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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.

Illustration of the head-down, face-up position

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.

Illustration of the frank breech position

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.

Illustration of a complete breech presentation

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 Positions for Labor and Birth

Knowing your baby's position can you help ease pain and speed up labor

In the last weeks of pregnancy , determining your baby's position can help you manage pain and discomfort. Knowing your baby's position during early labor can help you adjust your own position during labor and possibly even speed up the process.

Right or Left Occiput Anterior

Illustration by JR Bee, Verywell

Looking at where the baby's head is in the birth canal helps determine the fetal position.The front of a baby's head is referred to as the anterior portion and the back is the posterior portion. There are two different positions called occiput anterior (OA) positions that may occur.

The left occiput anterior (LOA) position is the most common in labor. In this position, the baby's head is slightly off-center in the pelvis with the back of the head toward the mother's left thigh.

The right occiput anterior (ROA) presentation is also common in labor. In this position, the back of the baby is slightly off-center in the pelvis with the back of the head toward the mother's right thigh.

In general, OA positions do not lead to problems or additional pain during labor or birth.

Right or Left Occiput Transverse

Illustration by JR Bee, Verywell

When facing out toward the mother's right thigh, the baby is said to be left occiput transverse (LOT). This position is halfway between a posterior and anterior position. If the baby was previously in a posterior position (in either direction), the LOT position indicates positive movement toward an anterior position.

When the baby is facing outward toward the mother's left thigh, the baby is said to be right occiput transverse (ROT). Like the previous presentation, ROT is halfway between a posterior and anterior position. If the baby was previously in a posterior position, ROT is a sign the baby is making a positive move toward an anterior position.

When a baby is in the left occiput transverse position (LOT) or right occiput transverse (ROT) position during labor, it may lead to more pain and a slower progression.

Tips to Reduce Discomfort

There are several labor positions a mother can try to alleviate pain and encourage the baby to continue rotating toward an anterior position, including:

Pelvic tilts
Standing and swaying

A doula , labor nurse, midwife , or doctor may have other suggestions for positions.

Right or Left Occiput Posterior

When facing forward, the baby is in the occiput posterior position. If the baby is facing forward and slightly to the left (looking toward the mother's right thigh) it is in the left occiput posterior (LOP) position. This presentation can lead to more back pain (sometimes referred to as " back labor ") and slow progression of labor.

In the right occiput posterior position (ROP), the baby is facing forward and slightly to the right (looking toward the mother's left thigh). This presentation may slow labor and cause more pain.

To help prevent or decrease pain during labor and encourage the baby to move into a better position for delivery, mothers can try a variety of positions, including:

Hands and knees
Pelvic rocking

Mothers may try other comfort measures, including:

Bathtub or shower (water)
Counter pressure
Movement (swaying, dancing, sitting on a birth ball )
Rice socks (heat packs)

How a Doctor Determines Baby's Position

Leopold's maneuvers are a series of hands-on examinations your doctor or midwife will use to help determine your baby's position. During the third trimester , the assessment will be done at most of your prenatal visits. Knowing the baby's position before labor begins can help you prepare for labor and delivery.

Once labor begins, a nurse, doctor, or midwife will be able to get a more accurate sense of your baby's position by performing a vaginal exam. When your cervix is dilated enough, the practitioner will insert their fingers into the vagina and feel for the suture lines of the baby's skull as it moves down in the birth canal. It's important to ensure the baby is head down and moving in the right direction.

Labor and delivery may be more complicated if the baby is not in a head-down position, such as in the case of a breech presentation.

How You Can Determine Baby's Position

While exams by health practitioners are an important part of your care, from the prenatal period through labor and delivery, often the best person to assess a baby's position in the pelvis is you. Mothers should pay close attention to how the baby moves and where different movements are felt.

A technique called belly mapping can help mothers ask questions of themselves to assess their baby's movement and get a sense of the position they are in as labor approaches.

For example, the position of your baby's legs can be determined by asking questions about the location and strength of the kicking you feel. The spots where you feel the strongest kicks are most likely where your baby's feet are.

Other landmarks you can feel for include a large, flat plane, which is most likely your baby's back. Sometimes you can feel the baby arching his or her back.

At the top or bottom of the flat plane, you may feel either a hard, round shape (most likely your baby's head) or a soft curve (most likely to be your baby's bottom).

Guittier M, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial . BJOG: An International Journal of Obstetrics & Gynaecology . 2016;123(13):2199-2207. doi:10.1111/1471-0528.13855

Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli G. Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy . Biomed Res Int . 2014;2014:1-7. doi:10.1155/2014/638093

Ahmad A, Webb S, Early B, Sitch A, Khan K, MacArthur C. Association between fetal position at onset of labor and mode of delivery: a prospective cohort study . Ultrasound in Obstetrics & Gynecology . 2014;43(2):176-182. doi:10.1002/uog.13189

Nishikawa M, Sakakibara H. Effect of nursing intervention program using abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment . Reprod Health . 2013;10(1). doi:10.1186/1742-4755-10-12

Choi S, Park Y, Lee D, Ko H, Park I, Shin J. Sonographic assessment of fetal occiput position during labor for the prediction of labor dystocia and perinatal outcomes . The Journal of Maternal-Fetal & Neonatal Medicine . 2016;29(24):3988-3992. doi:10.3109/14767058.2016.1152250

Bamberg C, Deprest J, Sindhwani N et al. Evaluating fetal head dimension changes during labor using open magnetic resonance imaging . J Perinat Med . 2017;45(3). doi:10.1515/jpm-2016-0005

Gabbe S, Niebyl J, Simpson J et al. Obstetrics . Philadelphia, Pa.: Elsevier; 2012.

By Robin Elise Weiss, PhD, MPH Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

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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

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

Anterior, lateral and posterior fetal presentations

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.

Vertex presentation, showing the narrow part of the baby’s head.

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.

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: October 2023

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

Foetal Version
Breech Presentation

Need more information?

Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

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.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

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

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

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

You have been pregnant before
In pregnancies of multiples
When there is a history of premature delivery
When the uterus has too much or too little amniotic fluid
When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC) is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

You are carrying more than one fetus
There are concerns about the health of the fetus
You have certain abnormalities of the reproductive system
The placenta is in the wrong place
The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

Prelabor rupture of membranes
Changes in the fetus’s heart rate
Placental abruption
Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

The baby is full-term and in the frank breech presentation
The baby does not show signs of distress while its heart rate is closely monitored.
The process of labor is smooth and steady with the cervix widening as the baby descends.
The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

Creating Your Birth Plan
Labor & Birth Terms to Know
Cesarean Birth After Care

Compiled using information from the following sources:

ACOG: If Your Baby is Breech
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

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Last Update: November 6, 2022 .

Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

Describe the pathophysiology of breech presentation.
Review the physical exam of a patient with a breech presentation.
Summarize the treatment options for breech presentation.
Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has also been described by some to increase the incidence of breech presentation two-fold.

Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in the breech presentation are those that affect fetal motility or the vertical polarity of the uterine cavity. [6] [7]

Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus
Placentation: Placenta previa as the placenta is occupying the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often intramural or submucosal, that prevent engagement of the presenting part.
Prematurity
Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
Congenital anomalies: Fetal sacrococcygeal teratoma, fetal thyroid goiter
Polyhydramnios: Fetus is often in unstable lie, unable to engage
Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex.

Any of these findings should raise suspicion and ultrasound should be performed.

Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis.

On ultrasound, the fetal lie and presenting part should be visualized and documented. If breech presentation is diagnosed, specific information including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously) should be documented.

Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000 compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, there was no significant difference in maternal morbidity or mortality between the two groups. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at two years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors since have argued that there are still some specific situations that vaginal breech delivery is a potential, safe alternative to planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these specific criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age will determine the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note, due to lack of recruitment, no prospective clinical trials are examining this issue.

Differential Diagnosis
Face and brow presentation
Fetal anomalies
Fetal death
Grand multiparity
Multiple pregnancies
Oligohydramnios
Pelvis Anatomy
Preterm labor
Primigravida
Uterine anomalies
Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor and delivery nurse, anesthesiologist and a neonatologist. The ultimate decison rests on the obstetrician. To prevent complications, today cesarean sections are performed and experienced with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

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Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan 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 Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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What Is Breech?

When a fetus is delivered buttocks or feet first

Types of Presentation

Risk Factors

Complications.

Breech concerns the position of the fetus before labor . Typically, the fetus comes out headfirst, but in a breech delivery, the buttocks or feet come out first. This type of delivery is risky for both the pregnant person and the fetus.

This article discusses the different types of breech presentations, risk factors that might make a breech presentation more likely, treatment options, and complications associated with a breech delivery.

Verywell / Jessica Olah

Types of Breech Presentation

During the last few weeks of pregnancy, a fetus usually rotates so that the head is positioned downward to come out of the vagina first. This is called the vertex position.

In a breech presentation, the fetus does not turn to lie in the correct position. Instead, the fetus’s buttocks or feet are positioned to come out of the vagina first.

At 28 weeks of gestation, approximately 20% of fetuses are in a breech position. However, the majority of these rotate to the proper vertex position. At full term, around 3%–4% of births are breech.

The different types of breech presentations include:

Complete : The fetus’s knees are bent, and the buttocks are presenting first.
Frank : The fetus’s legs are stretched upward toward the head, and the buttocks are presenting first.
Footling : The fetus’s foot is showing first.

Signs of Breech

There are no specific symptoms associated with a breech presentation.

Diagnosing breech before the last few weeks of pregnancy is not helpful, since the fetus is likely to turn to the proper vertex position before 35 weeks gestation.

A healthcare provider may be able to tell which direction the fetus is facing by touching a pregnant person’s abdomen. However, an ultrasound examination is the best way to determine how the fetus is lying in the uterus.

Most breech presentations are not related to any specific risk factor. However, certain circumstances can increase the risk for breech presentation.

These can include:

Previous pregnancies
Multiple fetuses in the uterus
An abnormally shaped uterus
Uterine fibroids , which are noncancerous growths of the uterus that usually appear during the childbearing years
Placenta previa, a condition in which the placenta covers the opening to the uterus
Preterm labor or prematurity of the fetus
Too much or too little amniotic fluid (the liquid that surrounds the fetus during pregnancy)
Fetal congenital abnormalities

Most fetuses that are breech are born by cesarean delivery (cesarean section or C-section), a surgical procedure in which the baby is born through an incision in the pregnant person’s abdomen.

In rare instances, a healthcare provider may plan a vaginal birth of a breech fetus. However, there are more risks associated with this type of delivery than there are with cesarean delivery.

Before cesarean delivery, a healthcare provider might utilize the external cephalic version (ECV) procedure to turn the fetus so that the head is down and in the vertex position. This procedure involves pushing on the pregnant person’s belly to turn the fetus while viewing the maneuvers on an ultrasound. This can be an uncomfortable procedure, and it is usually done around 37 weeks gestation.

ECV reduces the risks associated with having a cesarean delivery. It is successful approximately 40%–60% of the time. The procedure cannot be done once a pregnant person is in active labor.

Complications related to ECV are low and include the placenta tearing away from the uterine lining, changes in the fetus’s heart rate, and preterm labor.

ECV is usually not recommended if the:

Pregnant person is carrying more than one fetus
Placenta is in the wrong place
Healthcare provider has concerns about the health of the fetus
Pregnant person has specific abnormalities of the reproductive system

Recommendations for Previous C-Sections

The American College of Obstetricians and Gynecologists (ACOG) says that ECV can be considered if a person has had a previous cesarean delivery.

During a breech delivery, the umbilical cord might come out first and be pinched by the exiting fetus. This is called cord prolapse and puts the fetus at risk for decreased oxygen and blood flow. There’s also a risk that the fetus’s head or shoulders will get stuck inside the mother’s pelvis, leading to suffocation.

Complications associated with cesarean delivery include infection, bleeding, injury to other internal organs, and problems with future pregnancies.

A healthcare provider needs to weigh the risks and benefits of ECV, delivering a breech fetus vaginally, and cesarean delivery.

In a breech delivery, the fetus comes out buttocks or feet first rather than headfirst (vertex), the preferred and usual method. This type of delivery can be more dangerous than a vertex delivery and lead to complications. If your baby is in breech, your healthcare provider will likely recommend a C-section.

A Word From Verywell

Knowing that your baby is in the wrong position and that you may be facing a breech delivery can be extremely stressful. However, most fetuses turn to have their head down before a person goes into labor. It is not a cause for concern if your fetus is breech before 36 weeks. It is common for the fetus to move around in many different positions before that time.

At the end of your pregnancy, if your fetus is in a breech position, your healthcare provider can perform maneuvers to turn the fetus around. If these maneuvers are unsuccessful or not appropriate for your situation, cesarean delivery is most often recommended. Discussing all of these options in advance can help you feel prepared should you be faced with a breech delivery.

American College of Obstetricians and Gynecologists. If your baby is breech .

TeachMeObGyn. Breech presentation .

MedlinePlus. Breech birth .

Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term . Cochrane Database Syst Rev . 2015 Apr 1;2015(4):CD000083. doi:10.1002/14651858.CD000083.pub3

By Christine Zink, MD Dr. Zink is a board-certified emergency medicine physician with expertise in the wilderness and global medicine.

