vertex presentation in childbirth

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Vertex Position: What It Is, Why It's Important, and How to Get There

Jamie Grill / Getty Images

What Is the Vertex Position?

• Why It's Important

When the Vertex Position Usually Occurs

• How to Get Baby in This Position

Options if Baby Is Not in the Vertex Position

While you are pregnant, you may hear your healthcare provider frequently refer to the position or presentation of your baby, particularly as you get closer to your due date . What they are referring to is which part of your baby is presenting first—or which part is at the lower end of your womb or the pelvic inlet.

Consequently, when they tell you that your baby's head is down, that likely means they are in the vertex position (or another cephalic position). This type of presentation is the most common presentation in the third trimester. Here is what you need to know about the vertex position including how you might get your baby into that position before you go into labor .

The vertex position is a medical term that means the fetus has its head down in the maternal pelvis and the occipital (back) portion of the fetal skull is in the lowest position or presenting, explains Jill Purdie, MD, an OB/GYN and medical director at Northside Women’s Specialists , which is part of Pediatrix Medical Group.

When a baby is in the vertex position, their head is in the down position in the pelvis in preparation for a vaginal birth, adds Shaghayegh DeNoble, MD, FACOG , a board-certified gynecologist and a fellowship-trained minimally invasive gynecologic surgeon. "More specifically, the fetus’s chin is tucked to the chest so that the back of the head is presenting first."

Why the Vertex Position Is Important

When it comes to labor and delivery, the vertex position is the ideal position for a vaginal delivery, especially if the baby is in the occiput anterior position—where the back of the baby's head is toward the front of the pregnant person's pelvis, says Dr. DeNoble.

"[This] is the best position for vaginal birth because it is associated with fewer Cesarean sections , faster births, and less painful births," she says. "In this position, the fetus’s skull fits the birth canal best. In the occiput posterior position, the back of the fetus's head is toward the [pregnant person's] spine. This position is usually associated with longer labor and sometimes more painful birth."

Other fetal positions are sometimes less-than-ideal for labor and delivery. According to Dr. DeNoble, they can cause more prolonged labor, fetal distress, and interventions such as vacuum or forceps delivery and Cesarean delivery.

"Another important fact is that positions other than vertex present an increased risk of cord prolapse, which is when the umbilical cord falls into the vaginal canal ahead of the baby," she says. "For example, if the fetus is in the transverse position and the [pregnant person's] water breaks , there is an increased risk of the umbilical cord prolapsing through the cervix into the vaginal canal."

When it comes to your baby's positioning, obstetricians will look to see what part of the fetus is in position to present during vaginal birth. If your baby’s head is down during labor, they will look to see if the back of the head is facing your front or your back as well as whether the back of the head is presenting or rather face or brow, Dr. DeNoble explains.

"These determinations are important during labor, especially if there is consideration to the use of a vacuum or forceps," she says.

According to Dr. Purdie, healthcare providers will begin assessing the position of the baby as early as 32 to 34 weeks of pregnancy. About 75% to 80% of fetuses will be in the vertex presentation by 30 weeks and 96% to 97% by 37 weeks. Approximately 3% to 4% of fetuses will be in a non-cephalic position at term, she adds.

Typically, your provider will perform what is called Leopold maneuvers to determine the position of the baby. "Leopold maneuvers involve the doctor placing their hands on the gravid abdomen in several locations to find the fetal head and buttocks," Dr. Purdie explains.

If your baby is not in the vertex position, the next most common position would be breech, she says. This means that your baby's legs or buttocks are presenting first and the head is up toward the rib cage.

"The fetus may also be transverse," Dr. Purdie says. "The transverse position means the fetus is sideways within the uterus and no part is presenting in the maternal pelvis. In other words, the head is either on the left or right side of the uterus and the fetus goes straight across to the opposite side."

There is even a chance that your baby will be in an oblique position. This means they are at a diagonal within the uterus, Dr. Purdie says. "In this position, either the head or the buttocks can be down, but they are not in the maternal pelvis and instead off to the left or right side."

