posterior presentation of baby

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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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Posterior Presentation

Your baby’s position is fundamentally about the relationship between your body and yourself, and your baby and you. Your body gives you clues as to the positioning of your baby, some of which you can begin to learn to interpret yourself, although you may need an experienced and skilled midwife to help. It is the sensations that you feel that guide you through your progress in the exercises. And getting your baby into an optimal position for labor is one of the most important aspects of your relationship with your baby as you approach birth together.

At a time when medicalization of labor can act all too often to reinforce our natural fear and apprehension as we approach labor, when a lack of confidence in our abilities to give birth is paramount, perhaps we should start by trying to get the basics right, starting with the position of our babies. And as with the rest of motherhood, it often takes a lot of hard work to get the fundamentals right.

Defining A Baby in a Posterior Position

“Posterior” usually refers to an “occiput posterior” birth.

Posterior is when the baby is facing out your tummy, not out your back. Anterior (or what medical people consider “normal”) presentation is when the baby is facing your backbone; posterior is when the baby is facing your front. So, if you were looking between your legs as you birthed, a posterior baby would be looking right at you, where an anterior baby would be looking through to your butt. Posteriors are often called “stargazers” or “sunny-side-up” by midwives. Breech is butt-first. Vertex is head down. Many if not most babies who start out labor this way end up rotating during labor to birth occiput anterior or occiput to left or right. About one in four babies is posterior or “sunny-side-up.” This can cause longer labor and severe back pain in labor, although this is not necessarily so!

Posterior Positioning – Signs and Symptoms

In working with many VBAC women, I am amazed at the sheer number of cesarean births attributed to Failure to Progress or CPD, Cephalopelvic Disproportion. In reality, these women have prolonged labors not because of their babies inability to fit through their pelvises, but rather because their babies are posterior.

Pictured above is a view of a posterior baby. Note an indentation in a mother’s her belly button is caused by the gap between the babies arms, the bump below the mother’s belly button, and the babies knees and feet above the mother’s belly button.

Signs of Posterior positioning prenatally

Lots of Prodromal or Braxton-Hicks contractions, often felt as lower back ache or pain that is strong during the day and stops at night. My theory is baby is trying to turn before labor begins, thus the seemingly ineffective contractions.

The feeling that the baby has too many hands and feet, and the moving limbs may be easily felt and seen up front.

Frequent urination due to the baby’s brow pressing against her bladder. Incontinence may be felt as baby wiggles against the bladder, forcing out urine and often it feels like a urinary tract infection because of the constant pressure on the bladder and accompanying backache.

Fetal heart tones may be difficult to detect, or tones are indistinct.

It will be difficult or impossible to feel the babies back, and the head may appear to be engaged.

Signs of Posterior positioning during labor

Along with the symptoms above, the most distinct sign is persistent backache, which even in early labor may be severe enough that the pain of contractions are secondary. As a backache may be present even in normal anterior presentation, it is important that a vaginal examination be done to correctly assess the baby’s position by the fontanels.

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 vertex 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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Presentation and position of baby through pregnancy and at birth

9-minute read

If you are concerned about your baby’s movements, contact your doctor or midwife for advice immediately.

• If you baby is in a breech presentation, your doctor may recommend trying a technique called an external cephalic version to try and move your baby while they are still in the uterus for an easier birth.

What does presentation and position mean?

Presentation refers to the part of your baby’s body that is facing downwards in the direction of the birth canal.

Position refers to where your baby’s occiput (the bottom part of the back of their head) is in relation to your body.

If your baby is in a breech presentation , then position refers to where your baby’s sacrum (lower back) is in relation to your body.

People — including medical professionals — sometimes use these terms incorrectly. Sometimes when speaking about babies in breech presentation, the word ‘position’ will be used to refer to their presentation. For example, you may read information or hear people say ‘breech position’ instead of ‘breech presentation’.

What are the different types of presentation my baby could be in during pregnancy and birth?

Most babies present headfirst, also known as cephalic presentation. Most babies that are headfirst will be vertex presentation. This means that the crown of their head sits at the opening of your birth canal.

In rare cases, your baby can be headfirst but in face or brow presentation, which may not be suitable for vaginal birth.

If your baby is in a breech presentation, their feet or bottom will be closest to your birth canal. The 3 most common types of breech presentation are:

• frank or extended breech — where your baby’s legs are straight up in front of their body, with their feet up near their face
• complete or flexed breech — where your baby is in a sitting position with their legs crossed in front of their body and their feet near their bottom
• footling breech — where one or both of your baby’s feet are hanging below their bottom, so the foot or feet are coming first

Read more on breech presentation .

What are the different positions my baby could be in during pregnancy and birth?

If your baby is headfirst, the 3 main types of presentation are:

• anterior – when the back of your baby’s head is at the front of your belly
• lateral – when the back of your baby’s head is facing your side
• posterior – when the back of your baby’s head is towards your back

How will I know what presentation and position my baby is in?

Your doctor or midwife can usually work out your baby’s presentation by feeling your abdomen. They may also double check it with a portable ultrasound. Your baby’s presentation is usually checked around 36 weeks .

Your doctor or midwife will also confirm your baby’s head position in labour by examining your belly and using an ultrasound , and they may also do a vaginal examination . During the vaginal examination they are feeling for certain ridges on your baby’s head called sutures and fontanelles that help them work out which way your baby is positioned.

What is the ideal presentation and position for baby to be in for a vaginal birth?

For a vaginal birth, your baby will ideally be headfirst with the back of their head at the front of your belly, also known as being in the anterior position. This position is best for labour and birth since it means that the smallest part of your baby’s head goes down the birth canal first.

When does a baby usually get in the ideal presentation and position for birth?

Your baby will usually be in a headfirst position by 37 weeks of pregnancy. Around 3 in every 100 babies will be in breech presentation after 37 weeks.

Your baby’s position can change with your contractions during labour as they move down the birth canal, so their exact position can change during labour.

What are my options if baby isn't in the ideal presentation or position for a vaginal birth?