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How your twins’ fetal positions affect labor and delivery

Twin fetal presentation – also known as the position of your babies in the womb – dictates whether you'll have a vaginal or c-section birth. Toward the end of pregnancy, most twins will move in the head-down position (vertex), but there's a risk that the second twin will change position after the first twin is born. While there are options to change the second twin's position, this can increase the risk of c-section and other health issues. Learn about the six possible twin fetal presentations: vertex-vertex, vertex-breech, breech-breech, vertex-transverse, breech-transverse, and transverse-transverse – and how they'll impact your delivery and risks for complications.

What is fetal presentation and what does it mean for your twins?

As your due date approaches, you might be wondering how your twins are currently positioned in the womb, also known as the fetal presentation, and what that means for your delivery. Throughout your pregnancy, your twin babies will move in the uterus, but sometime during the third trimester – usually between 32 and 36 weeks – their fetal presentation changes as they prepare to go down the birth canal.

The good news is that at most twin births, both babies are head-down (vertex), which means you can have a vaginal delivery. In fact, nearly 40 percent of twins are delivered vaginally.

But if one baby has feet or bottom first (breech) or is sideways (transverse), your doctor might deliver the lower twin vaginally and then try to rotate the other twin so that they face head-down (also called external cephalic version or internal podalic version) and can be delivered vaginally. But if that doesn't work, there's still a chance that your doctor will be able to deliver the second twin feet first vaginally via breech extraction (delivering the breech baby feet or butt first through the vagina).

That said, a breech extraction depends on a variety of factors – including how experienced your doctor is in the procedure and how much the second twin weighs. Studies show that the higher rate of vaginal births among nonvertex second twins is associated with labor induction and more experienced doctors, suggesting that proper delivery planning may increase your chances of a vaginal birth .

That said, you shouldn't totally rule out a Cesarean delivery with twins . If the first twin is breech or neither of the twins are head-down, then you'll most likely have a Cesarean delivery.

Research also shows that twin babies who are born at less than 34 weeks and have moms with multiple children are associated with intrapartum presentation change (when the fetal presentation of the second twin changes from head-down to feet first after the delivery of the first twin) of the second twin. Women who have intrapartum presentation change are more likely to undergo a Cesarean delivery for their second twin.

Here's a breakdown of the different fetal presentations for twin births and how they will affect your delivery.

Head down, head down (vertex, vertex)

This fetal presentation is the most promising for a vaginal delivery because both twins are head-down. Twins can change positions, but if they're head-down at 28 weeks, they're likely to stay that way.

When delivering twins vaginally, there is a risk that the second twin will change position after the delivery of the first. Research shows that second twins change positions in 20 percent of planned vaginal deliveries. If this happens, your doctor may try to rotate the second twin so it faces head-down or consider a breech extraction. But if neither of these work or are an option, then a Cesarean delivery is likely.

In vertex-vertex pairs, the rate of Cesarean delivery for the second twin after a vaginal delivery of the first one is 16.9 percent.

Like all vaginal deliveries, there's also a chance you'll have an assisted birth, where forceps or a vacuum are needed to help deliver your twins.

Head down, bottom down (vertex, breech)

When the first twin's (the lower one) head is down, but the second twin isn't, your doctor may attempt a vaginal delivery by changing the baby's position or doing breech extraction, which isn't possible if the second twin weighs much more than the first twin.

The rates of emergency C-section deliveries for the second twin after a vaginal delivery of the first twin are higher in second twins who have a very low birth weight. Small babies may not tolerate labor as well.

Head down, sideways (vertex, transverse)

If one twin is lying sideways or diagonally (oblique), there's a chance the baby may shift position as your labor progresses, or your doctor may try to turn the baby head-down via external cephalic version or internal podalic version (changing position in the uterus), which means you may be able to deliver both vaginally.

Bottom down, bottom down (breech, breech)

When both twins are breech, a planned C-section is recommended because your doctor isn't able to turn the fetuses. Studies also show that there are fewer negative neonatal outcomes for planned C-sections than planned vaginal births in breech babies.

As with any C-section, the risks for a planned one with twins include infection, loss of blood, blood clots, injury to the bowel or bladder, a weak uterine wall, placenta abnormalities in future pregnancies and fetal injury.

Bottom down, sideways (breech, transverse)

When the twin lowest in your uterus is breech or transverse (which happens in 25 percent of cases), you'll need to have a c-section.

Sideways, sideways (transverse, transverse)

This fetal presentation is rare with less than 1 percent of cases. If both babies are lying horizontally, you'll almost definitely have a C-section.

Learn more:

Twin fetal development month by month
Your likelihood of having twins or more
When and how to find out if you’re carrying twins or more

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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 .

Cleveland Clinic. Fetal Positions for Birth: https://my.clevelandclinic.org/health/articles/9677-fetal-positions-for-birth Opens a new window [Accessed July 2021]

Mayo Clinic. Fetal Presentation Before Birth: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/multimedia/fetal-positions/sls-20076615?s=7 Opens a new window [Accessed July 2021]

NHS. Giving Birth to Twins or More: https://pubmed.ncbi.nlm.nih.gov/29016498/ Opens a new window [Accessed July 2021]

Science Direct. Breech Extraction: https://www.sciencedirect.com/topics/medicine-and-dentistry/breech-extraction Opens a new window [Accessed July 2021]

Obstetrics & Gynecology. Clinical Factors Associated With Presentation Change of the Second Twin After Vaginal Delivery of the First Twin https://pubmed.ncbi.nlm.nih.gov/29016498/ Opens a new window [Accessed July 2021]

American Journal of Obstetrics and Gynecology. Fetal presentation and successful twin vaginal delivery: https://www.ajog.org/article/S0002-9378(04)00482-X/fulltext [Accessed July 2021]

The Journal of Maternal-Fetal & Neonatal Medicine. Changes in fetal presentation in twin pregnancies https://www.tandfonline.com/doi/abs/10.1080/14767050400028592 Opens a new window [Accessed July 2021]

Reviews in Obstetrics & Gynecology. An Evidence-Based Approach to Determining Route of Delivery for Twin Gestations https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252881/ Opens a new window [Accessed July 2021]

Nature. Neonatal mortality and morbidity in vertex–vertex second twins according to mode of delivery and birth weight: https://www.nature.com/articles/7211408 Opens a new window [Accessed July 2021]

Cochrane. Planned cesarean for a twin pregnancy: https://www.cochrane.org/CD006553/PREG_planned-caesarean-section-twin-pregnancy Opens a new window [Accessed July 2021]

Kids Health. What Is the Apgar Score?: https://www.kidshealth.org/Nemours/en/parents/apgar0.html Opens a new window [Accessed July 2021]

American Journal of Obstetrics & Gynecology. Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery https://pubmed.ncbi.nlm.nih.gov/15467540/ Opens a new window [Accessed July 2021]

Lancet. Planned cesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group https://pubmed.ncbi.nlm.nih.gov/11052579/ Opens a new window [Accessed July 2021]

Cleveland Clinic. Cesarean Birth (C-Section): https://my.clevelandclinic.org/health/treatments/7246-cesarean-birth-c-section Opens a new window [Accessed July 2021]

St. Jude Medical Staff. Delivery of Twin Gestation: http://www.sjmedstaff.org/documents/Delivery-of-twins.pdf Opens a new window [Accessed July 2021]

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Fitting an IUS or IUD

Abnormal Fetal lie, Malpresentation and Malposition

Original Author(s): Anna Mcclune Last updated: 1st December 2018 Revisions: 12

1 Definitions
2 Risk Factors
3.2 Presentation
3.3 Position
4 Investigations
5.1 Abnormal Fetal Lie
5.2 Malpresentation
5.3 Malposition

The lie, presentation and position of a fetus are important during labour and delivery.

