The baby’s position in the womb is a crucial information for deciding the delivery method and understanding what are some possible implications for both the mother and the baby during childbirth. In this article, you’ll learn what is foetal position and foetal presentation!
If you’re pregnant and have been undergoing ultrasounds to monitor the baby’s development, you’ve likely come across references to “fetal position” and “fetal presentation” in your reports. But what do fetal presentation and position actually mean? What do all those words like posterior, anterior, dorsal, transverse, pelvic, and cephalic signify? Take a deep breath and keep reading to understand!
To understand how the baby is positioned inside the womb, we consider two aspects: fetal position (cephalic, pelvic, or breech) and fetal presentation (longitudinal, oblique, or transverse).
What is Fetal Presentation or Fetal Lie?
Fetal presentation refers to how the fetus is positioned, specifically whether if his/her back (dorsum) is facing the front of the mother’s belly, the right or left side of the mother’s ribs, or even the mother’s back (back-to-back). Let’s look at the image below:
There are 3 types of fetal presentation:
- Longitudinal: The fetus is in a vertical position;
- Transverse: The fetus is “lying down” horizontally;
- Oblique: The fetus is “crosswise,” not entirely vertical or horizontal.
What is fetal position?
Fetal position refers to the placement of the fetus in the uterus, indicating how the baby is positioned inside the mother’s belly. This information typically appears in ultrasound scans conducted during pregnancy and helps the healthcare professionals monitoring the expectant mother understand how the baby is positioned and whether it may facilitate or complicate a vaginal delivery.
If you’re pregnant, you’ve probably noticed that babies move A LOT in the belly! And, of course, with all these movements, along with the baby’s own development, which over time may need a change in position within the uterus given that he or she will get bigger and bigger and, consequently, will have less space, the way the baby is positioned in the belly also changes: the direction the baby is facing, whether facing towards or away from the mother, whether his/her head is fitted in the pelvis, or if he/she is “sitting” at the mother’s pelvis.
Let’s explore each of the fetal positions one by one!
Cephalic position (Occiput)
“Occiput position” may sound weird, but it’s simply the well-known cephalic position cephalic. This means that the baby’s head is positioned in the pelvis of the mother, indicating that the baby is head down. The occiput/cephalic position is the most common fetal position in the vast majority of pregnancies (approximately 96%). The baby typically assumes this position around week 36.
The term “occiput” refers to the occipital bone, which all humans have on the back of our head, therefore the name. That is, when we refer to the “occiput,” we are usually talking about the back of the baby’s head.
The cephalic position is the ideal fetal position for a vaginal birth. This is because the baby’s skull bones are not completely fused and are, in fact, quite malleable, allowing the head to adapt to the passage of the vaginal canal during the expulsion phase.
Left and Right Occiput Position
The term “back” refers to the baby’s back, indicating which side the baby’s back is facing relative to the mother. Right Occiput position means that the baby is head down, and its back is positioned to the right side of the mother’s pelvis. Left Occiput position means that the baby is head down and its back is facing the left side of the mother’s pelvis.
Anterior and Posterior Occiput Positions
The term “back” refers to the baby’s back, indicating which side the baby’s back is facing relative to the mother. Cephalic position with the back to the right means that the baby is head down, and its back is positioned to the right side of the mother’s pelvis. Cephalic position with the back to the left means that the baby is head down, and its back is facing the left side of the mother’s pelvis.
What does Breech Fetal Position mean?
“Transverse” is when the baby is “crossed” in the uterus, meaning neither head up nor head down but lying diagonally. The term “breech” specifically refers to the baby’s trunk and shoulders. This position is considered abnormal, and less than 1% of women carry a baby to full term in the transverse position.
If your baby is in this position, you may see the term “Cephalic Pole” in ultrasound reports. “Cephalic Pole” refers to which side the baby’s head is positioned, whether to the right or left of the mother’s pelvis.
Although, depending on the mother’s health conditions, the external cephalic version maneuver (ECV) may be a possibility. ECV is a maneuver performed on the women’s belly by experienced medical professionals to “re-arrange” the baby’s position. However, the breech or transverse position is the only fetal position with an absolute and real indication for a c-section.
What is the Breech Position?
Breech position means that the baby has its head up and buttocks down, in other words, it is “sitting” on the mother’s pelvis. While around 28% of babies are breech until 28 weeks, this position occurs in only 3% to 4% of cases after 26 weeks, making the breech fetal position uncommon.
Is a breech baby an indication for a c-section?
No, it is not. In fact, the World Health Organization (WHO) recommends that in cases of full-term pregnancies with breech babies, at least an attempt should be made to perform External Cephalic Version (ECV).
However, the reality is that few hospitals, both public and private, have professionals trained to perform this maneuver. There are various less invasive “techniques” recommended by different professionals worldwide, although there is limited scientific literature on their effectiveness. Some of these techniques include moxibustion, an acupuncture technique using heat; the Spinning Babies method, which combines prenatal yoga and pilates positions, utilizing gravity to influence the baby’s position; or, as a less robust option recommended as a “last resort” by some doulas, performing successive somersaults in the water.
Is it possible to have a vaginal birth with a breech baby?
Yes, it is possible, although it’s crucial to be under the care of experienced professionals in such situations, as it requires specific precautions to avoid injuring the baby during delivery. If the baby is in a longitudinal position and not transverse, a vaginal birth is still possible.
However, this is rare in public healthcare settings. Vaginal births with breech babies tend to be longer than those with cephalic babies and involve more risks for both the mother (especially the risk of tearing) and the baby. Therefore, each case should be carefully evaluated with attention to the smallest details.
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