If your baby's head is not down, your provider will look to see if the buttocks are in the pelvis or one or two feet, Dr. DeNoble adds. "If the baby is laying horizontally, then the doctor needs to know if the back of the baby is facing downwards or upwards since at a Cesarean delivery it can be more difficult to deliver the baby when the back is down."

How to Get Baby Into the Vertex Position

One way you can help ensure that your baby gets into the vertex position is by staying active and walking, Dr. Purdie says. "Since the head is the heaviest part of the fetus, gravity may help move the head around to the lowest position."

If you already know that your baby is in a non-cephalic position and you are getting close to your delivery date, you also can try some techniques to encourage the baby to turn. For instance, Dr. Purdie suggests getting in the knee/chest position for 10 minutes per day. This has been shown to turn the baby around 60% to 70% of the time.

"In this technique, the mother gets on all fours, places her head down on her hands, and leaves her buttock higher than her head," she explains. "Again, we are trying to allow gravity to help us turn the fetus."

You also might consider visiting a chiropractor to try and help turn the fetus. "Most chiropractors will use the Webster technique to encourage the fetus into a cephalic presentation," Dr. Purdie adds.

There also are some home remedies, including using music, heat, ice, and incense to encourage the fetus to turn, she says. "These techniques do not have a lot of scientific data to support them, but they also are not harmful so can be tried without concern."

You also can try the pelvic tilt , where you lay on your back with your legs bent and your feet on the ground, suggests Dr. DeNoble. Then, you tilt your pelvis up into a bridge position and stay in this position for 10 minutes. She suggests doing this several times a day, ideally when your baby is most active.

"Another technique that has helped some women is to place headphones low down on the abdomen near the pubic bone to encourage the baby to turn toward the sound," Dr. DeNoble adds. "A cold bag of vegetables can be placed at the top of the uterus near the baby’s head and something warm over the lower part of the uterus to encourage the baby to turn toward the warmth. [And] acupuncture has also been used to help turn a baby into a vertex position."

If you are at term and your baby is not in the vertex position (or some type of cephalic presentation), you may want to discuss the option of an external cephalic version (ECV), suggests Dr. Purdie. This is a procedure done in the hospital where your healthcare provider will attempt to manually rotate your baby into the cephalic presentation.

"There are some risks associated with this and not every pregnant person is a candidate, so the details should be discussed with your physician," she says. "If despite interventions, the fetus remains in a non-cephalic position, most physicians will recommend a C-section for delivery."

Keep in mind that there are increased risks for your baby associated with a vaginal breech delivery. Current guidelines by the American College of Obstetricians and Gynecologists recommend a C-section in this situation, Dr. Purdie says.

"Once a pregnant person is in labor, it would be too late for the baby to get in cephalic presentation," she adds.

A Word From Verywell

If your baby is not yet in the vertex position, try not to worry too much. The majority of babies move into either the vertex position or another cephalic presentation before they are born. Until then, focus on staying active, getting plenty of rest, and taking care of yourself.

If you are concerned, talk to your provider about different options for getting your baby to move into the vertex position. They can let you know which tips and techniques might be right for your situation.

American College of Obstetrics and Gynecology. Obstetrics data definitions .

National Library of Medicine. Vaginal delivery .

Sayed Ahmed WA, Hamdy MA. Optimal management of umbilical cord prolapse .  Int J Womens Health . 2018;10:459-465. Published 2018 Aug 21. doi:10.2147/IJWH.S130879

Hjartardóttir H, Lund SH, Benediktsdóttir S, Geirsson RT, Eggebø TM. When does fetal head rotation occur in spontaneous labor at term: results of an ultrasound-based longitudinal study in nulliparous women .  Am J Obstet Gynecol . 2021;224(5):514.e1-514.e9. doi:10.1016/j.ajog.2020.10.054

Management of breech presentation: green-top guideline no. 20b .  BJOG: Int J Obstet Gy . 2017;124(7):e151-e177. doi:10.1111/1471-0528.14465

Kenfack B, Ateudjieu J, Ymele FF, Tebeu PM, Dohbit JS, Mbu RE. Does the advice to assume the knee-chest position at the 36th to 37th weeks of gestation reduce the incidence of breech presentation at delivery?   Clinics in Mother and Child Health . 2012;9:1-5. doi:10.4303/cmch/C120601

Cohain JS. Turning breech babies after 34 weeks: the if, how, & when of turning breech babies .  Midwifery Today Int Midwife . 2007;(83):18-65.

