Babies born face up or down

Your baby in the birth canal Information | Mount Sinai

Shoulder presentation; Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude; Fetal descent; Fetal station; Cardinal movements; Labor-birth canal; Delivery-birth canal

During labor and delivery, your baby must pass through your pelvic bones to reach the vaginal opening. The goal is to find the easiest way out. Certain body positions give the baby a smaller shape, which makes it easier for your baby to get through this tight passage.

The best position for the baby to pass through the pelvis is with the head down and the body facing toward the mother's back. This position is called occiput anterior.

Childbirth is really a series of four stages that culminate in the actual birth and short period thereafter. For more specific information regarding emergency delivery see the information on childbirth, emergency delivery.

Emergency measures are indicated when childbirth is imminent and no health care professional is present. Indications of late labor include rupturing of the amniotic sac, dilation of the cervix, and appearance of the baby's head at the vaginal opening.

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.

In a normal pregnancy, the baby is positioned head down in the uterus.

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.

Information

Certain terms are used to describe your baby's position and movement through the birth canal.

FETAL STATION

Fetal station refers to where the presenting part is in your pelvis.

The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.

In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.

FETAL LIE

This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between his head and tailbone.

Your baby will most often settle into a position in the pelvis before labor begins.

If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.

FETAL ATTITUDE

The fetal attitude describes the position of the parts of your baby's body.

The normal fetal attitude is commonly called the fetal position.

The head is tucked down to the chest.
The arms and legs are drawn in towards the center of the chest.

Abnormal fetal attitudes include a head that is tilted back, so the brow or the face presents first. Other body parts may be positioned behind the back. When this happens, the presenting part will be larger as it passes through the pelvis. This makes delivery more difficult.

DELIVERY PRESENTATION

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

The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.

This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).

If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.

Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:

A complete breech is when the buttocks present first and both the hips and knees are flexed.
A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
Other breech positions occur when either the feet or knees present first.

The shoulder, arm, or trunk may present first if the fetus is in a transverse lie. This type of presentation occurs less than 1% of the time. Transverse lie is more common when you deliver before your due date, or have twins or triplets.

CARDINAL MOVEMENTS OF LABOR

As your baby passes through the birth canal, the baby's head will change positions. These changes are needed for your baby to fit and move through your pelvis. These movements of your baby's head are called cardinal movements of labor.

Engagement

This is when the widest part of your baby's head has entered the pelvis.
Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).

Descent

This is when your baby's head moves down (descends) further through your pelvis.
Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.

Flexion

During descent, the baby's head is flexed down so that the chin touches the chest.
With the chin tucked, it is easier for the baby's head to pass through the pelvis.

Internal Rotation

As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
Usually, the baby will be face down toward your spine.
Sometimes, the baby will rotate so it faces up toward the pubic bone.
As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.

Extension

As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.

External Rotation

As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.

Expulsion

After the head is delivered, the top shoulder is delivered under the pubic bone.
After the shoulder, the rest of the body is usually delivered without a problem.

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.

Kilpatrick SJ, Garrison E, Fairbrother E. Normal labor and delivery. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 11.

Last reviewed on: 12/3/2020

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

What Does It Mean to Have a Sunny Side Up Baby?

Sunny side up sounds intensely cheerful, conjuring images of bright morning breakfasts and summer days. But hearing that the baby you are carrying is positioned for a sunny side up delivery is far less cheerful.

Looking for information brings up stories of induction, intense back labor, and perineal tearing. Suddenly sunny side up doesn’t seem quite so happy.

But not to fear, only 5 to 8 percent of all births are sunny side up. While your baby may not be ideally positioned for birth there is plenty you can do to prepare for — and possibly even avoid — any issues.

Also known as the occiput posterior position (OP), or posterior position, a sunny side up baby is a baby positioned head down but facing mom’s abdomen, so the baby’s occipital bone (the skull) is against the back of your pelvis.

Because a baby birthed vaginally in this position enters the world facing up, the term “sunny side up” is often applied to these deliveries.

After 34 weeks of pregnancy, your prenatal care will include your healthcare practitioner, doctor, or midwife checking the position of your baby. They’ll often estimate the position by simply feeling the outside of your belly, but the most accurate and reliable way to determine the baby’s position is with an ultrasound.

At some point, they may tell you that your baby is in this position.