In this article, we will look at the risk factors, examination and management of abnormal fetal lie, malpresentation and malposition.

Definitions

Longitudinal, transverse or oblique
Cephalic vertex presentation is the most common and is considered the safest
Other presentations include breech, shoulder, face and brow
Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) – this is ideal for birth
Other positions include occipito-posterior and occipito-transverse.

Note: Breech presentation is the most common malpresentation, and is covered in detail here .

Fig 1 – The two most common fetal presentations: cephalic and breech.

Risk Factors

The risk factors for abnormal fetal lie, malpresentation and malposition include:

Multiple pregnancy
Uterine abnormalities (e.g fibroids, partial septate uterus)
Fetal abnormalities
Placenta praevia
Primiparity

Identifying Fetal Lie, Presentation and Position

The fetal lie and presentation can usually be identified via abdominal examination. The fetal position is ascertained by vaginal examination.

For more information on the obstetric examination, see here .

Face the patient’s head
Place your hands on either side of the uterus and gently apply pressure; one side will feel fuller and firmer – this is the back, and fetal limbs may feel ‘knobbly’ on the opposite side

Presentation

Palpate the lower uterus (above the symphysis pubis) with the fingers of both hands; the head feels hard and round (cephalic) and the bottom feels soft and triangular (breech)
You may be able to gently push the fetal head from side to side

The fetal lie and presentation may not be possible to identify if the mother has a high BMI, if she has not emptied her bladder, if the fetus is small or if there is polyhydramnios .

During labour, vaginal examination is used to assess the position of the fetal head (in a cephalic vertex presentation). The landmarks of the fetal head, including the anterior and posterior fontanelles, indicate the position.

Fig 2 – Assessing fetal lie and presentation.

Investigations

Any suspected abnormal fetal lie or malpresentation should be confirmed by an ultrasound scan . This could also demonstrate predisposing uterine or fetal abnormalities.

Abnormal Fetal Lie

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted – ideally between 36 and 38 weeks gestation.

ECV is the manipulation of the fetus to a cephalic presentation through the maternal abdomen.

It has an approximate success rate of 50% in primiparous women and 60% in multiparous women. Only 8% of breech presentations will spontaneously revert to cephalic in primiparous women over 36 weeks gestation.

Complications of ECV are rare but include fetal distress , premature rupture of membranes, antepartum haemorrhage (APH) and placental abruption. The risk of an emergency caesarean section (C-section) within 24 hours is around 1 in 200.

ECV is contraindicated in women with a recent APH, ruptured membranes, uterine abnormalities or a previous C-section .

Fig 3 – External cephalic version.

Malpresentation

The management of malpresentation is dependent on the presentation.

Breech – attempt ECV before labour, vaginal breech delivery or C-section
Brow – a C-section is necessary
If the chin is anterior (mento-anterior) a normal labour is possible; however, it is likely to be prolonged and there is an increased risk of a C-section being required
If the chin is posterior (mento-posterior) then a C-section is necessary
Shoulder – a C-section is necessary

Malposition

90% of malpositions spontaneously rotate to occipito-anterior as labour progresses. If the fetal head does not rotate, rotation and operative vaginal delivery can be attempted. Alternatively a C-section can be performed.

Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) - this is ideal for birth

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted - ideally between 36 and 38 weeks gestation.

Breech - attempt ECV before labour, vaginal breech delivery or C-section

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

Variations in Fetal Position and Presentation |

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Rutgers doctoral student gives birth on same day she defends dissertation

NEW JERSEY (WABC) -- This Mother's Day will be especially poignant for a New Jersey woman who will not only celebrate being a mom, but also becoming a doctor.

Tamiah Brevard-Rodriguez was working on her doctoral dissertation presentation from Rutgers when she went into labor on March 25.

She was only eight months pregnant and was scheduled to deliver her dissertation defense that day.

"I was physically prepared for a pregnancy, mentally my brain was not on a baby," she said. "So I was having a very emotional response to knowing I was in labor, knowing I had this defense. I was literally shaking."

She had everything planned out with staff and faculty at Rutgers to examine standards Black women face on historically white college campuses.

But things went off schedule when her water broke. Brevard-Rodriguez's wife rushed to their car after their doula told them to get moving as contractions increased.

The drive on the Garden State Parkway to the hospital was a race against time.

"The doula is trying to tell me don't grunt him out, just breathe and I'm like 'this baby is coming,'" Brevard-Rodriguez said.

At that point, her wife, Alyza Brevard-Rodriguez, said she was probably driving 120 mph on the highway.

"I had three pushes, so the first one was baby's head was crowning, second push he was out, third one we were just there," Brevard-Rodriguez said.

Once at the hospital, baby Enzo was checked out and all was well.

But since Tamiah was well-rehearsed for the dissertation, she delivered her defense about seven hours after Enzo came into the world.

"I was like, I think I could do it, I was prepared for it, what did I do, some final touches on it and I did the study," she said.

She said all she needed was a nap, a shower and to regroup.

No one knew about the delivery until after the successful defense was complete.

So she delivered a baby and became a doctor on the same very special day.

Sunday is not only Mother's Day, it is also her graduation ceremony.

ALSO READ | Comedian Tracy Morgan pays special visit to cancer patient and lifelong fan

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Tracking Abortion Bans Across the Country

By The New York Times Updated May 1, 4:40 P.M. ET

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Twenty-one states ban abortion or restrict the procedure earlier in pregnancy than the standard set by Roe v. Wade, which governed reproductive rights for nearly half a century until the Supreme Court overturned the decision in 2022.

In some states, the fight over abortion access is still taking place in courtrooms, where advocates have sued to block bans and restrictions. Other states have moved to expand access to abortion by adding legal protections.

Latest updates

The Arizona state legislature voted to repeal an 1864 ban on nearly all abortions. Officials warned that the near-total ban may be briefly enforceable this summer until the repeal takes effect in the fall. A 15-week ban remains in effect.
A ban on abortion after about six weeks of pregnancy took effect in Florida , following a ruling by the Florida Supreme Court that the privacy protections of the state’s Constitution do not extend to abortion.