American College of Obstetrics and Gynecology. If your baby is breech .

By Sherri Gordon Sherri Gordon, CLC is a published author, certified professional life coach, and bullying prevention expert. 

• Third Trimester
• Labor & Delivery

What Is Vertex Presentation?

Vertex presentation is just medical speak for “baby’s head-down in the birth canal and rearing to go!” About 97 percent of all deliveries are headfirst, or vertex—and rare is the OB who will try to deliver any other way.

Other, less common presentations include breech (when baby’s head is near your ribs) and transverse (which means the shoulder, arm or trunk is due to come out first because baby is lying on his side). Most babies will turn by about 34 weeks, but some have “unstable lies,” meaning they’re like a politician trying to make everyone happy—that is, they frequently flip positions.

About 95 percent of all babies will be head-down and ready to go by delivery day. If your little one isn’t vertex by 36 weeks, ask your doctor about your options. She may recommend doing a version procedure , in which the doctor tries to manually turn baby by pushing on your abdomen, but it does carry some risks and is only about 60 to 70 percent successful.

Expert: Melissa M. Goist, MD, assistant professor, obstetrics and gynecology, The Ohio State University Medical Center.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

Delivering a breech baby?

Shift breech baby before birth?

Will my baby be breech?

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Appointments at Mayo Clinic

• Pregnancy week by week
• Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

• Down, with the back facing the birth canal.
• Sideways, 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 stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

• An attempt to deliver the baby in the breech position is not successful.
• You do not want to try to have the baby delivered vaginally in the breech position.
• An attempt to move the baby into a head-down position is not successful.
• You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

• Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
• Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
• Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
• Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
• Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

Was this article helpful?

What to know if your baby is breech

What happens to your baby right after birth

What's a sunny-side up baby?

How your twins’ fetal positions affect labor and delivery

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls.  https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70.  https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

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When Will Your Baby Turn Head Down?

During pregnancy, your baby’s position can change frequently. One of the most important changes occurs when the baby turns to a headfirst, head-down position in the uterus, which often happens toward the end of your pregnancy. Wondering when “should” your baby be head down, or how to tell if your baby is head down? Get these answers as well as more information on the baby’s head-down position, the symptoms of a baby turning head down, and the optimal baby position for birth.

Why Does a Baby Turn to a Head-Down Position for Birth?

So, what does it mean when a baby is head down? Babies generally turn head down toward the birth canal as a part of their natural instinct to get into the best possible position for birth. This is known as the vertex or cephalic presentation . A baby may settle into the optimal position, which is head down and facing the mother's back ( occiput anterior position ), but occasionally they may position themselves head down and face forward ( occiput posterior position ). The face-forward position may cause more discomfort during delivery.

Remember, each pregnancy is unique. If you have any concerns about your baby's position, it's always best to consult your healthcare provider.

When Does a Baby Turn Head Down?

Curious about when a baby “should” be head down? It’s important to remember that the exact timing of when a baby turns head down can vary from pregnancy to pregnancy. Generally, babies turn head down during the third trimester (which ranges from 28 to 40 weeks), a few weeks before birth.

How to Tell if Your Baby Is Head Down

To determine your baby’s position, your healthcare provider will usually perform a physical exam during the final few weeks of your pregnancy, feeling your abdomen to locate your baby’s head. They may also perform an ultrasound to confirm the position, especially if your baby is suspected of being in breech presentation, meaning your baby’s feet or buttocks are positioned downward, lower than the head.

So, how to tell if your baby is head down without an ultrasound? And can you feel when your baby turns head down? You may notice signs and symptoms indicating your baby is turning head down. These could include:

Pressure on your bladder, which may cause frequent urination

Pressure in your pelvis and hips

A reduction of pressure against your diaphragm and lungs, making it easier to breathe

The area where you feel kicks when your baby is head down. You may feel kicks higher in your belly or under your ribs when your baby is head down, whereas in the breech position, you may feel kicks lower in your belly.