If your baby is in a breech presentation, your doctor may recommend a technique called an external cephalic version (ECV) to try and move your baby while they are still in the uterus . An ECV involves your doctor using their hands to apply pressure on your belly and help turn your baby to a headfirst position. It has a 1 in 2 chance of success and is a safe option in most pregnancies.

There is no evidence to show that alternative therapies, such as exercises, acupuncture or chiropractic treatments, help your baby change from a breech presentation to headfirst.

If your baby remains breech, your doctor may discuss having a breech vaginal birth. Not all doctors and hospitals offer this option. They may also suggest you birth your baby with a planned caesarean section .

If your baby’s presentation is headfirst but the position of your baby’s head is not ideal for labour, it can lead to a longer labour, and potential complications . The position of your baby’s head will often change as your labour progresses. If it doesn’t, sometimes you can still give birth without assistance, or you may need your doctor to help turn your baby’s head or help your birth with a vacuum or forceps .

Any procedure or decision for a type of birth will only go ahead with your consent . You will be able to discuss all the options with your doctor, and based on your preferences for yourself and your baby’s safety, make a decision together .

Resources and support

The Royal Australian and New Zealand College of Obstetrics and Gynaecology has a factsheet about the options available to you if your baby is in a breech presentation at the end of your pregnancy .

Mercy Perinatal has information on external cephalic version (ECV) safety and benefits if your baby is in a breech presentation at the end of your pregnancy.

The Women’s Hospital has information about the different presentations and positions your baby could be in, and how it can affect your birthing experience.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call . Available 7am to midnight (AET), 7 days a week.

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Last reviewed: October 2023

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External cephalic version (ecv), malpresentation, breech pregnancy, search our site for.

• Foetal Version
• Breech Presentation

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Breech Presentation at the End of your Pregnancy

Breech presentation occurs when your baby is lying bottom first or feet first in the uterus (womb) rather than the usual head first position. In early pregnancy, a breech position is very common.

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External Cephalic Version for Breech Presentation - Pregnancy and the first five years

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

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When a baby is positioned bottom-down late in pregnancy, this is called the breech position. Find out about 3 main types and safe birthing options.

Read more on Pregnancy, Birth & Baby website

Malpresentation is when your baby is in an unusual position as the birth approaches. Sometimes it’s possible to move the baby, but a caesarean maybe safer.

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

ECV is a procedure to try to move your baby from a breech position to a head-down position. This is performed by a trained doctor.

Having a baby

The articles in this section relate to having a baby – what to consider before becoming pregnant, pregnancy and birth, and after your baby is born.

Anatomy of pregnancy and birth - pelvis

Your pelvis helps to carry your growing baby and is tailored for vaginal births. Learn more about the structure and function of the female pelvis.

Planned or elective caesarean

There are important things to consider if you are having a planned or elective caesarean such as what happens during and after the procedure.

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Posterior Placenta Location: Is Posterior Positioning Good for the Baby?

Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles .

When you become pregnant, your body begins to adjust to the fetus and undergoes many changes. One of these changes is the growth of the placenta in your uterus.

The placenta is a temporary organ that attaches itself to the uterus and to the fetus’s umbilical cord. It’s through the placenta that the growing fetus is able to get oxygen and nutrients.

The positioning of the placenta is very important and determines whether you will be able to give birth vaginally or if a cesarean section  will be safer. 

Placental development stages

By attaching itself to the fetus’s umbilical cord, the placenta provides the fetus with nourishment and oxygen while also eliminating the fetus’s waste. 

How does the placenta develop?

The placenta begins to grow when the blastocyst implants itself into your uterus. The blastocyst is the bunch of cells, referred to as the inner cell mass, that develops into the embryo. The outer cluster of cells, known as the trophoblast , forms the placenta. 

The trophoblast grows quickly, and its cells split into two layers: cytotrophoblasts , which are the inner cells, and syncytiotrophoblasts , which are the outer cells. 

The inner cells of the placenta reshape blood vessels in your uterus. This is how the placenta receives blood to provide the fetus with nutrients. 

The placenta develops wherever the fertilized egg embeds itself in your uterus: 

• Anterior position — on the front wall of your uterus, closest to the belly
• Posterior position — on the back wall of your uterus, closest to the spine
• Fundal position — on the top wall of your uterus
• Lateral position — on the right or left side of your uterus

These are all normal places for the placenta to implant and grow.

When the placenta attaches itself to the back of the uterus, it is called a posterior placenta. When it attaches itself to the front of the uterus, it is known as an anterior placenta. 

The placenta undergoes numerous changes from conception to birth. As the fetus grows, the placenta grows to accommodate their development. By the time you give birth, the placenta may weigh as much as a pound (500 grams) and measure 9 inches in length. After the baby is born, your uterus will also contract to expel the placenta. 

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What is it?

The term posterior placenta describes the placenta’s attachment to the back wall of the uterus. 

If your health care provider determines that you have a posterior placenta, there’s no need to worry. It’s completely normal. The upper (or fundal) portion of the uterine back wall is one of the best locations for the fetus to be in. It allows them to move into the anterior position just before birth.

Furthermore, a posterior placenta does not affect or interfere with the growth and development of the fetus.

How does placenta positioning affect delivery?

During pregnancy, the placenta location can change. This is why your health care provider may perform an ultrasound scan in the second trimester of pregnancy (roughly 18 to 21 weeks). Another scan may be necessary in the third trimester to double-check placenta positioning before delivery.

One placental location that might be problematic is when the placenta grows toward the cervix. This is called placenta previa. In this position, the placenta could detach from the uterine wall and cause premature labor or internal bleeding. 

Another condition, known as placenta accreta, happens when parts of the placenta attach too deeply into the uterine wall. Instead of completely detaching itself after delivery, some or all of the placenta remains in the uterus, sometimes resulting in bleeding.  

In such cases, your health care provider may recommend a caesarian section and a post-delivery hysterectomy. 

In some rare instances, the placenta remains in the uterus after the baby has been delivered. This is called a retained placenta , and when left untreated, it can lead to complications including infections and heavy vaginal bleeding.  

