Delivery presentations

Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

Your baby must pass through your pelvic bones to reach the vaginal opening. The ease at which this passage will take place depends on how your baby is positioned during delivery. The best position for the baby to be in to pass through the pelvis is with the head down and the front of the body facing towards the mother's back. This position is called occiput anterior (OA).

In breech position, the baby's bottom is facing down instead of the head. Your health care provider will most often detect this in an office visit before your labor begins. Most babies will be in the head-down position by about 34 weeks.

Part of your prenatal care after 34 weeks will involve making sure your baby is in the head-down position.

If your baby is breech, it is not safe to deliver vaginally. If your baby is not in a head-down position after your 36th week, your provider can explain your choices and their risks to help you decide what steps to take next.

Your choices and their risks

The best position for your baby inside your uterus at the time of delivery is head down. This position makes it easier and safer for your baby to pa...

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Occiput Posterior (OP)

In occiput posterior position, your baby's head is down, but it is facing the mother's front instead of her back.

It is safe to deliver a baby facing this way. But it is harder for the baby to get through the pelvis. If a baby is in this position, sometimes it will rotate around during labor so that the head stays down and the body faces the mother's back (OA position).

The mother can walk, rock, and try different delivery positions during labor to help encourage the baby to turn. If the baby does not turn, labor can take longer. Sometimes, the provider may use forceps or a vacuum device to help get the baby out. If the baby stays in the OP position during labor, you have a higher risk of needing to deliver your baby by cesarean delivery (C-section).

Transverse Position

A baby in the transverse position is sideways. Often, the shoulders or back are over the mother's cervix. This is also called the shoulder, or oblique, position.

The risk for having a baby in the transverse position increases if you:

Go into labor early
Have given birth 3 or more times
Have placenta previa
Placenta previa
Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening t...
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Unless your baby can be turned into head-down position, a vaginal birth will be too risky for you and your baby. A doctor will deliver your baby by cesarean birth (C-section).

C-section

A C-section is the delivery of a baby by making an opening in the mother's lower belly area. It is also called a cesarean delivery.

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Less Common Presentations

With the brow-first position, the baby's head extends backward (like looking up), and the forehead leads the way. This position may be more common if this is not your first pregnancy.

Your provider rarely detects this position before labor. An ultrasound may be able to confirm a brow presentation.
Ultrasound
A pregnancy ultrasound is an imaging test that uses sound waves to create a picture of how a baby is developing in the womb (uterus). It is also use...
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More likely, your provider will detect this position while you are in labor during an internal exam.

With face-first position, the baby's head is extended backwards even more than with brow first position.

Most of the time, the force of contractions causes the baby to be in face-first position.
It is also detected when labor does not progress.

In some of these presentations, a vaginal birth is possible, but labor will generally take longer. After delivery, the baby's face or brow will be swollen and may appear bruised. These changes will go away over the next few days.

Open References

References

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Thorp JM, Grantz KL. Clinical aspects of normal and abnormal labor. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 40.

Delivery presentations - illustration
Cephalic (head first) presentation is considered normal, but a breech (feet or buttocks first) delivery can be very difficult, even dangerous for the mother and the baby.
Delivery presentations
illustration
Breech - series
Presentation

<strong>Breech - series</strong><p>The term fetal presentation refers to the part of your baby's body that is closest to the birth canal. In most full-term pregnancies, the baby is positioned head down, or cephalic, in the uterus.</p>

<strong>Breech presentation</strong><p>If your baby is breech, his bottom is the part of his body closest to the birth canal. No one is sure what causes a breech presentation, but it happens in 3% to 5% of single-baby deliveries. As your pregnancy nears full term, your caregiver will check your baby's position during regular prenatal visits. Common methods for assessing fetal position include vaginal exams, ultrasound, feeling your abdomen, and listening to the baby's heartbeat with a Doppler device.</p>

<strong>Types of breech presentation</strong><p>There are three types of breech presentation complete, incomplete, and frank. Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal. Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal. Frank breech is when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal. There is also footling breech where one or both feet are presenting.</p>

<strong>Complications of breech</strong><p>A prolapsed umbilical cord is common in breech deliveries. This happens when part of the umbilical cord slips down through the cervix before the baby does. The cord is then compressed during contractions, which cuts down on blood flow to the baby. An emergency cesarean section is usually needed.</p>

<strong>Correcting breech</strong><p>If you are near term and your baby is breech, your doctor may try to manually move him into a head-down position for delivery. There are two ways to do this. During an external version, the doctor moves your baby by pressing on the outside of your belly. During an internal version, the doctor inserts his hand through your vagina and cervix and moves the baby from the inside. If your doctor cant manually reposition your baby, a cesarean section may be needed.</p>

<strong>Other presentations</strong><p>If your baby is in a posterior position, his face is turned up toward your belly. This can make labor longer and more difficult, since the widest part of his head has to fit through the birth canal. You may be able to help your baby rotate into a normal, face-down position by getting on all fours with your bottom in the air, which allows your uterus to drop forward. Your doctor may also try to reposition your baby by reaching in through your vagina and gently rotating his head with his hand or forceps. If none of these methods works, a cesarean section may be needed.</p>

<strong>Other presentations, Part 2</strong><p>If your baby is transverse, he is lying horizontally in your uterus. Your doctor may try to manually turn him into a head-down position, but a cesarean section is usually needed.</p>

Delivery presentations - illustration
Cephalic (head first) presentation is considered normal, but a breech (feet or buttocks first) delivery can be very difficult, even dangerous for the mother and the baby.
Delivery presentations
illustration
Breech - series
Presentation

Review Date: 11/8/2024

Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Delivery presentations

Your choices and their risks

Occiput Posterior (OP)

Transverse Position

Placenta previa

C-section

Less Common Presentations

Ultrasound

References

Delivery presentations - illustration

Delivery presentations

Breech - series

Delivery presentations - illustration

Delivery presentations

Breech - series

Related Information