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Fetal Positions for Birth


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Ideally, for labor, the baby is positioned head-down, facing your back, with the chin tucked to its chest and the back of the head ready to enter the pelvis. This is called a cephalic presentation. Most babies settle into this position between the 32nd and 36th weeks of pregnancy. Other fetal positions for birth include different types of breech (feet down) and occiput posterior positions (face up).

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.

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.

Can my baby change positions on its own?
It’s always possible that your baby will reposition on its own. In the weeks leading up to birth, the baby still has time to make adjustments and change positions. 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 to the umbilical cord is much higher. If the cord is compressed during birth, the baby could be deprived of oxygen, which 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:
1. 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.
2. 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.
3. Having multiple pregnancies. 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.
4. 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.