Anterior vs. posterior placenta

To recap, a posterior placenta is one that attaches itself to the back of the uterus, while an anterior placenta attaches itself to the front. Both placental positions are considered normal. Aside from being an ideal location for delivery, the other benefit of a posterior placenta is being able to feel your baby’s movements early on. 

This is not the case with an anterior placenta because the placenta may create more space between the baby and your abdomen. Neither posterior or anterior placental location will affect the development or growth of a strong and healthy baby.

Zia, Shumaila. “Placental Location and Pregnancy Outcome.” Journal of the Turkish German Gynecological Association, AVES, 1 Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3935544/ . Mayo Clinic Staff. “Know the Role the Placenta Plays in Pregnancy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Mar. 2020, www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425 . Wang, Yuping. “Cell Types of the Placenta.” Vascular Biology of the Placenta., U.S. National Library of Medicine, 1 Jan. 1970, www.ncbi.nlm.nih.gov/books/NBK53245/ . Weeks, Andrew. “Retained Placenta after Vaginal Birth.” UpToDate, 7 Apr. 2020, www.uptodate.com/contents/retained-placenta-after-vaginal-birth .

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Current version (18 july 2022), published (17 april 2019), in this article, related articles.

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How to Turn a Posterior Baby: Tips I Used Before and During Labor

You’re sitting at 38 week prenatal week when your doctor delivers the news: your baby is posterior.

At first, you might think, “what the heck is posterior?” You’ve probably heard that head-up isn’t the best scenario. But this curve ball was so far off your radar you’re not even sure how to react.

Posterior babies (AKA sunny side up baby) isn’t really a situation many pregnant women consider. Sometimes a posterior baby means absolutely nothing. Labor comes and goes, and that baby is delivered without any complications.

Other times, a posterior baby can wreck your labor and undo all of the hard preparation you’ve done.

I had no clue that my baby was posterior until I had already been in labor for almost 27 hours. My body was exhausted and I knew that if I didn’t get that baby to turn to anterior soon, there was a good chance that I would have a c-section. With the help of my L&D nurse, my baby posterior baby turned.

Hopefully, you don’t fall into the same scenario, but if you do, this post is here to help you prepare. Below, we’re going to talk about w hat a posterior baby is , the complications and risks associated and, most importantly, how to turn a posterior baby .

I truly believe that these tips can turn your baby into the optimal birthing position and give you an easier labor. So, let’s get started!

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• 5 Best Online Birthing Classes for New Moms

What is a Posterior Baby?

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Believe it or not, your baby’s fetal position can affect your labor quite a bit.

The ideal birthing position for a baby is head down and with th e front of his body facing toward your right shoulder . This is called left occiput anterior .

If your baby’s spine is in line with yours , your baby is posterior.

You may have also heard a posterior pregnancy referred to as “sunny side up baby”, “op baby”, or simply “backwards.” Whatever you want to call it, its technically an abnormal fetal position that you should probably adjust if you can.

Posterior to Anterior: Why Your Baby’s Position Matters

Before we dive into how to turn a sunny side up baby, let’s talk about why your main goal should be to turn your baby from posterior to anterior .

A posterior baby isn’t usually a source of concern until labor hits. In an ideal situation, your baby will move into your pelvic cradle, tuck his chin into his chest, and slide right through your birth canal.

The issue is, the top of a posterior baby’s head will reach your pelvis first. At this angle, the full circumference of your baby’s head approaches your narrow pelvic opening.

This can cause you a lot of pain and hinder your baby’s progress.

Posterior Birth Complications

HAVING SAID THAT, if your baby is posterior, that does not necessarily mean that your baby will get stuck during childbirth.

However, there are several hiccups associated with the posterior position, that will probably inspire you to take turning an op baby pretty seriously.

It really depends on your baby’s head circumference, the narrowness of your hips, and the position of your baby.

Here are a posterior complications experts have found:

• Painful Back Labor- Back labor sucks. It’s also one of the most common side-effects of a posterior baby.
• Your Water May Break Prematurely-  There’s nothing more exciting than your water breaking…unless it’s because your baby is posterior. The pressure from your baby’s position may burst one of your amniotic bags prematurely. This puts you in a tricky situation, because you will need to give birth soon, but your body may not actually be ready.
• Prodromal Labor-  Your body isn’t happy that your baby is posterior. This creates labor that stops and goes. While prodromal labor may not lead anywhere quickly, it can be painful and exhausting for you
• Longer Labor- Posterior babies cause a longer labor for a myriad of reasons, including the amniotic sack breaking prematurely (which may for your doctor to induce you. Induced labor=longer labor), his head may get stuck, or your cervix may take longer to dilate.
• Perineal or Cervical Injury- Let me premise this section by saying that a tear to your cervix is extremely rare while perineal tears are very, very common. A posterior baby applies a ton of pressure to your back, which can tell your body to push early, before your cervix is completely dilated.
• Increased Likelihood of a C-Section- Cervical tears, head entrapment, and fetal distress can prompt a provider to recommend an emergency c-section. This is an extreme situation, even for posterior babies , but it would be the safest option for you and baby. The duration of your labor may also attribute to an emergency c-section. If you’ve been laboring for 30+ hours and you’re not getting anywhere, there has to be an end.

RELATED POST: 5 Mistakes You’ll Want to Avoid if You Want to Go Natural

What Causes a Posterior Baby?

Okay, now you get why anterior is the best position. But, maybe you’re wondering, why me? Why do I have a posterior baby? How can I prevent having a posterior baby in the future?

Honestly, this is kind of a tricky topic. Experts can make educated guesses as to why some women experience posterior births, but the exact causes aren’t know.

If you’ve read my Breech Baby Series , you might remember that formerly breech pregnancies are much more likely to result in posterior presentations. BUT doctors aren’t sure if that is because your baby was breech or if its due to the underlying problem that made your baby breech in the first place!