What about this position makes it less desirable?

In the sunny side up position, the baby’s back is extended along mom’s spine and baby’s chin is lifted, making the head seem larger as it enters the pelvis versus if the baby is in the anterior position. (The head circumference measures larger from the back than it does from the front).

If you learn that your baby is in this position, take a deep breath. It will be okay! You can still have an entirely successful vaginal delivery, despite the additional strain a face-up position may bring.

Also, keep in mind, while many women are told their near-term babies are in this position, most babies naturally move into the preferred anterior position before delivery.

There are several positions that your baby may be in over the course of your pregnancy.

The best position for delivery is occiput anterior (OA), or “face-down.” This is also referred to as cephalic presentation. This is when baby is in a head-down position and the body is facing mom’s back. In this position, it is easier for the baby’s back to curl and chin to tuck as it travels through the pelvis.

Breech

If the baby is situated head-up in the mother’s uterus, feet aimed to enter the pelvis first, this is called the breech position. Most babies turn to head down naturally by 34 weeks.

But if the baby hasn’t turned by 36 weeks (when there is little to no room left to wiggle around), your healthcare provider will want to discuss the options for turning the baby and for delivery.

Transverse lie

Extremely rare and also known as the sideways or shoulder position, when the baby is transverse lie, he or she is laying horizontally (crosswise) in the uterus.

This means the baby’s shoulder may enter the pelvis first, causing the baby to potentially sustain more birth trauma. If an examination finds that your baby is still in this position by 38 weeks, your doctor or midwife will discuss the delivery options available for you.

As with everything in life, labor comes with some risks. The sunny side up, or posterior position, puts baby’s head where it is more likely to get wedged against the pubic bone.

When this happens, pressure is placed on your spine and sacrum and can cause a longer and more painful delivery.

The potential complications of a sunny side up delivery include:

back labor (more pain in the back than in the abdomen)
prolonged labor and delivery
severe perineal tearing
increased risk for assisted vaginal delivery (forceps or vacuum)
increased need for a cesarean delivery
start and stop labor pattern
less engagement from baby during pushing stage
longer neonatal stay (admission to NICU) in the hospital

If too much strain is placed on you or your baby during labor, your healthcare practitioner, doctor, or midwife will decide if an assisted vaginal delivery or cesarean delivery is necessary.

If you’re nearing full term and your baby is in the occiput posterior position, try not to stress. The human body is capable of many things. Do spend some time discussing the potential risks for both you and your baby in detail with your healthcare provider before agreeing to any procedure.

Pay attention to your body. Your anatomical structure, your posture, and your level of activity all play an important role in how you progress through labor and delivery.

First-time mothers and women with an android pelvis (a narrow pelvic canal) are more likely to have a sunny side up baby. While you can’t change your pelvic shape, you can be aware of possible challenges and discuss options with your doctor.

Likely to be present in taller women, an android shaped pelvis has a heart-shaped or triangular inlet, which can make childbirth more difficult. Unlike women with a gynaecoid pelvis (optimal pelvic shape for having babies), women with an android pelvis typically have to push harder, move around more, and may encounter more labor and delivery difficulties.

Good posture also plays is a key role in how the baby’s position presents at the time of labor and delivery.

Staying in proper alignment while moving your hip and pelvic joints will help the baby move into a more optimal position. To help facilitate a natural rotation of position, stand up straight and keep active. Use an exercise ball instead of a chair (it forces proper alignment). Take a walk around the block.

If you sit for hours throughout the day, keep both feet firmly on the ground, lengthen your spine like a giraffe’s neck, and keep your shoulders back

Once active labor has begun, don’t feel like you have to stay in one laboring position. One 2014 study found that rotation to anterior position is less likely to occur in women who spend at least 50 percent of laboring time in a recumbent position (lying on your back or side).

Women who favor other positions, such as on all fours, squatting, and sitting on a ball, may have a better chance of rotating the baby to an anterior position before delivery. As an added bonus, hands-and-knees positioning, where you’re relieving pressure of the baby pushing against your spine, can help provide pain relief, too.

It’s possible during labor that your doctor may suggest using forceps or a vacuum when a sunny side up baby gets stuck against the pelvic bone. Some doctors and midwives will even perform manual rotation from a posterior to an anterior position at full dilation.

Every woman, every baby, and every delivery is different.