The New York Times is tracking abortion laws in each state after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization , which ended the constitutional right to an abortion.

Where abortion is legal

In a few states that have enacted bans or restrictions, abortion remains legal for now as courts determine whether these laws can take effect. Abortion is legal in the rest of the country, and many states have added new protections since Dobbs.

Ban in effect

Note: TK note here.

Legal for now

State details.

More details on the current status of abortion in each state are below.

An earlier version of this article misstated the legal status of abortion in Utah. As of 4 p.m. on June 24, the state attorney general had issued a statement saying the state’s abortion ban had been triggered, but it had not yet been authorized by the legislature’s general counsel. By 8:30 p.m., the counsel authorized the ban and it went into effect.

A table in an earlier version of this article misstated which abortion ban is being challenged in Texas state court. Abortion rights supporters are challenging a pre-Roe ban, not the state’s trigger ban.

An earlier version of this article referred incorrectly to the legal status of abortion in Indiana. While Indiana abortion providers stopped offering abortion services in anticipation of an abortion ban taking effect on Aug. 1, the law did not take effect.

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Section 5 - Rubella
Section 5 - Smallpox & Other Orthopoxvirus-Associated Infections

Rubeola / Measles

Cdc yellow book 2024.

Author(s): Paul Gastañaduy, James Goodson

Infectious Agent

Transmission, epidemiology, clinical presentation.

INFECTIOUS AGENT: Measles virus

TRAVELER CATEGORIES AT GREATEST RISK FOR EXPOSURE & INFECTION

PREVENTION METHODS

Rubeola is a vaccine-preventable disease

DIAGNOSTIC SUPPORT

Measles virus is a member of the genus Morbillivirus of the family Paramyxoviridae .

Measles is transmitted from person to person via respiratory droplets and by the airborne route as aerosolized droplet nuclei. Infected people are usually contagious from 4 days before until 4 days after rash onset. Measles is among the most contagious viral diseases known; secondary attack rates are ≥90% among susceptible household and institutional contacts. Humans are the only natural host for sustaining measles virus transmission, which makes global eradication of measles feasible.

Measles was declared eliminated (defined as the absence of endemic measles virus transmission in a defined geographic area for ≥12 months in the presence of a well-performing surveillance system) from the United States in 2000. Measles virus continues to be imported into the country from other parts of the world, however, and recent prolonged outbreaks in the United States resulting from measles virus importations highlight the challenges faced in maintaining measles elimination.

Given the large global measles burden and high communicability of the disease, travelers could be exposed to the virus in any country they visit where measles remains endemic or where large outbreaks are occurring. Most measles cases imported into the United States occur in unvaccinated US residents who become infected while traveling abroad, often to the World Health Organization (WHO)–defined Western Pacific and European regions. These travelers become symptomatic after returning to the United States and sometimes infect others in their communities, causing outbreaks.

Nearly 90% of imported measles cases are considered preventable by vaccination (i.e., the travelers lacked recommended age- and travel-appropriate vaccination). Furthermore, observational studies in travel clinics in the United States have shown that 59% of pediatric and 53% of adult travelers eligible for measles-mumps-rubella (MMR) vaccine at the time of pretravel consultation were not vaccinated at the visit, highlighting a missed opportunity to reduce the likelihood of measles introductions and subsequent spread. Encourage all eligible travelers to receive appropriate MMR vaccination. Outbreak investigations are costly and resource intensive, and infected people—in addition to productivity losses—can incur direct costs for the management of their illness, including treatment, quarantine, and caregiving.

The incubation period averages 11–12 days from exposure to onset of prodrome; rash usually appears ≈14 days after exposure. Symptoms include fever, with temperature ≤105°F (≤40.6°C); conjunctivitis; coryza (runny nose); cough; and small spots with white or bluish-white centers on an erythematous base appearing on the buccal mucosa (Koplik spots). A characteristic red, blotchy (maculopapular) rash appears 3–7 days after onset of prodromal symptoms. The rash begins on the face, becomes generalized, and lasts 4–7 days.

Common measles complications include diarrhea (8%), middle ear infection (7%–9%), and pneumonia (1%–6%). Encephalitis, which can result in permanent brain damage, occurs in ≈1 per 1,000–2,000 cases of measles. The risk for serious complications or death is highest for children aged ≤5 years, adults aged ≥20 years, and in populations with poor nutritional status or that lack access to health care.

Subacute sclerosing panencephalitis (SSPE) is a progressive neurologic disorder caused by measles virus that usually presents 5–10 years after recovery from the initial primary measles virus infection. SSPE manifests as mental and motor deterioration, which can progress to coma and death. SSPE occurs in ≈1 of every 5,000 reported measles cases; rates are higher among children <5 years of age.

Measles is a nationally notifiable disease. Laboratory criteria for diagnosis include a positive serologic test for measles-specific IgM, IgG seroconversion, or a significant rise in measles IgG level by any standard serologic assay; isolation of measles virus; or detection of measles virus RNA by reverse transcription PCR (RT-PCR) testing. The Centers for Disease Control and Prevention’s Measles Virus Laboratory is the national reference laboratory; it provides serologic and molecular testing for measles and technical assistance to state public health laboratories for the collection and shipment of clinical samples for molecular diagnostics and genetic analysis. See detailed information on diagnostic support .

A clinical case of measles illness is characterized by generalized maculopapular rash lasting ≥3 days; temperature ≥101°F (38.3°C); and cough, coryza, or conjunctivitis. A confirmed case is one with an acute febrile rash illness with laboratory confirmation or direct epidemiologic linkage to a laboratory-confirmed case. In a laboratory-confirmed or epidemiologically linked case, the patient’s temperature does not need to reach ≥101°F (38.3°C) and the rash does not need to last ≥3 days.

Treatment is supportive. The WHO recommends vitamin A for all children with acute measles, regardless of their country of residence, to reduce the risk for complications. Administer vitamin A as follows: for infants <6 months old, give 50,000 IU, once a day for 2 days; for infants 6 months old and older, but younger than 12 months, give 100,000 IU once a day for 2 days; for children ≥12 months old give 200,000 IU once a day for 2 days. For children with clinical signs and symptoms of vitamin A deficiency, administer an additional (i.e., a third) age-specific dose of vitamin A 2–4 weeks following the first round of dosing.

Measles has been preventable through vaccination since a vaccine was licensed in 1963. People who do not have evidence of measles immunity should be considered at risk for measles, particularly during international travel. Acceptable presumptive evidence of immunity to measles includes birth before 1957; laboratory confirmation of disease; laboratory evidence of immunity; or written documentation of age-appropriate vaccination with a licensed, live attenuated measles-containing vaccine 1 , namely, MMR or measles-mumps-rubella-varicella (MMRV). For infants 6 months old and older, but younger than 12 months, this includes documented administration of 1 dose of MMR; for people aged ≥12 months, documentation should include 2 doses of MMR or MMRV (the first dose administered at age ≥12 months and the second dose administered no earlier than 28 days after the first dose). Verbal or self-reported history of vaccination is not considered valid presumptive evidence of immunity.