Still, let’s take a look at a few factors that might cause a baby to be sunny side up:

• Poor posture or desk jobs: This is a big one. If your feet are regularly elevated or you’re exercising poor posture, you’re not giving your baby the space he needs to wiggle into the optimal birthing position
• Epidural: This is another tricky thing. Is your baby posterior because you had an epidural or did you have an epidural because your baby is posterior? Experts don’t know. However, studies have found a correlation .
• Maternal low thyroid issues
• Poor hip alignment (either from that desk job, driving, injury, or genetic factors)
• Late stage Breech baby
• Anterior placenta

How to Tell if Your Baby is Posterior

Okay, full disclosure: the only real way to know if your baby is posterior is to check with your provider.

Some practitioners can tell if your baby is posterior just by palpitation. However, this is entirely dependent on your baby’s position, your physique, and the experience of your providers.

Most providers rely on an ultrasound for confirmation.

Having said that, here are a few posterior baby signs you should look out for:

• Little flutters facing your abdomen, just above your pubic bone – According to one of the leading experts on the subject, Spinning Babies, this could be your baby’s fingers.
• No butt by your rib cage (not to be confused with the stiff, immovable mass of a baby’s head)
• Firm kicks to your ribs
• Pressure on your sacrum
• Consistent lower back pain
• Failure to engage

Related Post: How to Tell if Your Baby is Breech

How to Tell if Your Baby is Posterior Through Belly Mapping

In case you’re new to the concept, belly mapping is estimating your baby’s position through a combination of fetal movement tracking, non-toxic body paint, and a heart monitor (optional).

(Breech Baby readers, if you tried belly mapping when your baby is breech,I think you’ll be pleasantly surprised by how easy it is to do  when your baby is head down.)

I highly recommend that you investigate belly mapping and at least give it a try. If you discover that your baby is posterior, you can prepare and get a jumpstart on your labor.

However, don’t feel bad if it doesn’t work for you. If you have an anterior placenta, lots of “cushion” (I took eating for two way too far 😉 ), and a lot of amniotic fluid, you may not be able to assess your baby’s position accurately.

SHORT ON TIME? PIN IT FOR LATER!

 How to Turn a Posterior Baby Before Labor Starts

If your baby is posterior, remember not to freak out. The majority of posterior babies will turn into the anterior position during labor.

Having said that, I’d leave nothing to chance! These exercises can encourage a baby to turn from posterior to anterior before labor even starts.

1 Hip Rotations

If you haven’t bought an exercise ball yet, you need to.

Exercise balls are an incredibly cheap, efficient way to prepare you for labor. You can use an exercise ball to help with hip thrusts and rotations AND use it as a substitute for a chair. Really, you can buy any exercise ball, but I like this one on Amazon for the simple reason that it includes non-slip socks (absolutely essential for labor) and a pregnancy-specific workbook.

When you’re trying to turn a posterior baby, hands and knees positions are your best friend. I guess now is the perfect time to give in to your nesting urges and scrub those baseboards.

3 Pelvic Tilts

This exercise is very similar to the cat/cow yoga position. It’s a great way to encourage posterior and breech babies to turn into the right position. Spinning Babies recommends doing these exercises any time you feel the baby moving significantly.

4 Apply Warmth to Your Belly

I’m pretty sure I learned this technique from Genevieve Howland (AKA Mama Natural and the creator of the popular childbirth course, Mama Natural’s Birth Class ).

The idea behind the concept is that babies love warmth. So, you can add an ice pack to your back and a warm cloth to your bellow. Ideally, your baby will shift back against the warmth and away from the cold.

You can also achieve this by floating in warm water, putting an ice pack on your spine, or putting a warm towel on your tummy. 

5 Swim or Bath Submersions

Your goal is to relax your body and give your baby the opportunity to move into the right position. Providing a zero-gravity environment is a great way to do that.

Once again, your focus should be on letting your belly hang. Try breaststrokes or simply floating.

6 Chiropractic Adjustments

Desk jobs do tend to take a toll on our bodies.

If your baby is posterior or breech there could be a chance that your hips could have a slight torsion that needs to be corrected. Having your hips aligned prepares the way for your baby to easily slip out the birth canal.

Exercises to Turn a Sunny Side Up Baby During Labor

Let’s say you encourage your baby to get into the optimal position, but nothing takes. Labor begins and your baby is still posterior.

Don’t give up!

Sometimes, you just can’t turn posterior baby before you go into labor. Below are several exercises you can try during labor to encourage that baby into the right position. The goal of these exercises is to open your hips, relax your muscles, and reduce pain (which prevents babies from turning).

7 Stand or Use Vertical Positions

Avoid reclining at all costs during labor. Studies show that laboring in vertical positions can reduce the duration of your labor, minimize pain, and can lower the risk for perineal tears.

Slow dancing and sitting on your exercise (or birthing) ball is also an excellent way to wiggle your baby out. You can also continue the hip rotations and thrusts you practiced before labor.

8 Crawl or Labor on Your Hands and Knees

Laboring on your hands and knees opens your hips and let’s your belly hang, which can turn a posterior baby.

I can personally attest to the effectiveness of this position.

Not only did it ease the pressure from my sacrum (remember, pain causes your muscles to tense, which discourages your baby from turning), but it actively provided an environment for by baby to turn.

9 Apply Sacral Pressure

This technique will not turn your posterior baby, however, it may relieve some of your back labor.

This technique is extremely easy for your partner or L & D nurse to help you with. Basically, pressure is applied (either with a hand or a tennis ball) to your sacrum. This relieves the interior pressure from your baby’s head.

10 Rebozo or Belly Sifting

A rebozo is a common tool used in childbirth. It’s simply a large scarf that is wrapped around your belly. Typically, you will lean over while your birthing partner will stand behind you and gently sway the rebozo from behind. It’s kind of difficult to imagine this technique, so definitely check out the video above.

If you haven’t hired a midwife or doula, you should become familiar with this trick, just in case. Not only can it turn an op baby, but it’s a seriously effective technique for coping with labor pains.

Help! My Baby Won’t Turn From Posterior To Anterior

It’s not the end of the world, I promise!