These symptoms may be more evident when your baby “drops” lower into your pelvis in preparation for labor. This process is known as lightening .

Remember, every pregnancy is different, and you may not experience any sensation or signs that your baby is head down.

If you're unsure if your baby is head down, your healthcare provider can confirm the position during a prenatal checkup.

What if Your Baby Doesn’t Move Head Down?

When a baby is not head down, they might be in what's known as a breech position or a sideways transverse lie position . In a breech position, the baby's buttocks or feet are positioned to descend down the birth canal first, instead of the head. This position can pose certain risks during vaginal birth , as the baby's head is the last part to emerge. Three main types of breech positions include frank breech, complete breech, and footling breech.

If you're getting closer to your due date and your baby is still not head down, there are a few options that your healthcare provider may consider:

External cephalic version (ECV), a procedure in which a healthcare provider gently manipulates the baby's position from outside the belly. This procedure is usually performed if your baby isn’t in the head-down position after 36 weeks of pregnancy.

A planned cesarean birth ( cesarean section or c-section ) , if the baby's position cannot be changed or poses risks during vaginal delivery.

It's important to discuss these options with your healthcare provider to determine the best course of action for you and your baby. In some cases, your little one may continue to move around and switch positions in the weeks before birth. Again, keep in mind that every pregnancy and birth is unique and your healthcare team will work with you to ensure a safe delivery for both you and your little one.

Can You Help Your Baby Move to a Head-Down Position?

If your baby is not yet in a head-down position and your due date is approaching, you may be wondering how to “get” your baby to turn head down. While you can’t actually make your little one do something, there are some gentle things you can try to encourage them to move, after checking with your healthcare provider. It's important to note that these methods are not guaranteed to work. They include:

Spending time on all fours and rocking back and forth gently

Doing pelvic tilts or rotating your hips in a circular motion

Swimming or walking in water, which can provide buoyancy and help the baby move into a head-down position

Talking to your baby and using gentle and stimulating sounds, such as music, may also encourage them to turn.

Remember to always consult your provider before attempting any exercises or techniques to help your baby move.

The Bottom Line

In the final weeks of pregnancy, you could be concerned about your baby's positioning and wondering “When do babies turn head down?” if your little one hasn't settled into this position yet. But rest assured, your baby still has time to turn head down, and even if they don't do this, there are safe delivery options available. Remember to stay in close communication with your healthcare provider and reach out if you have any questions or concerns. You're doing a great job—keep up the good work!

How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.

• American College of Obstetricians and Gynecologists, Your Pregnancy and Childbirth: Month to Month, 7th ed. (Washington, DC: American College of Obstetricians and Gynecologists, 2021).
• ACOG. “If Your Baby is Breech.”
• Cleveland Clinic. “Breech Baby.”
• Cleveland Clinic. “Fetal Positions for Birth.”
• Cleveland Clinic. “Vertex Presentation.”
• Mayo Clinic. “Fetal Presentation Before Birth.”

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Abnormal Fetal Position and Presentation

Under normal circumstances, a baby is in the vertex (cephalic) position before delivery. In the vertex position, the baby’s head is at the lower part of the abdomen, and the baby is born head-first. However, some babies present differently before delivery. In these cases, abnormal presentations may place the baby at risk of experiencing umbilical cord problems and/or a birth trauma (1). Types of abnormal fetal positions and presentations include the following. We’ll cover each in more detail on this page.

What is the difference between fetal presentation and position?

In the womb, a fetus has both a presentation and a position . Presentation refers to the baby’s body that leads, or is expected to lead, out of the birth canal (9). For example, if a baby’s rear is set to come out of the birth canal first, the baby is said to be in “breech presentation.” Position refers to the direction the baby is facing in relation to the mother’s spine (9). A baby could be lying face-first against a mother’s spine, or face up towards the mother’s belly.

What way should a baby come out during birth?

Vertex presentation is the ‘normal’ way that a baby is positioned for birth and the lowest-risk presentation for vaginal birth (1). In vertex presentation, the baby is positioned head-first with their occiput (the part of the head close to the base of the skull) entering the birth canal first. In this position, the baby’s chin is tucked into their chest and they are facing the mother’s back (occipito-anterior position). Any position other than vertex position is abnormal and can make vaginal delivery much more difficult or sometimes impossible (2). If a baby’s chin isn’t tucked into their chest, they may come out face-first (face presentation), which can cause birth injury (1).