1 From 1963–1967, a formalin-inactivated measles vaccine was available in the United States and was administered to ≈600,000–900,000 people. It was discontinued when it became apparent that the immunity it produced was short-lived. Consider people who received this vaccine unvaccinated.

Vaccination

Measles vaccine contains live, attenuated measles virus, which in the United States is available only in combination formulations (e.g., MMR and MMRV vaccines). MMRV vaccine is licensed for children aged 12 months–12 years and can be used in place of MMR vaccine if vaccination for measles, mumps, rubella, and varicella is needed.

International travelers, including people traveling to high-income countries, who do not have presumptive evidence of measles immunity and who have no contraindications to MMR or MMRV, should receive MMR or MMRV before travel per the following schedule.

Infants (6 months old and older, but younger than 12 months): 1 MMR dose. Infants vaccinated before age 12 months must be revaccinated on or after the first birthday with 2 doses of MMR or MMRV separated by ≥28 days. MMRV is not licensed for children aged <12 months.

Children (aged ≥12 months): 2 doses of MMR or MMRV separated by ≥28 days.

Adults born in or after 1957: 2 doses of MMR separated by ≥28 days.

One dose of MMR is ≈85% effective when administered at age 9 months; MMR and MMRV are 93% effective when administered at age ≥1 year. Vaccine effectiveness of 2 doses is 97%.

Adverse Reactions

In rare circumstances, MMR vaccination has been associated with anaphylaxis (≈2–14 occurrences per million doses administered); febrile seizures (≈1 occurrence per 3,000–4,000 doses administered, but overall, the rate of febrile seizures after measles-containing vaccine is much lower than the rate with measles disease); thrombocytopenia (≈1 occurrence per 40,000 doses during the 6 weeks after immunization); or joint symptoms (arthralgia develops among ≈25% of nonimmune postpubertal females from the rubella component of the MMR vaccination, and ≈10% have acute arthritis-like signs and symptoms that generally persist for 1–21 days and rarely recur; chronic joint symptoms are rare, if they occur at all). No evidence supports a causal link between MMR vaccination and autism, type 1 diabetes mellitus, or inflammatory bowel disease.

Contraindications

People who experienced a severe allergic reaction (difficulty breathing, hives, hypotension, shock, swelling of the mouth or throat) following a prior dose of MMR or MMRV vaccine, or who had an anaphylactic reaction to topically or systemically administered neomycin, should not be vaccinated or revaccinated. People who are allergic to eggs can receive MMR or MMRV vaccine without prior routine skin testing or the use of special protocols.

Immunosuppression

Enhanced replication of live vaccine viruses can occur in people who have immune deficiency disorders. Death related to vaccine-associated measles virus infection has been reported among severely immunocompromised people; thus, severely immunosuppressed people should not be vaccinated with MMR or MMRV vaccine. For a thorough discussion of recommendations for immunocompromised travelers, see Sec. 3, Ch. 1, Immunocompromised Travelers .

MMR vaccination is recommended for all people with HIV infection aged ≥12 months who do not have evidence of measles, mumps, and rubella immunity, and who do not have evidence of severe immunosuppression. The assessment of severe immunosuppression can be based on CD4 values (count or percentage); absence of severe immunosuppression is defined as CD4 ≥15% for ≥6 months for children aged ≤5 years, or CD4 ≥15% and CD4 count ≥200 cells/mL for ≥6 months for people aged >5 years.

People with leukemia in remission and off chemotherapy, who were not immune to measles when diagnosed with leukemia, may receive MMR vaccine. At least 3 months should elapse after termination of chemotherapy before administering the first dose of vaccine.

Steroids & Other Immunosuppressive Therapies

Avoid vaccinating people who have received high-dose corticosteroid therapy (in general, considered to be ≥20 mg or 2 mg/kg body weight of prednisone, or its equivalent, daily for ≥14 days) with MMR or MMRV for ≥1 month after cessation of steroid therapy. Corticosteroid therapy usually is not a contraindication when administration is short-term (<14 days) or a low to moderate dose (<20 mg of prednisone or equivalent per day).

In general, withhold MMR or MMRV vaccine for ≥3 months after cessation of other immunosuppressive therapies and remission of the underlying disease. See Sec. 3, Ch. 1, Immunocompromised Travelers , for more details.

MMR vaccines should not be administered to pregnant people or people attempting to become pregnant. Because of the theoretical risk to the fetus, people should be counseled to avoid becoming pregnant for 28 days after receiving a live-virus (e.g., MMR) vaccine.

Precautions

Personal or family history of seizures of any etiology.

Compared with administration of separate MMR and varicella vaccines at the same visit, use of MMRV vaccine is associated with a higher risk for fever and febrile seizures 5–12 days after the first dose among children aged 12–23 months. Approximately 1 additional febrile seizure occurs for every 2,300–2,600 MMRV vaccine doses administered. Use of separate MMR and varicella vaccines avoids this increased risk for fever and febrile seizures.

Thrombocytopenia

The benefits of primary immunization are usually greater than the potential risks for vaccine- associated thrombocytopenia. Avoid giving subsequent doses of MMR or MMRV vaccine, however, if an episode of thrombocytopenia occurred ≤6 weeks after a previous dose of vaccine.

Postexposure Prophylaxis

Measles-containing vaccine or immune globulin (IG) can be effective as postexposure prophylaxis. MMR or MMRV administered ≤72 hours after initial exposure to measles virus might provide some protection. If the exposure does not result in infection, the vaccine should induce protection against subsequent measles virus infection.

When administered ≤6 days of exposure, IG can be used to confer temporary immunity in a susceptible person. If the exposure does not result in modified or typical measles, vaccination with MMR or MMRV is still necessary to provide long-lasting protection. Six months after receiving intramuscularly administered IG, or 8 months after receiving intravenously administered IG, administer MMR or MMRV vaccine, provided the patient is aged ≥12 months and the vaccine is not otherwise contraindicated.

CDC website: Measles

The following authors contributed to the previous version of this chapter: Paul A. Gastañaduy, James L. Goodson

Bibliography

Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1–34.

Gastañaduy P, Redd S, Clemmons N, Lee AD, Hickman CJ, Rota PA, et al. Measles. In: Roush SW, Baldy LM, Kirkconnell Hall MA, editors. Manual for the surveillance of vaccine-preventable diseases. Atlanta: Centers for Disease Control and Prevention; 2019. Available from: www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html .