Many, many moms are giving birth to posterior babies every day. Some moms won’t even experience additional pain.

Not to mention, while you might go into labor with a posterior baby, there’s a very good chance he’ll turn naturally during the later stages.

Having said that, if you plan on getting an epidural, many experts suggest waiting for as long as possible. This allows your baby to turn to anterior.

If you’re planning on going natural, pay special attention to relaxation and back pain coping techniques. When you’re in pain, you will tense up. Your body needs to relax for your baby to turn from posterior to anterior.

Take a Prenatal Class

Whether you plan on getting an epidural or giving birth naturally, please, PLEASE take a good prenatal class. These courses range from dirt cheap to a true investment, depending on what your expectations for birth are.

I’ve rounded up the best online prenatal classes on the internet to help you decide which one is best for you.

Having said that, if you’re planning on giving birth naturally and your baby is posterior, the class I would personally recommend for your situation is the KOPA Prepared Childbirth Class or the Mama Natural Birth Class . The KOPA PREPARED class teaches women how to give birth naturally, step-by-step, and the instructor actually addresses this exact scenario.

Meanwhile, the Mama Natural Birth Class offers a more personal, natural experience with plenty of holistic pain coping techniques thrown in. If you’re a relational, easy-going person, the Mama Natural Birth class probably fits your personality type better.

Turning a Posterior Baby Conclusion

I hope these tips were helpful to you, Mama.

A posterior baby can throw a wild card at you, but don’t let this complication bring your birthing experience down.

You can get through this and have the birth you want. Try these exercises before and during labor, really focus on pain-coping techniques, and come prepared for anything.

As a final tip, please don’t try to do this alone. Have a support team ready to go before you go into labor. I think that’s the final piece of the puzzle for an easier birth. Whether that’s your doula, L&D nurse, midwife, or partner, make sure that they are on board with these techniques before things get hot and heavy.

I hope you have a truly amazing birth. In the meantime, I’d love to hear from you. Post your questions and experiences below!

I'm a mom of two, writer, and small business owner. I love giving new and expecting moms the tips they need to overcome the challenges of early motherhood. Check out the About page to learn more!

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Am scared am 40weeks+ nd my baby face is facing up was advised to go for cesarean. Section; cuz the baby is big 4.1kg..is that the best ?

Hi! This article is so helpful. I am 27 weeks pregnant and due 9/9/20. I have an AP and I read that having an AP can increase the chances of having a sunny side up baby. This article stated it as well. I was wondering, should I start these exercises now? I am seeing a team of midwives and no one has checked to see if the baby is head down or to check her position. I’m a FTM so I’m assuming all of this happens closer towards my due date? Again, should I start the exercise now to help or should I wait until the midwives tell her that baby is sunny side up? Thank you so much and thanks for all the helpful tips found here!

First of all, congratulations! That’s so exciting! For the most part, these tips are safe to do throughout your pregnancy (especially the good practice tips like walking, avoiding long-term reclining, etc). The only exercises that providers seem to caution against are inversion exercises (designed to flip a baby). I would definitely ask your midwives first, just to be safe 🙂 And at 27 weeks it seems like babies do what they want lol. Plenty of time to spin to the perfect position! Having said that, there’s no harm in expressing your concern to your midwife on your next visit! At the very least for your own peace of mind. 🙂

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A Labor and Delivery Nurse’s Guide to Occiput Posterior Positioning and Your Birth

By Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

This article may contain affiliate links. This means that if you make a purchase through these links, we may earn a small commission at no additional cost to you. Learn more about affiliate links.

Let’s face it, mama. When you see the words “ occiput posterior “, your brain goes a little numb. Am I right ?

First things first: if you ever have to say it out loud, it sounds like OX-uh-puht pah-STEER-EE-uhr. Prepare to amaze both your doctors and your friends by rattling this one off in casual conversation, mama. You deserve it.

What is occiput posterior?

In short, it’s when baby is head down, but facing out towards your belly . You may have heard it called “sunnyside up” . This is NOT considered optimal positioning for birth. Ideally, you want baby head down and looking at your spine.

But, as you can imagine, there’s a little more to it than that. So read on, mama. We’ll learn all about occiput posterior positioning, optimal positioning for birth, and what you can do to try to turn baby!

Follow @mommy.labornurse on Instagram to join our community of over 650k for education, tips, and solidarity on all things pregnancy, birth, and postpartum!

**As always, and with any of these recommendations, you can always try to diagnose and solve for it at home, but the very best advice is always ALWAYS what you can get from a medical professional under clinical circumstances. **

The literal terms used here are occiput, meaning (generally) the back of the head or skull . You know, that occipital lobe thinger they talked about in human bio? It’s the part of the brain that is at the BACK.

So, good! we can assume that the occiput in “occiput posterior” means the back of the skull. Probably the baby’s skull, since you haven’t ever found much need for a medical term to refer to the back of your own head.

And then there’s posterior: posterior refers to the back end of something . The back half, if that something were to be divided symmetrically down the front-to-back axis.

Occiput posterior plain and simple

Occiput : the back of the baby’s head. Posterior : located generally at or toward the back half of your body.

Plain and simple: The back of baby’s head is pointed toward the BACK END of your body.

Put more specifically (or at least officially), the baby is lying–or presenting –headfirst (or upside down) inside your body, and is facing out toward your tummy instead of backward at your lower spine .

Note: the opposite, it follows, would be the occiput anterior position, which is headfirst and facing backward, toward your spine. This is the most common and typically considered the safest way to birth a baby.

What is persistent occiput posterior position?

Some confusion I see a lot is that mamas are looking for a different answer when trying to define the persistent occiput posterior position definition . People think that persistent means again and again–presumably over multiple pregnancies.

Really, persistent occiput posterior position just means occiput posterior positioning that LASTS . Babies can often get themselves swirled around into this position throughout pregnancy.

Even if this positioning is noticed early during labor, babies often resolve their position as labor progresses.

The term persistent in this case simply refers to the fact that the baby persists in being positioned in occiput posterior throughout the entire birthing process.