Despite the difficulties, you can have a healthy vaginal delivery with a sunny side up baby. Working with your healthcare provider and discussing your options is key to your success.

If you have a sunny side up baby, it will be okay! Stay positive.

And don’t forget to stand up straight.

Effect of turning unborn babies [fetuses] from buttocks down to head down at the end of pregnancy (around 36 weeks or later) on reducing problems during childbirth

What is the problem (question)?

The best birth outcomes for mothers and their babies are achieved when the baby is born head first. If the baby is in a different position, this poses a high risk of complications, including the need for a caesarean section. In a breech presentation, the baby is in the buttocks down position instead of the head down position. External cephalic rotation (ECT) is a technique in which the unborn baby is rotated so that it lies in the head-down position. This review looked at the impact of NPG use on babies who were in breech position at the end of pregnancy (around 36 weeks and beyond). nine0005

Why is this important?

Everyone wants to avoid complications in childbirth, and many women want to avoid having a caesarean section. The ability to avoid the need for surgery is very important in countries with limited health care resources. NPG is sometimes used until the end of pregnancy (around 34 weeks), but results may vary if this method is used just before delivery. Also, at this late stage, it may not be possible to rotate the unborn child [fetus]. We wanted to find out whether the use of NPG at the end of pregnancy leads to safe delivery (safe delivery of the baby) or whether it could be harmful. nine0005

What evidence did we find?

We found 8 studies involving 1308 women. (We included studies published up to 28 February 2015). All studies were randomized and included women with low-risk pregnancies. The use of NPG at around 36 weeks' gestation or later increased the chances of having babies head-first and reduced the risk of having a caesarean section. There were no clear differences in other outcomes, such as the risk of infant death. The quality of the studies, and hence the strength of the evidence, varied. nine0005

What does this mean?

If the unborn child [fetus] is in the buttocks down position, performing external cephalic rotation just before delivery may reduce some of the problems that this fetal position can cause. These studies are too small to show whether NPG use is safe in low-risk pregnant women, but other types of studies suggest it is safe. We also do not know whether NPG should be used in high-risk cases, such as mothers who have had a previous caesarean section or mothers who are expecting twins. nine0005

An illustrative summary of some of the results of this survey can be found here.

Translation notes:

Translation: Yudina Ekaterina Viktorovna. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]

nine0000 How your baby is born: the whole process step by step - Parents.ru

Photo: Mustafagull/Getty Images/E+

neonatologist

The baby decides when to be born. It is his endocrine system that triggers the birth mechanism, stimulating the production of the main birth hormone, oxytocin, in the mother. Normally, this happens when all the systems and organs of the child are already fully prepared for independent life - usually at the 38-40th week of pregnancy. nine0005

In order for the birth of a baby to go smoothly, the process must be gradual, and therefore preparation for it begins in advance, about 2 weeks before the decisive day. Under the influence of the hormones of the child's body, in particular, those produced by the adrenal cortex, more and more oxytocin is produced in the mother's body, which causes contractions of the muscles of the uterus, estrogen (they increase uterine tone) and relaxin (it softens the muscles and ligaments). At the 38th week, the baby's head moves closer to the exit from the uterus, and the expectant mother notices that the stomach has dropped a little. The uterus is increasingly contracting - but so far these irregular preparatory contractions do not cause discomfort to either the child or the mother and usually go unnoticed by them. nine0005

Photo: kieferpix/Getty Images/iStockphoto

The first stage

Birth is stressful and hard work for a little man. The walls of the native dwelling, where the baby spent 9 months, suddenly begin to put pressure on their inhabitant, he is irresistibly drawn somewhere down, where he has to squeeze through a narrow winding labyrinth, and besides, in the process of childbirth, the supply of oxygen and nutrition stops every now and then. As in an adult in moments of physical and mental stress, a child during childbirth sharply increases the level of "stress hormones" catecholamines (adrenaline, norepinephrine and dopamine). Fortunately, wise nature has provided a number of protective measures that make it easier for the baby to be born. So, along with catecholamines, endorphins and enkephalins are intensively produced in the child's body - substances that create an analgesic effect and help the body mobilize forces. nine0005

During the first stage of labor, when the cervix opens under the influence of contractions, the baby is busy gradually descending from the uterine cavity to the entrance to the small pelvis. Moving head forward and pushing it like a battering ram, the child covers a distance of only a few centimeters, but this journey takes as much as 6-12 hours. Such slowness is very important, because if the process happens too quickly, it threatens the child with birth injuries.