What happens if a baby isn’t in the standard vertex position during birth?

Before delivery, it is critical that the fetus is in the standard vertex presentation and within the normal range for weight and size. This helps ensure the safety of both baby and mother during labor. When the baby’s size or position is abnormal, physician intervention is usually warranted (1). This may mean simple manual procedures to help reposition the baby or, in many cases, a planned C-section delivery . The failure of healthcare professionals to identify and quickly resolve issues related to fetal size, weight, and presentation is medical malpractice . There are numerous complications related to abnormal weight, size, abnormal position, or abnormal presentation.

Compound presentation

In the safest presentation (vertex presentation), the baby is born head first, with the rest of the body following. In a compound presentation, however, there are multiple presenting parts. Most commonly, this means that the baby’s head and an arm come out first at the same time. Sometimes compound presentation can occur with twins where the head of the first twin presents with the extremity of the second twin (3).

Risk factors for compound presentation include (3):

• Prematurity
• Intrauterine growth restriction (IUGR)
• Multiple gestations ( twins , triplets, etc.)
• Polyhydramnios
• A large pelvis
• External cephalic version
• Rupture of membranes at high station

Compound presentations can be detected via ultrasound before the mother’s water breaks. During labor, compound presentation is identified as an irregular finding during a cervical examination (3).

If a mother has polyhydramnios, the risk of compound presentation is higher, as the flow of amniotic fluid when the membranes rupture can sweep extremities into the birth canal, or cause a cord prolapse , which is a medical emergency (3). If compound presentation continues, it is likely to cause dystocia (the baby becoming stuck in the birth canal), which is also a medical emergency (3). Often, the safest way to deliver a baby with compound presentation is C-section, because complications like dystocia and cord prolapse carry risks of severe adverse outcomes, including cerebral palsy , intellectual and developmental disabilities, and hypoxic-ischemic encephalopathy (HIE) (3).

Limb presentation

Limb presentation during childbirth means that the part of the baby’s body that emerges first is a limb – an arm or a leg. Babies with limb presentation cannot be delivered safely via vaginal delivery; they must be delivered quickly by emergency C-section (4). Limb presentation poses a large risk for dystocia (the baby getting stuck on the mother’s pelvis), which is a medical emergency.

Occipitoposterior (OP) position

Approximately 1 out of 19 babies present  in a posterior position rather than an anterior position. This  is called an occipitoposterior (OP) position or occiput posterior position (3)  In OP position, the baby is head-first with the back part of the head turned towards the mother’s back, rotated to the right  (right occipitoposterior position, or ROP), or to the left (left occipitoposterior position, or LOP) of the sacroiliac joint. Occipitoposterior position increases the baby’s risk of experiencing prolonged labor , prolapsed umbilical cord , and use of delivery instruments, such as forceps and vacuum extractors (5). These conditions can cause brain bleeds , a lack of oxygen to the brain, and birth asphyxia .

When OP position is present, if a manual rotation cannot be quickly and effectively performed in the face of fetal distress, the baby should be delivered via C-section (5).  A C-section can help prevent oxygen deprivation caused by prolonged labor, umbilical cord prolapse, or forceps and vacuum extractor use.

A nurse explains posterior position

Breech presentation

Breech presentation is normal throughout pregnancy. However, by the 37th week, the baby should turn to the cephalic position in time for labor. Breech presentation occurs when a baby’s buttocks or legs are positioned to descend the birth canal first. Breech positions are dangerous because when vaginal delivery is attempted, a baby is at increased risk for prolapsed umbilical cord, traumatic head injury, spinal cord fracture, fatality, and other serious problems with labor (6).

There are 4 types of breech positions:

• Footling breech presentation : In footling position, one or both feet enter the birth canal first, with the buttocks at a higher position than the feet.
• Kneeling breech presentation : This is when the baby has one or both legs extended at the hips and flexed at the knees.
• Frank breech presentation : This is when the baby’s buttocks present first, the legs are flexed at the hip and extended at the knees, and the feet are near the ears.
• Complete breech presentation : In this position, the baby’s hips and knees are flexed so that the baby is sitting cross-legged, with the feet beside the buttocks.