Occiput posterior delivery

Labor is still possible and potentially 100% safe with a baby in occiput posterior positioning. Even if this isn’t considered “optimal” positioning.

It DOES mean that your little one will have a harder time getting through your pelvis .

During the begin and early parts of labor, you may be able to move around or use different initial birthing positions to encourage the little rascal to roll over on their own – and many do!

Forceps and vacuum extraction to help guide an OP baby out

When in doubt, the doctor should have a few tricks up her sleeve. Forceps might help her shimmy the little one into a barrel roll or help the doc pull her out. Otherwise, there’s always THE VACUUM.

That sounded kind of funny, but I mean it. There’s a vacuum device that doctors can use to literally suck your baby out.

Obviously it’s a little more gentle (and probably more complicated) than that sounds, but knowing it is an option might help you appropriately plan your birth in the case of a persistent occiput posterior position.

How common is persistent occiput posterior positioning?

Be sure not to let this one freak you out, especially outside of the labor and delivery unit. It’s actually pretty rare for baby to stay occiput posterior for long!

Proof for the pudding? In a study of more than 6000 women in 2003, doctors identified that only about 5.5% of the studied population gave natural (spontaneous) birth in occiput posterior position .

This was a little higher for first-time mamas at around 7%, and a little lower for ladies with previous kiddoes, sitting at around 4%.

Related Reading:  How To Have a Natural Birth? 25 Tips From A Labor Nurse! Related Reading: Scared Of Giving Birth For The First Time? The Top 6 Labor Fears Answered

Occiput posterior position risk factors

Regardless of how many options we have these days, it has to be said that occiput posterior position ABSOLUTELY DOES come with more potential complications.

According to the National Institutes of Health , around 18% of all c-sections are listed with occiput posterior position as the cause. That’s a fair chunk of cesarian operations, to be sure.

But the important thing is that C-section IS an option. Before that, occiput positioning was much more risky. Thanks to modern science, you don’t have to go through this without a potential alternative.

This is why it’s a good idea for ALL mamas to learn about the C-section process , even if it’s not the birth you’re expecting. You never know how things might end up for you. I actually have a whole course dedicated to C-section mamas !

Occiput posterior position interventions

It’s a good idea to ask your provider how they handle occiput posterior positioning at one of your prenatal visits .

The key points you’re looking for here are a few of the facts, but most importantly, the PROCESS. If baby is presenting OP early in labor does your provider:

• Lean more heavily towards C-section to avoid ANY of the risks associated with delivering a sunny side up baby
• Lean more heavily towards a wait and see approach to see if baby will turn on their own, accepting that forceps or vacuum extraction may be necessary

Thinking about occiput posterior in your birth plan

Occiput posterior is the most common malposition that can occur in labor and delivery , and it’s only a 7% chance at that. It’s more likely than a breech or other positioning complication.

If I had a 7 in 100 chance of winning the lottery, I would probably play a lot more often. 7 out of every 100 powerballs and I’m guaranteed to win? Count me in, mama.

Because of that, let’s be prepared with some good instructions in your birth plan, and make sure the right crew is running the ship around you.

Myths and Thoughts about OP that don’t totally hold up (or aren’t well researched)

• Prenatal maneuvers can be used to rotate the occiput posterior fetus to an anterior (REAR-facing) position –a good provider knows this but recognizes that it will not always be possible if caught too late in the pregnancy. This is called an external cephalic version which I shared about over on Instagram !
• Your providers can detect occiput posterior positioning prenatally –maybe! Many women do not get late third trimester ultrasounds, but external belly mapping can totally help you figure this out
• It’s generally believed that once childbirth begins, a fetus will not move from occiput anterior (ideal positioning) once they’re in it –this is usually true, but rotating out of this position is not impossible, so keep that in mind!
• Back pain in labor is a reliable sign that your baby is in occiput posterior– back labor can indicate a sunnyside up baby, but it can also happen in ideal positioning.. It can’t be counted on 100%, but if you have back labor it can give your provider a clue that occiput posterior might be in play
• Your nurse can use a digital vaginal exam (with fingers) to tell if the baby is in occiput posterior position– If you are far enough along, sure, you can probably start feeling for features, but it’d be pretty late in the birth game

Well-researched approaches to OP

• An ultrasound scan is a reliable way to detect fetal positioning –it’s served you well throughout pregnancy; it’s hard to say why more L&D units don’t do this as a primary and standard part of the process when you arrive at the hospital in labor
• Different maternal positions (labor positions for mommy) CAN facilitate rotation of the occiput posterior to the anterior –if you paired different positions with the ultrasound, it would be a small matter of time and patience before baby will naturally just flop over. Like a little fishy
• Manual rotation of the fetal head from occiput anterior improves the chances that your baby will flop over on the way out –this would certainly limit many of the complications that can result

Related Reading:  Postoperative Care After Your Cesarean Section Related Reading: A Labor and Delivery Nurse’s Birth Story!

Childbirth education can make a difference

View this post on Instagram A post shared by Liesel Teen BSN, RN | Pregnancy + Birth (@mommy.labornurse)

As you are probably realizing, there are so many fluid and dynamic aspects of birth. Even if you think you know the general flow of things, there are just so many unknowns.

Unknowns you may not have even known you needed to know about!

This is why I’m such a huge advocate of childbirth education. In a good birth course you’ll learn more details about things like occiput posterior positioning, this way you’re not caught off guard if it does happen to you.

You’ll be made aware of possible complications or ways that things could progress so that you can ASK about them ahead of time and plan for them mentally.

It’s why I created an affordable, online birth course . Because I want mamas to go into birth with more knowledge, confidence and empowerment. And knowledge is power y’all.

In my course you’ll learn about a typical labor and birth progression, but also what to expect if things don’t progress so typically. You’ll learn about belly mapping, and labor positions to get that baby turning and moving down into the optimal position for your vaginal birth.

Go check it out! It’s going to make all the difference. And I want that for you.

OP in review

So at this point, you should now have a firm grasp on what it means for that little one to be upside down and aiming the wrong direction.