Hyle EP, Fields NF, Fiebelkorn AP, Taylor Walker A, Gastañaduy P, Rao SR, et al. The clinical impact and cost-effectiveness of measles-mumps-rubella vaccination to prevent measles importations among US international travelers. Clin Infect Dis. 2019;69(2):306–15.

Hyle EP, Rao SR, Bangs AC, Gastañaduy P, Parker Fiebelkorn A, Hagmann SHF, et al. Clinical practices for measles-mumps-rubella vaccination among US pediatric international travelers. JAMA Pediatr. 2020;174(2):e194515.

Hyle EP, Rao SR, Jentes ES, Parker Fiebelkorn A, Hagmann SHF, Taylor Walker A, et al. Missed opportunities for measles, mumps, rubella vaccination among departing U.S. adult travelers receiving pretravel health consultations. Ann Intern Med. 2017;167(2):77–84.

Lee AD, Clemmons NS, Patel M, Gastañaduy PA. International importations of measles virus into the United States during the post-elimination era, 2001–2016. J Infect Dis. 2019;219(10):1616–23.

National Notifiable Diseases Surveillance System. Measles (rubeola): 2013 case definition. Atlanta: CDC; 2013. Available from: https://ndc.services.cdc.gov/conditions/measles/ .

Patel MK, Goodson JL, Alexander JP Jr., Kretsinger K, Sodha SV, Steulet C, et al. Progress toward regional measles elimination—Worldwide, 2000–2019. MMWR Morb Mortal Wkly Rep. 2020;69(45):1700–5.

Pike J, Leidner AJ, Gastañaduy PA. A review of measles outbreak cost estimates from the US in the post-elimination era (2004–2017): Estimates by perspective and cost type. Clin Infect Dis. 2020;1(6):1568–76.

World Health Organization. Measles vaccines: WHO position paper—April 2017. Wkly Epidemiol Rec. 2017;92(17):205–27.

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New York judge blocks amendment barring discrimination on gender identity and pregnancy outcomes

A proposed amendment to New York’s constitution barring discrimination based on “gender identity” and “pregnancy outcomes” cannot appear on the state ballot in November because legislators made a procedural error during an initial round of approval

ALBANY, N.Y. — A proposed amendment to New York’s constitution barring discrimination based on “gender identity” and “pregnancy outcomes” cannot appear on the state ballot in November because legislators made a procedural error during an initial round of approval, a judge ruled Tuesday.

The ruling from state Supreme Court Justice Daniel J. Doyle found lawmakers incorrectly approved the language before getting a written opinion from the attorney general.

The decision removes a politically charged question from the November ballot that Democrats hoped would drive turnout.

Democrats passed the proposed constitutional amendment last year to bar discrimination based on “pregnancy outcomes” or “gender expression,” putting the change to voters in the 2024 election for final approval.

The amendment wouldn’t explicitly preserve a woman’s right to have an abortion . Instead, it would effectively prevent someone from being discriminated against for having the procedure, though backers have said it would have the practical effect of protecting reproductive rights.

The ruling is a blow to Democrats in New York who have sought to spur voter turnout by framing key battleground House races around abortion access , betting that their base would be encouraged to cast a ballot to protect abortion rights following the overturning of Roe v. Wade.

New York Attorney General Letitia James said her office would appeal the decision.

“The Equal Rights Amendment was advanced to protect New Yorkers’ fundamental rights, including reproductive freedom and access to abortion care. This is a disappointing court decision, but we will appeal because New Yorkers deserve to be protected by their Constitution, especially as our basic freedoms and rights are under attack,” said James, a Democrat.

The New York Constitution currently bans discrimination based on race, color, creed or religion. The proposed amendment would add ethnicity, national origin, age, disability, sex, sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes and reproductive health care and autonomy to the list.

As the 2024 election nears, Republicans have begun to criticize the amendment’s language on gender identity and expression, arguing it would allow transgender girls to play in girls sports.

The lawsuit was filed by Republican state Assemblywoman Marjorie Byrnes. In a statement, Ed Cox, chairman of the New York Republican Party, applauded the ruling.

“In their rush to pass this amendment, the legislature never held a single hearing on the proposal, never consulted with outside constitutional experts, and falsely asserted this amendment was necessary to protect abortion rights in the state,” Cox said.

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New York judge blocks amendment barring discrimination on gender identity and pregnancy outcomes

FILE - The New York state Capitol is seen from the steps of the State Education Building in Albany, N.Y., Wednesday, June 7, 2023. A New York judge on Tuesday, May 7, 2024, blocked a politically important abortion rights amendment from appearing before voters on the November ballot. State Supreme Court Justice Daniel J. Doyle found that state lawmakers failed to follow procedural rules around passing constitutional amendments, incorrectly approving the amendment before getting a written opinion on the language from the attorney general. (AP Photo/Hans Pennink, File)

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ALBANY, N.Y. (AP) — A proposed amendment to New York’s constitution barring discrimination based on “gender identity” and “pregnancy outcomes” cannot appear on the state ballot in November because legislators made a procedural error during an initial round of approval, a judge ruled Tuesday.

The ruling from state Supreme Court Justice Daniel J. Doyle found lawmakers incorrectly approved the language before getting a written opinion from the attorney general.

The decision removes a politically charged question from the November ballot that Democrats hoped would drive turnout.

Arkansas Attorney General Tim Griffin speaks at a news conference at the attorney general's office in Little Rock, Ark., Tuesday, May 7, 2024, about a lawsuit challenging a new regulation aimed at protecting the rights of transgender students in schools. Missouri Attorney General Andrew Bailey, right, and Arkansas Solicitor General Nicholas Bronni and high school athlete Amelia Ford, left, listen. (AP Photo/Andrew DeMillo)

New York Attorney General Letitia James said her office would appeal the decision.

What to know about the 2024 Election

Democracy: American democracy has overcome big stress tests since 2020. More challenges lie ahead in 2024.
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As the 2024 election nears, Republicans have begun to criticize the amendment’s language on gender identity and expression, arguing it would allow transgender girls to play in girls sports.

The lawsuit was filed by Republican state Assemblywoman Marjorie Byrnes. In a statement, Ed Cox, chairman of the New York Republican Party, applauded the ruling.