With each contraction, the baby feels pressure from the muscles of the uterus and abdominals. But, due to the fact that the baby is surrounded by amniotic fluid, this pressure is softened. When the uterus contracts, the placenta contracts, and the blood flow to the baby for the duration of the contraction (and in the midst of childbirth, it lasts up to 1 minute) stops. To compensate for the lack of oxygen, the baby's heart begins to beat faster - up to 180 beats per minute instead of 140 at rest. At the moment of tension of the uterus, the baby freezes, in order to then take the next “step” forward. nine0005

Photo: Robert Lang Photography/Getty Images

Steep route

The baby's direct entry into the world occurs during the period of pushing, which occurs after the cervix is fully dilated. This stage of childbirth is considered the most time-consuming for both the child and the mother. The woman is actively pushing, straining the abdominal muscles, and the baby's head, under the influence of contractions, passes through the small pelvis and enters the genital gap. As the child moves through the narrow space of the small pelvis, the bones of his skull are on top of each other, adapting to the winding route. The torso of the baby, first of all, the chest, is also “compacted”. nine0005

On the top of the head and the back of the head, there is swelling of the subcutaneous adipose tissue - a birth tumor that protects the baby's brain from pressure. In the most common development of events, the back of the baby's head is shown first, then the crown, forehead and face facing down towards the floor. After the birth of the entire head, the baby turns 90 °, facing the mother's thigh, and the upper and lower shoulders come out in turn. Now we can assume that the main work has already been done: after the birth of the head (the largest part of the child's body) and shoulders, the torso and legs come out without problems. nine0005

During childbirth, mother and baby work in sync. So, at the initial stage of labor, contractions force the child to move towards the exit from the uterus, and he, in turn, presses his head on the cervix, opening it from the inside. During the period of exile, the mother pushes, straining the abdominal muscles, and the baby pushes the back of the head against the pelvic floor more and more, due to which the attempts become more frequent and intense.

Cardiotocography helps doctors judge how the baby feels during childbirth. It allows you to evaluate the heart rate of the baby, as well as the tone of the uterus of his mother. The rhythm of the baby's heartbeat changes every now and then during childbirth. But doctors, knowing what changes should occur in the norm, can immediately respond if violations occur. For example, during the period of attempts, the pulse becomes less frequent when the baby's head passes the narrowest part of the mother's small pelvis. Movement in this area normally takes only a few minutes, but if the baby is delayed and the heart rate remains slow for too long, then the child needs urgent help: a caesarean section or the imposition of obstetric instruments. nine0005

Photo: Handemandaci/Getty Images

Welcome!

A baby greets his birth with a loud cry - this is a reflex reaction to a change in environmental conditions (temperature, lighting, etc.) and the first supply of oxygen to the lungs. Thanks to this, they straighten out, and the fetal fluid that filled them before birth comes out of them. The deeper the first breath, the more the newborn cries. It is no coincidence that the loud crying of a baby is considered one of the important indicators of his health. If there is no scream or it is barely audible, then the baby has breathing problems and needs emergency help. A healthy newborn breathes frequently, actively moves his arms and legs, his heart beats quickly (more than 100 beats per minute). He screams indignantly if his heels are tickled to test his reflexes; sneezes and coughs when clearing the nose and mouth. nine0005

As soon as the baby is born, a whole flurry of new sensations falls upon him. These are the touches of human hands (before, the baby only felt the splash of amniotic fluid), bright light and loud sounds, too harsh after darkness and silence in the uterus. And yet ... cold - after all, in the uterine cavity the temperature is 37-38 ° C, and in the birth block - "only" 23-24 ° C.

As soon as the baby is born, it is immediately placed on the mother's chest and a few drops of colostrum are dripped into the mouth. It’s great if dad is next to the newborn at this moment. The closeness of parents (of course, primarily mothers) in the first minutes of life is very important, because on a subconscious level, the whole situation of birth is stored in the memory of the child. The atmosphere, emotions, sensations with which a little man crosses the threshold of a new world may affect his psychological health in the future. It is no coincidence that psychologists and biologists consider imprinting - the perception of the first life impressions (tactile, auditory, visual, etc.