Occiput posterior positioning can be a significant source of complication, so be sure to ask your provider questions WELL in advance of the L&D unit.

Occiput posterior positioning can be scary, but if you have all the knowledge, you’ll come through this swinging.

Related Reading:  Scared Of Giving Birth For The First Time? The Top 6 Labor Fears Answered

Liesel Teen

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Delivery, face and brow presentation.

Julija Makajeva ; Mohsina Ashraf .

Affiliations

Last Update: January 9, 2023 .

• Continuing Education Activity

Face and brow presentation is a malpresentation during labor when the presenting part is either the face or, in the case of brow presentation, it is the area between the orbital ridge and the anterior fontanelle. This activity reviews the evaluation and management of these two presentations and explains the interprofessional team's role in safely managing delivery for both the mother and the baby.

• Identify the mechanism of labor in the face and brow presentation.
• Differentiate potential maternal and fetal complications during the face and brow presentations.
• Evaluate different management approaches for the face and brow presentation.
• Introduction

The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The most common presentation in term labor is the vertex, where the fetal neck is flexed to the chin, minimizing the head circumference. Face presentation is an abnormal form of cephalic presentation where the presenting part is the mentum. This typically occurs because of hyperextension of the neck and the occiput touching the fetal back. Incidence of face presentation is rare, accounting for approximately 1 in 600 of all presentations. [1] [2] [3]  In brow presentation, the neck is not extended as much as in face presentation, and the leading part is the area between the anterior fontanelle and the orbital ridges. Brow presentation is considered the rarest of all malpresentation, with a prevalence of 1 in 500 to 1 in 4000 deliveries. [3]

Both face and brow presentations occur due to extension of the fetal neck instead of flexion; therefore, conditions that would lead to hyperextension or prevent flexion of the fetal neck can all contribute to face or brow presentation. These risk factors may be related to either the mother or the fetus. Maternal risk factors are preterm delivery, contracted maternal pelvis, platypelloid pelvis, multiparity, previous cesarean section, and black race. Fetal risk factors include anencephaly, multiple loops of cord around the neck, masses of the neck, macrosomia, and polyhydramnios. [2] [4] [5]  These malpresentations are usually diagnosed during the second stage of labor when performing a digital examination. Palpating orbital ridges, nose, malar eminences, mentum, mouth, gums, and chin in face presentation is possible. Based on the position of the chin, face presentation can be further divided into mentum anterior, posterior, or transverse. In brow presentation, the anterior fontanelle and face can be palpated except for the mouth and the chin. Brow presentation can then be further described based on the position of the anterior fontanelle as frontal anterior, posterior, or transverse. Diagnosing the exact presentation can be challenging, and face presentation may be misdiagnosed as frank breech. To avoid any confusion, a bedside ultrasound scan can be performed. [6]  Ultrasound imaging can show a reduced angle between the occiput and the spine or the chin is separated from the chest. However, ultrasound does not provide much predictive value for the outcome of labor. [7]

• Anatomy and Physiology

Before discussing the mechanism of labor in the face or brow presentation, it is crucial to highlight some anatomical landmarks and their measurements. 

Planes and Diameters of the Pelvis

The 3 most important planes in the female pelvis are the pelvic inlet, mid-pelvis, and pelvic outlet. Four diameters can describe the pelvic inlet: anteroposterior, transverse, and 2 obliques. Furthermore, based on the landmarks on the pelvic inlet, there are 3 different anteroposterior diameters named conjugates: true conjugate, obstetrical conjugate, and diagonal conjugate. Only the latter can be measured directly during the obstetric examination. The shortest of these 3 diameters is obstetrical conjugate, which measures approximately 10.5 cm and is the distance between the sacral promontory and 1 cm below the upper border of the symphysis pubis. This measurement is clinically significant as the fetal head must pass through this diameter during the engagement phase. The transverse diameter measures about 13.5 cm and is the widest distance between the innominate line on both sides. The shortest distance in the mid pelvis is the interspinous diameter and usually is only about 10 cm. 

Fetal Skull Diameters

There are 6 distinguished longitudinal fetal skull diameters:

• Suboccipito-bregmatic: from the center of anterior fontanelle (bregma) to the occipital protuberance, measuring 9.5 cm. This is the diameter presented in the vertex presentation. 
• Suboccipito-frontal: from the anterior part of bregma to the occipital protuberance, measuring 10 cm 
• Occipito-frontal: from the root of the nose to the most prominent part of the occiput, measuring 11.5 cm
• Submento-bregmatic: from the center of the bregma to the angle of the mandible, measuring 9.5 cm. This is the diameter in the face presentation where the neck is hyperextended. 
• Submento-vertical: from the midpoint between fontanelles and the angle of the mandible, measuring 11.5 cm 
• Occipito-mental: from the midpoint between fontanelles and the tip of the chin, measuring 13.5 cm. It is the presenting diameter in brow presentation. 

Cardinal Movements of Normal Labor

• Neck flexion
• Internal rotation
• Extension (delivers head)
• External rotation (restitution)
• Expulsion (delivery of anterior and posterior shoulders)

Some key movements are impossible in the face or brow presentations. Based on the information provided above, it is obvious that labor be arrested in brow presentation unless it spontaneously changes to the face or vertex, as the occipito-mental diameter of the fetal head is significantly wider than the smallest diameter of the female pelvis. Face presentation can, however, be delivered vaginally, and further mechanisms of face delivery are explained in later sections.

• Indications

As mentioned previously, spontaneous vaginal delivery can be successful in face presentation. However, the main indication for vaginal delivery in such circumstances would be a maternal choice. It is crucial to have a thorough conversation with a mother, explaining the risks and benefits of vaginal delivery with face presentation and a cesarean section. Informed consent and creating a rapport with the mother is an essential aspect of safe and successful labor.

