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Mayo Clinic Health Library

Slide show: Fetal presentation before birth

Updated: 08-11-2020

Settling into position

Illustration of babies in various fetal positions

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.

Head down — Facing down

Illustration of baby in the facedown position

Your baby's position refers to the relationship of its presenting body part to your pelvis. In headfirst presentations (cephalic), the back of the head (occiput) is the reference.

Head down — Facing up

Illustration of baby in the faceup position

This baby is presenting headfirst (cephalic) with its head facing up (occiput posterior). In this position, the baby might have a harder time extending his or her head from under the pubic bone.

Most babies eventually turn on their own, if there's enough room. If your baby is in this position and the second stage of labor is taking too long, your health care provider might reach through your vagina and use his or her hand to help your baby rotate (manual rotation). Your baby might also be delivered in this position.

Frank breech presentation

Illustration of baby in the buttocks-first position

A breech presentation occurs when the baby's buttocks or feet or both are in place to come out first during birth. Breech presentation is often determined by fetal ultrasound at the end of pregnancy.

This baby is in the frank breech presentation — with both hips flexed and both knees extended and the feet close to the head. The frank breech presentation is the most common type of breech presentation.

At or near term, your health care provider might try to rotate the baby by placing his or her hands on your abdomen and applying pressure (external cephalic version). Your baby's health will be evaluated before and after the procedure. If it is not safe for you to have a vaginal delivery, for example, due to the location of your placenta, your health care provider will not recommend an external cephalic version. The procedure is only done in a setting where a C-section is readily available if needed.

Complete breech presentation

Illustration of baby in the feet-first position

This baby is in a complete breech presentation — with both hips and both knees flexed. In an incomplete breech, one or both hips are not flexed and one or both feet or knees lie below the buttocks. In either presentation, you might feel kicking in your lower abdomen.

If your baby is in a complete or incomplete breech, at or near term your health care provider might try to rotate the baby by placing his or her hands on your abdomen and applying pressure (external cephalic version). Your baby's health will be evaluated before and after the procedure. If it is not safe for you to have a vaginal delivery, for example, due to the location of your placenta, your health care provider will not recommend an external cephalic version. The procedure is only done in a setting where a C-section is readily available if needed.

Lying sideways

Illustration of baby lying sideways

This baby is in a transverse lie — positioned horizontally across the uterus, rather than vertically. In a transverse lie, the baby's back might be positioned:

  • 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

Although many babies are sideways early in pregnancy, few remain this way when labor begins.

If your health care provider determines that your baby is in a transverse lie before labor starts, at week 37 of pregnancy he or she will try to rotate the baby by placing his or her hands on your abdomen and applying pressure (external cephalic version). Your baby's health will be evaluated before and after the procedure. If it is not safe for you to have a vaginal delivery, for example, due to the location of your placenta, your health care provider will not recommend an external cephalic version. The procedure is only done in a setting where a C-section is readily available if needed. If active labor has already begun, a C-section is recommended.

Twins

Illustration of twins

Twins can usually be delivered vaginally if the lower twin is presenting headfirst (cephalic). If only the lower twin is headfirst, as shown here, your health care provider might deliver the lower twin vaginally. Then, your health care provider will rotate the remaining twin by placing his or her hands on your abdomen and applying pressure (external cephalic version) and deliver the baby vaginally or if the baby is breech and certain conditions are met, deliver the baby buttocks first. If this can't be done, your health care provider will discuss delivery by C-section.

If the lower twin isn't positioned headfirst or neither twin is headfirst, both twins are usually delivered by C-section.

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