Birth Presentations How Does Your Baby Lie?

As babies grow and develop they need to find the most comfortable and accommodating position in the womb. Babies can switch positions in the womb frequently, depending on how large they are and how generous the uterus is. However, by the time labor arrives, babies generally figure out how to get in the right position to make their way out into the world. But what position is the right position? What if your baby can't turn around? It is important to know the possible positions of childbirth and what steps to take to have a safe and healthy labor delivery.

The term presentation refers to the position of your baby as it moves into the birth canal. Babies can move many times and into many different positions before labor arrives. Generally speaking, most babies come to the same final presentation. These babies are born in a head-first (or crowning labor) position and facing downwards.

[line drawing of delivery]

However, some will position themselves in a more difficult presentation. The positions of these babies, who account for less than 5% of all births, are called fetal malpresentations. Babies who have a premature birth, have little room in the uterus, or are stuck in a breech position may be unable to reposition. If they are unable to do so, a doctor may be able to assist the baby in turning. If this fails, a natural birth may be impossible. A cesarean birth instead of a vaginal birth may be the safest option.

Fetal Lie
Fetal lie is another important part of a baby's presentation. The position of the baby's spine in relation to its mother's is called the fetal lie. The vast majority of babies lie in the same direction as the mother's spine. This is called a cephalic lie. However, a baby's spine can sometimes lie at an angle to the mother's. When the baby is off on a slight angle it is called an oblique lie. This is fairly rare, occurring in only 1 out of every 300 births. When your baby lies at a right angle to your spine, creating a T-shape, it is called a transverse lie. This too is rare, occurring in only 1 out of every 300 births.

When the fetal lie is not in line with the mother's spine, some problems can occur. Cord prolapse, or when your baby's umbilical cord arrives before she does, is the most common problem associated with oblique and transverse fetal lies. This can sometimes stop oxygen and blood from reaching your baby's brain, resulting in tissue, organ, or brain damage. Generally, most babies will right themselves before labor. However, if you know your baby is in a difficult lie and your water breaks, seek medical help right away.

Flexion Attitude
Flexion attitude is the final aspect making up your baby's presentation. The position of baby's head at childbirth is called flexion attitude. Most babies arrive in a downward-facing position, with their chin touching their chest. Although irregularities in flexion attitude are rare, they can occur. Some babies arrive looking up, called face presentation. Others arrive in brow presentation. These babies do not have their chins tucked up to their chest, resulting in the brow of the head arriving first. However, only 1 out of every 500 births exhibit these types of flexion attitude.

Breech Birth
The most common type of fetal malpresentation is the breech birth. In this position the baby arrives feet, knees, or buttocks first. Fewer than 3-4% of babies are born in this position. Often, the doctor or midwife can try to gently move the baby by applying pressure to your abdominal wall. Half of all breech babies can be moved into a better presentation by doing this. Shifting of the baby is best done after 36 weeks and before labor begins. If your baby is still in a breech presentation during labor, a natural or home birth may be difficult. Instead a cesarean section is likely the best option.

There are various breech positions in which your baby can present herself. If she arrives buttocks first in a V-shaped position, with the legs extending over the head, it is called a frank breech. In a complete breech, your baby arrives sitting with both legs crossed and pushed up. An incomplete breech presentation will have the baby arriving with one leg crossed and one leg extending down the birth canal.

A footling presentation is similar to an incomplete breech presentation. In this presentation, the baby will arrive with one leg stretched down the birth canal. If two legs are extended into the birth canal, it is called a double footling presentation.

Compound Presentation
In a compound presentation, more than one part of the baby arrives at the same time. The most common arrival is likely to be the head and the arm together. This presentation is only a problem if your pelvis will not allow for the extra space necessary to birth the baby. In this case, an episiotomy may need to be done while you are giving birth or, in extreme cases, a cesarean section, to ensure the safe delivery of the baby.

Shoulder Presentation
This presentation, with the shoulders arriving first, is among the most rare. Only 1 out of every 1000 babies arrive in this position. It is necessary to have your doctor reposition the baby if possible. If labor has already begun, a cesarean section will be required

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