• Contraindications

Vaginal delivery of face presentation is contraindicated if the mentum is lying posteriorly or is in a transverse position. In such a scenario, the fetal brow is pressing against the maternal symphysis pubis, and the short fetal neck, which is already maximally extended, cannot span the surface of the maternal sacrum. In this position, the diameter of the head is larger than the maternal pelvis, and it cannot descend through the birth canal. Therefore, the cesarean section is recommended as the safest mode of delivery for mentum posterior face presentations. Attempts to manually convert face presentation to vertex, manual or forceps rotation of the persistent posterior chin to anterior are contraindicated as they can be dangerous. Persistent brow presentation itself is a contraindication for vaginal delivery unless the fetus is significantly small or the maternal pelvis is large.

Continuous electronic fetal heart rate monitoring is recommended for face and brow presentations, as heart rate abnormalities are common in these scenarios. One study found that only 14% of the cases with face presentation had no abnormal traces on the cardiotocograph. [8]  External transducer devices are advised to prevent damage to the eyes. When internal monitoring is inevitable, monitoring devices on bony parts should be placed carefully. 

Consultations that are typically requested for patients with delivery of face/brow presentation include the following:

• Experienced midwife, preferably looking after laboring women 1:1
• Senior obstetrician 
• Neonatal team - in case of need for resuscitation 
• Anesthetic team - to provide necessary pain control (eg, epidural)
• Theatre team  - in case of failure to progress, an emergency cesarean section is required.
• Preparation

No specific preparation is required for face or brow presentation. However, discussing the labor options with the mother and birthing partner and informing members of the neonatal, anesthetic, and theatre co-ordinating teams is essential.

• Technique or Treatment

Mechanism of Labor in Face Presentation

During contractions, the pressure exerted by the fundus of the uterus on the fetus and the pressure of the amniotic fluid initiate descent. During this descent, the fetal neck extends instead of flexing. The internal rotation determines the outcome of delivery. If the fetal chin rotates posteriorly, vaginal delivery would not be possible, and cesarean section is permitted. The approach towards mentum-posterior delivery should be individualized, as the cases are rare. Expectant management is acceptable in multiparous women with small fetuses, as a spontaneous mentum-anterior rotation can occur. However, there should be a low threshold for cesarean section in primigravida women or women with large fetuses.

The pubis is described as mentum-anterior when the fetal chin is rotated towards the maternal symphysis. In these cases, further descent through the vaginal canal continues, with approximately 73% of cases delivering spontaneously. [9]  The fetal mentum presses on the maternal symphysis pubis, and the head is delivered by flexion. The occiput is pointing towards the maternal back, and external rotation happens. Shoulders are delivered in the same manner as in vertex delivery.

Mechanism of Labor in Brow Presentation

As this presentation is considered unstable, it is usually converted into a face or an occiput presentation. Due to the cephalic diameter being wider than the maternal pelvis, the fetal head cannot engage; thus, brow delivery cannot occur. Unless the fetus is small or the pelvis is very wide, the prognosis for vaginal delivery is poor. With persistent brow presentation, a cesarean section is required for safe delivery.

• Complications

As the cesarean section is becoming a more accessible mode of delivery in malpresentations, the incidence of maternal and fetal morbidity and mortality during face presentation has dropped significantly. [10]  However, some complications are still associated with the nature of labor in face presentation. Due to the fetal head position, it is more challenging for the head to engage in the birth canal and descend, resulting in prolonged labor. Prolonged labor itself can provoke fetal distress and arrhythmias. If the labor arrests or signs of fetal distress appear on CTG, the recommended next step in management is an emergency cesarean section, which in itself carries a myriad of operative and post-operative complications. Finally, due to the nature of the fetal position and prolonged duration of labor in face presentation, neonates develop significant edema of the skull and face. Swelling of the fetal airway may also be present, resulting in respiratory distress after birth and possible intubation.

• Clinical Significance

During vertex presentation, the fetal head flexes, bringing the chin to the chest, forming the smallest possible fetal head diameter, measuring approximately 9.5 cm. With face and brow presentation, the neck hyperextends, resulting in greater cephalic diameters. As a result, the fetal head engages later, and labor progresses more slowly. Failure to progress in labor is also more common in both presentations compared to the vertex presentation. Furthermore, when the fetal chin is in a posterior position, this prevents further flexion of the fetal neck, as browns are pressing on the symphysis pubis. As a result, descending through the birth canal is impossible. Such presentation is considered undeliverable vaginally and requires an emergency cesarean section. Manual attempts to change face presentation to vertex or manual or forceps rotation to mentum anterior are considered dangerous and discouraged.

• Enhancing Healthcare Team Outcomes

A multidisciplinary team of healthcare experts supports the woman and her child during labor and the perinatal period. For a face or brow presentation to be appropriately diagnosed, an experienced midwife and obstetrician must be involved in the vaginal examination and labor monitoring. As fetal anomalies, such as anencephaly or goiter, can contribute to face presentation, sonographers experienced in antenatal scanning should also be involved in the care. It is advised to inform the anesthetic and neonatal teams in advance of the possible need for emergency cesarean section and resuscitation of the neonate. [11] [12]

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Disclosure: Julija Makajeva declares no relevant financial relationships with ineligible companies.

Disclosure: Mohsina Ashraf declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Makajeva J, Ashraf M. Delivery, Face and Brow Presentation. [Updated 2023 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Protocol for Persistent Posterior in Labor

• By: Gail Tully
• May 17, 2018
• Pregnancy , Preparing for Birth

Manual rotation of the posterior baby’s head to the anterior position is an option before resorting to cesarean to finish a stalled labor. This technique is proven to reduce cesarean. Midwife researcher and speaker, Catherine Os learned about Spinning Babies® from Approved Trainer  Jennifer Walker , at the Gynzone conference in Europe. Catherine Os says:

“At my workshops I am very clear that manual rotation is a tool to consider during second stage of labor. The head needs to be well engaged and then it is beneficial to use it before failure to progress. This indicates that the woman has already been in labor for a long time and Spinning Babies® is one of the most important tools to help malpositions resolve in the first stage. But I also use Spinning Babies after manual rotation in second stage, because my aim with manual rotation is not necessarily for the baby to be born directly, but to aid progress.” – Midwife Cathrine Os

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