When a baby is in breech position, physicians often try to maneuver the baby into a head-first position. This should only be attempted if fetal heart tracings are normal (the baby is not in distress ) (7). The only type of breech position that may allow for a vaginal delivery is frank breech , and the following conditions must be met:

• The baby’s heart rate is being closely monitored and the baby is not in distress.
• Cephalopelvic disproportion (CPD) is not present; x-rays and ultrasound show that the size of the mother’s pelvis will allow a safe vaginal birth.
• The hospital is equipped for and the physician is skilled in performing an emergency C-section .

If these conditions are not present, vaginal birth should not be attempted. Most experts recommend C-section delivery for all types of breech positions because it is the safest method of delivery and it helps avoid birth injuries (6). Mismanaged breech birth can result in the following conditions:

• Brain bleeds, intracranial hemorrhages
• Spinal cord fractures
• Hypoxic-ischemic encephalopathy (HIE)
• Cerebral palsy
• Intellectual disabilities
• Developmental delays

Face presentation

A face presentation occurs when the face is the presenting part of the baby. In this position, the baby’s neck is deflexed (extended backward) so that the back of the head touches the baby’s back. This prevents head engagement and descent of the baby through the birth canal. In some cases of face presentation, the trauma of a vaginal delivery causes face deformation and fluid build-up (edema) in the face and upper airway, which often means the baby will need a breathing tube placed in the airway to maintain airway patency and assist breathing (1).

Image by healthhand.com

There are three types of face presentation:

• Mentum anterior (MA) : In this position, the chin is facing the front of the mother.
• Mentum posterior (MP) : The chin is facing the mother’s back, pointing down towards her buttocks in mentum posterior position. In this position, the baby’s head, neck, and shoulders enter the pelvis at the same time, and the pelvis is usually not large enough to accommodate this. Also, an open fetal mouth can push against the bone (sacrum) at the upper and back part of the pelvis, which also can prevent descent of the baby through the birth canal.
• Mentum transverse (MT) : The baby’s chin is facing the side of the birth canal in this position.

Trauma is very common during vaginal delivery of a baby in face presentation, so parents must be warned that their baby may be bruised and that a C-section is available to avoid this trauma.

Babies presenting face-first can sometimes be delivered vaginally, as long as the baby is in MA position (1). Safe vaginal delivery of a term-sized infant in persistent MP position is impossible due to the presenting part of the baby compared to the size of the mother’s pelvis (1). Babies in MP position must be delivered by C-section. Babies in MT position must also be delivered by C-section. Some babies in the MP and MT positions will spontaneously convert to the MA position during the course of labor, which makes vaginal delivery a possibility. If the baby is in the MA position and vaginal delivery is able to proceed, engagement of the presenting part of the baby probably will not occur until the face is at a +2 station (1).

The management of face presentation requires close observation of the progress of labor due to the high incidence of CPD with face presentation. In face presentation, the diameter of the presenting part of the head is, on average, 0.7 cm greater than in the normal vertex position (1).

In any face presentation situation, if progress in dilation and descent ceases despite adequate contractions, delivery must occur by C-section. In fact, when face presentation occurs, experts recommend liberal use of C-section (1).

Since there is an increased risk of trauma to the baby when the face presents, the physician should not try to rotate the baby internally. In addition, the physician must not use vacuum extractors or manual extraction (grasping the baby with hands) to extract the baby from the uterine cavity. Outlet forceps should only be used by experienced physicians; these forceps increase the risk of trauma and brain bleeds. In almost all clinical circumstances a cesarean delivery is the safest method of delivery.

