle in the intrauterine cavity.
The doctor’s assertion that the baby is in the head position seems to reassure expectant mothers. In actuality, though, things are not that easy. Certain forms of cephalic presentation necessitate a scheduled cesarean section and do not suggest a typical childbirth. Let’s investigate the various forms of this presentation and any potential risks.
Classification and causes of occurrence
When declaring that the infant is in a cephalic presentation, the physician will undoubtedly consider the infant’s posture, position in relation to the uterine cavity’s middle central axis, and the baby’s arms and legs’ placement in relation to the body (limb arrangement).
Thus, there exist various types of cephalic presentation. These are the primary types:
- occipital, when the adjacent part of the head is the back of the baby"s head;
- anterior cephalic, in which the baby is pressed to the exit from the mother"s uterus with the parietal part of the head;
- facial (the baby is pressed to the exit with his face);
- frontal, when the baby is adjacent to the exit into the pelvis with the forehead area.
The flexed occipital presentation is thought to be the most ideal and secure for the child and his mother. The tiny fontanel, which is supplied by nature for this reason, will be the point of advancement when the baby goes head first during labor with it. The occipital region is the largest, so it will be much easier to remove the rest of the baby’s body. The baby will be born with a birth injury to the cervical spine, with the back of the head emerging first and the neck bent and unbending. In this scenario, up to 90% of all natural births take place.
The head can be "inserted" into the small pelvis at a different angle, though, and this will largely depend on the baby’s head structure and the angle at which the neck extends to "launch" into the world.
- Anterior cephalic presentation is the first degree of head extension. The point of advancement along the genital tract during birth in this position is the second (large) fontanel. The area of the pushed part of the head is larger, which means that the baby"s passage through the birth canal will be longer. Can a woman give birth in this case? Yes, it is quite, but the risk of injury by her and the child is much higher than at birth by the back of his head forward. Such births have a longer course, it is likely that the fights will become weaker, the primary or secondary weakness of the tribal forces will develop, the baby may occur in hypoxia (oxygen starvation).
- Frontal presentation is the second degree of extension of the head. The mother’s small pelvis includes the largest part of the head, which can cause significant difficulties during the birth. "Punch" the road of the baby in childbirth in this position will be a forehead. This increases ten times the likelihood of developing injuries of the spine, brain and spinal cord, the onset of acute hypoxia, which can lead to irreversible consequences and even to the death of the child. For mother, such births are dangerous due to ruptures of the uterus, cervix, perineum, injuries to the bones and ligaments of the small pelvis.
For this reason, it is thought to be extremely risky for a woman to give birth spontaneously while facing front. It is advised that a woman have a cesarean section.
- Facial presentation is the third degree of extension of the head, which is rightfully considered the extreme in obstetrics — there is simply nowhere to extend the head further. During natural childbirth through the mother"s genital tract, the baby will come out with its chin first. It is the chin that will be the main point of application. Theoretically, a woman can give birth on her own, but only if her baby is small in size and light in weight, and at the same time the woman"s pelvis is large enough. There are risks of injury, although not as great as in the case of frontal presentation.
A woman is typically offered a cesarean section in order to reduce the likelihood of complications.
Extension positions are not as common in real life. In 1.5–2% of cases with cephalic presentations, surgery is necessary. The baby is positioned with extension in the cervical region for a variety of reasons, including the woman’s narrow pelvis, tumors, fibroids, and scars from prior uterine cavity surgeries. The truth is that newborns attempt, on autopilot, to orient their bodies in the most comfortable ways possible to minimize pressure on their heads.
The baby may definitely settle head down if a tumor or fibroid affects the lower uterine segment, but with slight adjustments, such as extension.
A low placenta and its presentation are frequently linked to incorrect head positions. Polyhydramnios is a common cause of this position. Additionally, there is a genetic component to this relationship: if a woman was born with her chin first, there’s a good chance her offspring will wish to follow in her footsteps when it comes to facial presentation.
A weak, stretched abdominal wall can occasionally be the root cause of the pathology; this is common in women who have given birth repeatedly. Moreover, children born to pregnant women who have congenital uterine structural defects, such as a saddle-shaped or bicornuate uterus, may present incorrectly in terms of their cephalic presentation and uterine extension.
Diagnostics
Ultrasonography can be used to locate the fetus in the womb as early as the 12th week of pregnancy, but this information is not useful at this point in the pregnancy. The position in which the baby was "caught" at the time of ultrasound scanning is all that the doctor describes, so you can disregard this part of the protocol. The obstetrician-gynecologist who is keeping an eye on the expectant mother starts to identify the general type of presentation around the 28th week of pregnancy.
