About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy. Your healthcare provider will monitor the fetus’s position during the last weeks of gestation to ensure this has happened by week 36.
If the fetus is not in the cephalic position at that point, the provider may try to turn it. If this doesn’t work, some—but not all—practitioners will attempt to deliver vaginally, while others will recommend a Cesarean (C-section).
Why Is the Cephalic Position Best?
During labor, contractions stretch the birth canal so the fetus has adequate room to come through at birth. The cephalic position is the easiest and safest way for the baby to pass through the birth canal.
If the fetus is in a noncephalic position, delivery becomes more challenging. Different fetal positions have a range of difficulties and varying risks.
Risks of Other Positions
A small percentage of babies present in noncephalic positions. This can pose risks both to the fetus and the mother, and make labor and delivery more challenging. It can also influence the way in which someone can deliver.
A fetus may actually find itself in any of these positions throughout pregnancy, as the move about the uterus. But as they grow, there will be less room to tumble around and they will settle into a final position.
It is at this point that noncephalic positions can pose significant risks.
Cephalic Posterior
A fetus may also present in an occiput or cephalic posterior position. This means they are positioned head down, but they are facing the abdomen instead of the back.
This position is also nicknamed “sunny-side up.”
Presenting this way increases the chance of a painful and prolonged delivery.
Breech
There are three different types of breech fetal positioning:
Frank breech: The legs are up with the feet near the head. Footling breech: One or both legs is lowered over the cervix. Complete breech: The fetus is bottom-first with knees bent.
A vaginal delivery is most times a safe way to deliver. But with breech positions, a vaginal delivery can be complicated.
When a baby is born in the breech position, the largest part—its head—is delivered last. This can result in them getting stuck in the birth canal (entrapped). This can cause injury or death.
The umbilical cord may also be damaged or slide down into the mouth of the womb, which can reduce or cut off the baby’s oxygen supply.
Some providers are still comfortable performing a vaginal birth as long as the fetus is doing well. But breech is always a riskier delivery position compared with the cephalic position, and most cases require a C-section.
Transverse Lie
In transverse lie position, the fetus is presenting sideways across the uterus rather than vertically. They may be:
Go into early labor before you’re full term Have an abnormally shaped uterus, fibroids, or too much amniotic fluid Are pregnant with multiples Have placenta previa (when the placenta covers the cervix)
Down, with the back facing the birth canalWith one shoulder pointing toward the birth canalUp, with the hands and feet facing the birth canal
If a transverse lie is not corrected before labor, a C-section will be required. This is typically the case.
Determining Fetal Position
Your healthcare provider can determine if your baby is in cephalic presentation by performing a physical exam and ultrasound.
In the final weeks of pregnancy, your healthcare provider will feel your lower abdomen with their hands to assess the positioning of the baby. This includes where the head, back, and buttocks lie
If your healthcare provider senses that the fetus is in a breech position, they can use ultrasound to confirm their suspicion.
Turning a Fetus So They Are in Cephalic Position
External cephalic version (ECV) is a common, noninvasive procedure to turn a breech baby into cephalic position while it’s still in the uterus.
This is only considered if a healthcare provider monitors presentation progress in the last trimester and notices that a fetus is maintaining a noncephalic position as your delivery date approaches.
They may also recommended several other ways to encourage a head-down position.
None of these options are sure to work or have long-lasting results, however.
External Cephalic Version (ECV)
ECV involves the healthcare provider applying pressure to your stomach to turn the fetus from the outside. They will attempt to rotate the head forward or backward and lift the buttocks in an upward position. Sometimes, they use ultrasound to help guide the process.
The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the fetal heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after having ECV done.
ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the fetus will return to the breech position before birth.
Natural Methods For Turning a Fetus
There are also natural methods that can help turn a fetus into cephalic position. There is no medical research that confirms their efficacy, however.
Changing your position: Sometimes a fetus will move when you get into certain positions. Two specific movements that your provider may recommend include: Getting on your hands and knees and gently rocking back and forth. Another you could try is pushing your hips up in the air while laying on your back with your knees bent and feet flat on the floor (bridge pose). Playing stimulating sounds: Fetuses gravitate to sound. You may be successful at luring a fetus out of breech position by playing music or a recording of your voice near your lower abdomen. Chiropractic care: A chiropractor can try the Webster technique. This is a specific chiropractic analysis and adjustment which enables chiropractors to establish balance in the pregnant person’s pelvis and reduce undue stress to the uterus and supporting ligaments. Acupuncture: This is a considerably safe way someone can try to turn a fetus. Some practitioners incorporate moxibustion—the burning of dried mugwort on certain areas of the body—because they believe it will enhance the chances of success.
A Word From Verywell
While most babies are born in cephalic position at delivery, this is not always the case. And while some fetuses can be turned, others may be more stubborn.
This may affect your labor and delivery wishes. Try to remember that having a healthy baby, and staying well yourself, are your ultimate priorities. That may mean diverting from your best laid plans.
Speaking to your healthcare provider about turning options and the safest route of delivery may help you adjust to this twist and feel better about how you will move ahead.
