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Malpresentation

High-Risk Obstetrics, Fetal Malpresentation, Menopause Center of Los AngelesAs the baby reaches the later stages of pregnancy, it moves into position for delivery. If the mother is lying on her back, the most common and safest birth presentation for the baby is:

  • Facing downward
  • Coming out headfirst
  • Tucking its chin into its chest
  • Folding its arms across the chest
  • Angling its face and body to the right or left of the mother’s spine

There are many variations on this position, which are called malpresentation or abnormal presentations. Some of these can, unfortunately, make labor more difficult or painful. Others may require a Cesarean delivery.

Breech Presentation

A baby in breech presentation is coming out bottom-first or feet-first. Breech babies can sometimes be cross-legged or have their feet reaching up toward their head. The doctor may be able to adjust the baby’s position before the mother goes into labor by strategically pressing on the abdomen and using an ultrasound as a guide. This can be uncomfortable and might require some regional anesthesia. If this doesn’t work, a Cesarean delivery may be recommended.

Face Up

Babies exiting the womb head first but facing up instead of down towards the mother’s back are in the occiput posterior position, which is commonly called “sunny side up.” Most of the time, uterine contractions or the mother’s pushing will rotate the baby to face down. If they don’t, the mother might experience longer labor, more back pains, and difficulty pushing out the baby.

Transverse Presentation

In most pregnancies, the baby will end up with its spine vertical in the womb. Some, however, are lying horizontally, or “transverse”, in the womb. It’s very unsafe to deliver the baby vaginally in this way.  The doctor may try to adjust the baby’s positioning before labor or recommend a Cesarean delivery.

Compound Presentation

Breech Presentations, Transverse Presentation, Malpresentation, Menopause Center of Los AngelesWhen a baby’s hand or foot is presented alongside the baby’s head or bottom, this is known as compound presentation. Usually, we don’t know if the baby will present this way until the mother starts pushing. Luckily, it is not a cause for concern.  Most babies presenting this way can continue with vaginal delivery.

Face/Brow Presentation

If the baby’s neck is outstretched and its chin is pointing away from its chest, its face or brow will present first. This presentation is fairly rare, but when it does happen, labor is usually longer. The newborn’s face and head may be swollen or bruised for a few days. Typically this presentation can be delivered vaginally but occasionally a C-section is required.

Shoulder Dystocia

Shoulder dystocia occurs when the baby’s head has exited the birth canal, but its shoulders get stuck in the canal by the pelvic bone. It’s hard to predict when this may happen, but if it does, it is considered a medical emergency.

Your doctor may need to manually adjust the baby in order to free the shoulders. In the best-case scenario, the maneuvering works and the baby is delivered vaginally with no harm. Occasionally, the baby is injured in the process. It’s rare for a C-section to be performed in this case.

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