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Cephalic Presentation of Baby During Pregnancy
types of presentation in delivery
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Fetal presentation before birth
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.
Fetal presentation: Breech, posterior, transverse lie, and more
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. ... 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 ...
Fetal Presentation, Position, and Lie (Including Breech Presentation)
Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant patient's spine) with the face and body angled to one side and the neck flexed. Abnormal presentations include face, brow, breech, and shoulder.
Fetal Positions For Birth: Presentation, Types & Function
Possible fetal positions can include: Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth parent's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left.
Breech Baby: Causes, Complications, Turning & Delivery
A breech baby (breech birth or breech presentation) ... If a baby is still breech at 37 weeks of pregnancy, your options for delivery may change. This is because there are risks to a vaginal delivery when a baby is breech. In many cases, a C-section is the best and safest option for birth.
External Cephalic Version (ECV): Procedure & Risks
External cephalic version (sometimes called ECV or EV) is a procedure healthcare providers will use to rotate a baby from a breech position to a head-down position. A breech position is when a baby's feet or buttocks present first or horizontally across your uterus (called a transverse lie). A baby changes positions frequently throughout pregnancy.
Delivery, Face and Brow Presentation
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.
Fetal Positions for Labor and Birth
This presentation can lead to more back pain (sometimes referred to as "back labor") and slow progression of labor. In the right occiput posterior position (ROP), the baby is facing forward and slightly to the right (looking toward the mother's left thigh). This presentation may slow labor and cause more pain. Tips to Reduce Discomfort
Presentation and position of baby through pregnancy and at 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. Top row: 'right anterior — left anterior'.
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The Trusted Provider of Medical Information since 1899
Breech Presentation
Breech Births. In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby's buttocks, feet, or both are positioned to come out first during birth. This happens in 3-4% of full-term births.
The evolution of fetal presentation during pregnancy: a retrospective
Introduction. Cephalic presentation is the most physiologic and frequent fetal presentation and is associated with the highest rate of successful vaginal delivery as well as with the lowest frequency of complications 1.Studies on the frequency of breech presentation by gestational age (GA) were published more than 20 years ago 2, 3, and it has been known that the prevalence of breech ...
Breech Presentation
Epidemiology. Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech. Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10% ...
Breech: Types, Risk Factors, Treatment, Complications
At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.
Fetal presentation: how twins' positioning affects delivery
Twin fetal presentation - also known as the position of your babies in the womb - dictates whether you'll have a vaginal or c-section birth. Toward the end of pregnancy, most twins will move in the head-down position (vertex), but there's a risk that the second twin will change position after the first twin is born.
Abnormal Fetal lie, Malpresentation and Malposition
Abnormal Fetal Lie. If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted - ideally between 36 and 38 weeks gestation. ECV is the manipulation of the fetus to a cephalic presentation through the maternal abdomen. It has an approximate success rate of 50% in primiparous women and 60% in multiparous women.
How Long Does a C-Section Take? All You Need To Know
Day of C-section. On the day of the C-section, you'll likely have a pump to deliver a low dosage of a narcotic, such as morphine, as needed. Some doctors will let you eat solids, while others will ...
Fetal Presentation, Position, and Lie (Including Breech Presentation
Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed. Variations in fetal presentations include face, brow, breech, and shoulder.
New York sues anti-abortion groups for promoting false treatments to
NEW YORK (AP) — New York is suing an anti-abortion group and almost a dozen pregnancy counseling centers for promoting an unproven method to reverse medication abortions, Attorney General Letitia James announced Monday.. James, a Democrat, sued Heartbeat International and 11 pregnancy centers in state Supreme Court in Manhattan, arguing the groups violated laws around making false or ...
Tamiah Brevard-Rodriguez was working on her doctoral dissertation
She was only eight months pregnant and was scheduled to deliver her dissertation defense that day. "I was physically prepared for a pregnancy, mentally my brain was not on a baby," she said.
Tracking Abortion Bans Across the Country
The state's Supreme Court ruled in 2019 that a pregnant woman's right to personal autonomy is protected in the state Constitution, and Kansans voted in 2022 to reject a ballot measure that ...
What defines a heartbeat? Judge hears arguments in South Carolina
COLUMBIA, S.C. (AP) — South Carolina's ban on abortions after roughly six weeks, before many women know they are pregnant, returned to court Thursday with Planned Parenthood and the state arguing over what could be two different ways to define a heartbeat in the law.. Even the state Supreme Court justices who upheld the new law in August noted there appeared to be two definitions of ...
Denmark to liberalize its abortion law to allow the procedure until
"After 50 years, it is time for the abortion rules to keep up with the times," Health Minister Sophie Løhde said. She said neighboring Sweden, which set the legal limit at 18 weeks of gestation in 1996, has not experienced a significant increase in the number of abortions or when they are carried out.
C-Section (Cesarean Section): Procedure, Risks & Recovery
Breech presentation: In a breech presentation, your baby is feet- or bottom-first in your uterus. Some providers may attempt to turn your baby, but a C-section will be necessary if that's unsuccessful. ... The advantages of a C-section depend on your pregnancy. In most cases, the biggest benefit of a C-section is that it's safer for both you ...
Enforcement Guidance on Harassment in the Workplace
Example 13: Harassment Based on Pregnancy-Related Medical Condition (Morning Sickness). Kristina, a graphic designer at a marketing firm, is experiencing pregnancy-related morning sickness. Kristina's employer accommodates her limitations due to morning sickness by permitting Kristina to telework up to three days per week and utilize flexible ...
Rubeola / Measles
Pregnancy. MMR vaccines should not be administered to pregnant people or people attempting to become pregnant. Because of the theoretical risk to the fetus, people should be counseled to avoid becoming pregnant for 28 days after receiving a live-virus (e.g., MMR) vaccine. Precautions Personal or Family History of Seizures of Any Etiology
New York sues anti-abortion groups for promoting false treatments to
NEW YORK — New York is suing an anti-abortion group and almost a dozen pregnancy counseling centers for promoting an unproven method to reverse medication abortions, Attorney General Letitia ...
Vertex Presentation: Position, Birth & What It Means
The vertex presentation describes the orientation a fetus should be in for a safe vaginal delivery. It becomes important as you near your due date because it tells your pregnancy care provider how they may need to deliver your baby. Vertex means "crown of the head.". This means that the crown of the fetus's head is presenting towards the ...
New York judge blocks amendment barring discrimination on gender
A proposed amendment to New York's constitution barring discrimination based on "gender identity" and "pregnancy outcomes" cannot appear on the state ballot in November because ...
New York judge blocks amendment barring discrimination on gender
The New York Constitution currently bans discrimination based on race, color, creed or religion. The proposed amendment would add ethnicity, national origin, age, disability, sex, sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes and reproductive health care and autonomy to the list.

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Fetal Positions for Labor and Birth

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Presentation and position of baby through pregnancy and at birth

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

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

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

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

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

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

Position and Presentation of the Fetus

Occiput posterior position

Breech presentation

Other presentations

Breech Births

What are the different types of breech birth presentations?

What causes a breech presentation?

How is a breech presentation diagnosed?

Can a breech presentation mean something is wrong?

Can a breech presentation be changed?

Medical Techniques

ECV will not be tried if:

Complications of EVC include:

Vaginal delivery versus cesarean for breech birth?

What are the risks and complications of a vaginal delivery?

When is a cesarean delivery used with a breech presentation?

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Head down, head down (vertex, vertex)

Head down, bottom down (vertex, breech)