Listed below are complications that can occur if face presentation is mismanaged by the medical team:

• Prolonged labor
• Facial trauma
• Facial and upper airway edema (fluid build-up in the face, often caused by trauma)
• Skull molding (abnormal head shape that results from pressure on the baby’s head during childbirth)
• Respiratory distress or difficulty in ventilation (the baby being able to move air in and out of lungs) due to upper airway trauma and edema
• Spinal cord injury
• Abnormal fetal heart rate patterns
• 10-fold increase in fetal compromise
• Brain bleeds
• Intracranial hemorrhages
• Permanent brain damage

Brow presentation

Brow presentation is similar to face presentation, but the baby’s neck is less extended. A fetus in brow presentation has the chin untucked, and the neck is extended slightly backward. As the term “brow presentation” suggests, the brow (forehead) is the part that is situated to go through the pelvis first. Vaginal delivery can be difficult or impossible with brow presentation, because the diameter of the presenting part of the head may be too big to safely fit through the pelvis.

Risk factors and conditions associated with brow presentation

Brow presentation has been linked to several risk factors and co-occurring conditions. These include:

• Multiparity (having previously given birth)
• Premature delivery
• Fetal anomalies such as anencephaly (an absence of major parts of the brain and skull) or anterior neck mass (a growth on the front of the neck)
• Previous c-section delivery
• Polyhydramnios (excessive amniotic fluid: infants swallow amniotic fluid while in utero, but this may be difficult if their neck is extended)

Diagnosis of brow presentation

Brow presentation can often be diagnosed through a vaginal examination during labor. If there are no conclusive signs from the physical examination alone, an ultrasound can also be used. Warning signs of brow presentation may include signs of fetal distress or lack of labor progression.

Management of brow presentation

Infants who assume a brow presentation early in labor may spontaneously move into a more optimal position during the delivery process. Additionally, safe delivery in brow presentation may be possible if the infant is unusually small and/or the mother’s pelvic opening is unusually large. For these reasons, physicians occasionally recommend vaginal delivery of infants in brow presentation.

Doctors attempting vaginal delivery of a baby in brow presentation must be very careful to watch for signs of fetal distress (such as an abnormal heart rate), and to monitor the progression of labor. Prolonged labor can cause extended periods of fetal oxygen deprivation, which can cause birth asphyxia and permanent injury. Signs of fetal distress can indicate that a baby is in danger of sustaining serious brain damage if action is not quickly taken to prevent this. If an infant in brow presentation begins to show signs of distress, or if labor progress stops or slows significantly, physicians should be ready to move on to a cesarean delivery.

Labor induction or augmentation with the drug Pitocin (synthetic oxytocin) is very dangerous in cases of brow presentation. Pitocin can lead to excessive uterine contractions, which can put pressure on the infant’s head and cut off their oxygen supply; this is especially risky when safe fetal descent is already compromised, such as in cases of brow presentation.

Complications of brow presentation

If brow presentation is diagnosed in a timely fashion and is appropriately managed, there are typically no serious negative effects on the mother or baby. However, if medical professionals fail to recognize brow presentation and intervene as necessary, there can be lasting consequences. Infants may suffer  oxygen deprivation  due to prolonged labor, or  traumatic injuries from a difficult delivery. Some of the most severe conditions resulting from mismanaged brow presentation births include:

• Hypoxic-ischemic encephalopathy
• Periventricular leukomalacia
• Seizure disorders
• Developmental disabilities

Shoulder presentation (transverse lie)

Shoulder presentation (transverse lie) is when the arm, shoulder or trunk of the baby enter the birth canal first. When a baby is in a transverse lie position during labor, C-section is almost always used as the delivery method (8).  Mothers who have polyhydramnios (too much amniotic fluid), are pregnant with more than one baby, have placenta previa, or have a baby with intrauterine growth restriction (IUGR) are more likely to have a baby in the transverse lie position (8). Once the membranes rupture, there is an increased risk of umbilical cord prolapse in this position; thus, a C-section should ideally be performed before the membranes break (8). Failure to quickly deliver the baby by C-section when transverse lie presentation is present can cause severe birth asphyxia due to cord compression and trauma to the baby. This can cause hypoxic-ischemic encephalopathy (HIE), seizures, permanent brain damage, and cerebral palsy.

Legal help for birth injuries from abnormal position or presentation

The award-winning birth injury attorneys at ABC Law Centers have over 100 years of joint experience handling birth trauma cases related to abnormal position or presentation. If you believe your loved one’s birth injury resulted from an instance of medical malpractice, you may be entitled to compensation from a medical malpractice or personal injury case. During your free legal consultation, our birth injury attorneys will discuss your case with you, determine if negligence caused your loved one’s injuries, identify the negligent party, and discuss your legal options with you.