Using the methods of external obstetric examination, he palpates the part that is presenting through the pregnant woman’s abdomen and measures the height of the uterus’ fundus. When a baby is presented breech, the bottom of the abdomen, which is softer and less mobile than the baby’s head, can be felt above the pubis. Additionally, the height of the uterine fundus is higher than usual for the period. The head is located on either the right or left side in transverse presentation, and the uterine fundus frequently falls behind normal height standards.
When the baby is in a cephalic position, its heartbeat can be heard in the lower abdomen, below the navel, and when it is in a breech or transverse position, it can be heard above or in the vicinity of the expectant mother’s navel. For this reason, the doctor feels the presenting part and uses a tape measure to measure the abdomen at every checkup following the 28th week. But even the most skilled obstetrician-gynecologist is unable to assess the degree of head extension by feeling or, if any, by vaginal examination.
Thus, ultrasonography is the most accurate diagnostic technique. It lets you know precisely what kind of longitudinal cephalic presentation the baby should have, how much weight the baby should weigh, where its back should be in relation to the mother’s anterior abdominal wall (anterior or posterior view), where other body parts should be located, and whether the placenta previa and umbilical cord are entangled. To decide on the delivery method, all of this information is necessary.
How labor occurs?
As was previously mentioned, the most common presentation of labor is a flexed occipital. This is an example of a traditional birth, the "gold standard" of obstetrics. There is very little chance of harm coming to the mother or baby when using them. The dimensions of the woman’s pelvis and the birthing head are exactly in line when the presentation is occipital.
The infant instinctively turns as it passes through the birth canal, facing the sacrum with its face turned toward the womb. The baby turns its shoulders and faces the mother’s thigh when the head is sliced through. This guarantees the baby’s body has the safest and smoothest passage.
Labor may start a little later if the baby is in a posterior occipital presentation. Medical professionals need to pay closer attention to this situation. In order to prevent the baby from going too long without water or developing hypoxia, contractions are induced when needed.
Obstetric forceps are sometimes necessary for these types of births, but as of late, efforts have been made to use them as infrequently as possible due to the high risk of baby harm associated with their use.
If a natural birth is chosen, face presentation is the traditional method of childbirth; however, because the baby will emerge chin first, doctors closely watch to ensure that the baby’s facial structures are not harmed. An emergency cesarean section is carried out if there is a possibility of harm or rupture to the uterus and cervix.
When a woman presents frontally, an intentional cesarean section is typically performed because spontaneous labor is not desired. If spontaneous labor happens for any reason, there’s a chance it will be prolonged; the fetus will take a while to emerge from the uterus, and the intensity of the contractions might lessen as well.
Of course, a skilled obstetrician could theoretically turn the baby by hand, but there’s a chance the child’s cervical spine could get hurt in the process. Most often, these injuries result in the birth of disabled children.
Spontaneous labor is possible with any kind of cephalic presentation, barring the frontal one, provided the physician determines that the woman’s pelvis and the child’s size are fairly similar. In cases where the child’s size is large and does not match the size of the pelvis, even an ideal occipital presentation may result in a cesarean section.
At 36 to 37 weeks of pregnancy, the choice of labor tactics is typically decided. Should a cesarean section be recommended, the patient must visit the hospital ahead of time, without waiting for her period to start on its own. Physicians typically aim to carry out scheduled procedures between weeks 38 and 39 of pregnancy.
The woman may choose to remain at home until the onset of contractions, the discharge of water, or mucus plug appears, if the baby’s appearance does not cause her to feel anxious or uncomfortable.
| Term | Description |
| Fetal cephalic presentation | When the baby is positioned head-down in the womb, preparing for birth. This is the most common and ideal position for delivery. |
| Types of cephalic presentation | There are different variations, such as vertex (baby"s head is fully flexed, chin to chest), brow (head is slightly extended), and face (baby"s head is fully extended). |
| How labor proceeds | In cephalic presentation, the baby"s head enters the birth canal first. This allows for a smoother, more natural labor, reducing complications during delivery. |
The most common position for a baby during pregnancy is fetal cephalic presentation, in which the head is angled downward and prepared for delivery. Since the head of the baby is the largest part to pass through the birth canal, this position is ideal for a safe and easy delivery.
Depending on where the baby’s head is positioned, there are various cephalic presentations. The baby’s chin is tucked into his or her chest in the vertex presentation, which is the most advantageous. While they are less common, other types, such as the face or brow presentation, may make labor more challenging.
Labor typically proceeds as planned when the baby is presented cephalic. A more seamless delivery is usually the consequence of the head leading the way and gradually widening the birth canal. All labors are different, though, and the baby’s position can affect how the birth goes overall.