• Free Case Review
• Available 24/7
• No Fee Unless We Win

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• Julien, S., and Galerneau, F. (2017). Face and brow presentations in labor. Retrieved from https://www.uptodate.com/contents/face-and-brow-presentations-in-labor .
• World Health Organization, UNICEF, and United Nations Population Fund. Malpositions and malpresentations. Retrieved from http://hetv.org/resources/reproductive-health/impac/Symptoms/Malpositions__malpresetations_S69_S81.html .
• Barth, W. (2016). Compound fetal presentation. Retrieved from https://www.uptodate.com/contents/compound-fetal-presentation .
• Gabbe, S.G., … Grobman, W.A. (2017). Compound Presentation. Retrieved from https://expertconsult.inkling.com/read/gabbe-obstetrics-normal-problem-pregnancies-7e/chapter-17/compound-presentation .
• Argani, C.H. and Satin, A.J. (2018) Occiput posterior position. Retrieved from https://www.uptodate.com/contents/occiput-posterior-position .
• Hofmeyr, G.J. (2018). Overview of issues related to breech presentation. Retrieved from https://www.uptodate.com/contents/overview-of-issues-related-to-breech-presentation .
• Hofmeyr, G.J. (2017). Delivery of the fetus in breech presentation. Retrieved from https://www.uptodate.com/contents/delivery-of-the-fetus-in-breech-presentation .
• Strauss, R.A. (2017). Transverse fetal lie. Retrieved from https://www.uptodate.com/contents/transverse-fetal-lie .
• Moldenhauer, J.S. (2018). Abnormal Position and Presentation of the Fetus. Retrieved from https://www.merckmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/abnormal-position-and-presentation-of-the-fetus .

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Vanda pharmaceuticals announces presentations at sleep 2024.

WASHINGTON , May 29, 2024 /PRNewswire/ -- Vanda Pharmaceuticals Inc. (Vanda) (Nasdaq: VNDA) today announced participation at SLEEP 2024, to be held in Houston, TX from June 1 through June 5, 2024 .

The following will be presented:

June 4, 2024

Presentation Title: "Drug Screening and CRISPR/Cas9 Screening of HCN Channels" Poster Presentation Session: P-17 Poster Number: 10 Presenter: Dr. Sandra Paulina Smieszek , Head of Genetics

Presentation Title: "Melanopsin Crispants in Zebrafish Display Difference in Sleep Latency" Poster Presentation Session: P-17 Poster Number: 11 Presenter: Dr. Sandra Paulina Smieszek , Head of Genetics

Presentation Title: "Genetic Variants Associated with Dim Light Melatonin Onset in a Delayed Sleep-Wake Phase Disorder Cohort" Poster Presentation Session: P-22 Poster Number: 146 Presenter: Dr. Sandra Paulina Smieszek , Head of Genetics

Presentation Title: "Genetic variants associated with TST and LPS in insomnia patients: whole genome sequencing study" Poster Presentation Session: Late-Breaking Abstracts (LBA); P-31 Poster Number: 451 Presenter: Dr. Sandra Paulina Smieszek , Head of Genetics

For more information on SLEEP 2024, please refer to  https://www.sleepmeeting.org/

About Vanda Pharmaceuticals Inc.

Vanda is a leading global biopharmaceutical company focused on the development and commercialization of innovative therapies to address high unmet medical needs and improve the lives of patients. For more on Vanda Pharmaceuticals Inc., please visit www.vandapharma.com  and follow us on X @vandapharma.

Corporate Contact: Kevin Moran Senior Vice President, Chief Financial Officer and Treasurer Vanda Pharmaceuticals Inc. 202-734-3400 [email protected]

Jim Golden / Jack Kelleher / Dan Moore Collected Strategies [email protected]

View original content to download multimedia: https://www.prnewswire.com/news-releases/vanda-pharmaceuticals-announces-presentations-at-sleep-2024-302158424.html

SOURCE Vanda Pharmaceuticals Inc.