What Is Cephalic Position?

During pregnancy, there are important finishing touches that happen to the baby in the last weeks to prepare for delivery. One critical step that doctors monitor is the baby's fetal position. Cephalic (head down) position is the ideal position for labor and delivery.

What Is Cephalic Position?

A lot of orchestration occurs between a fetus and a person's body to ensure a healthy birth.

Throughout pregnancy, your baby will change positions in your uterus. As your baby grows, there will be less room to tumble around, and they will settle into their final position—or presentation—at the end of the third trimester.

Ultimately, by about 36 weeks gestation, your doctor will want to see that your baby is in the cephalic position. This is the best position for labor, especially with the baby presenting in the womb as head down, facing your back, with the chin tucked, and the back of the head ready to enter the birth canal.

Purpose

During labor, contractions stretch the birth canal so the baby has adequate room to come through at birth. The purpose of the cephalic position is so that the baby has the easiest and safest time passing through the birth canal.

If the fetus is in a noncephalic position, delivering the baby becomes more challenging. Different fetal positions have a range of difficulties and the risks can vary depending on the position of your child.

Risks

Most babies (96%) are born in the cephalic position. But a small percentage of babies present in breech position or other positions. Breech means that the baby's bottom, versus their head, is down.

A vaginal delivery is most times a safe way to deliver, however, when the baby is breech, a vaginal delivery can be complicated. Because the baby’s head is larger than the bottom, there is a risk of head entrapment where the baby’s head becomes stuck in the uterus. In this situation, it becomes too challenging to safely deliver the baby.

Some providers are comfortable performing a vaginal birth as long as the baby is doing well. But a breech baby is always in a riskier delivery position compared with cephalic position and in most cases requires a cesarean section (C-section).

There are several possible breech types:

• Frank breech: The baby's legs are up, with feet near the head. This position raises the chance of forming an umbilical cord loop that could come out through the cervix before the head. This may cause the baby to be injured during a vaginal delivery.
• Footling breech: When one leg or both legs is lowered over the cervix. This position increases the chances of the umbilical cord sliding down into the mouth of the womb, cutting off the baby's blood supply.
• Complete breech: When the baby is bottom-first, with knees bent. As with other breech presentations, this position raises the chance of forming an umbilical cord loop that could come out through the cervix before the head. This may cause the baby to be injured during a vaginal delivery.

Your baby may also present in a transverse lie position at the end of the third trimester, which means the baby is presenting sideways across the uterus rather than vertically. In a transverse lie, the baby might be positioned:

• Down, with the back facing the birth canal
• With one shoulder pointing toward the birth canal
• Up, with the hands and feet facing the birth canal

If a transverse lie is not corrected before labor, a C-section will be required.

Your baby may also present in an occiput or cephalic posterior position. This means the baby is 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.

Diagnosis

Your doctor can determine if your baby is in cephalic presentation by 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 doctor senses that the baby is in a breech position, they can use ultrasound to confirm their suspicions.

Treatment

Your doctor will monitor your baby's presentation progress in the last trimester. Most babies will turn into the cephalic position. However, if they have not turned as your delivery date approaches, your doctor may recommend several ways to encourage the baby to move into a head-down position.

There are no sure-fire treatments for turning a baby into cephalic position. Sometimes they work and sometimes not. In some cases, the procedure may work only for the baby to then return to their original position.

External Cephalic Version (ECV)

External cephalic version is a common, noninvasive procedure performed by an obstetrician. The goal is to turn a breech baby into cephalic position while it's still in the uterus.

ECV involves the doctor applying pressure to your stomach to turn the baby from the outside to rotate the baby's head forward or backward and lift the baby's buttocks in an upward position. Sometimes, they use ultrasound as well to help guide the process.

The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the baby’s heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after ECV.

ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the baby will return to the breech position before birth.

Other Methods

There are also natural methods that can help turn a baby into cephalic position, including:

• Changing your position. Sometimes a baby 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. Babies gravitate to sound so moms may be successful at luring their babies out of breech position by playing music or a recording of their voice near their 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 baby. Some practitioners incorporate moxibustion to enhance the chances of success.

It's important to note that the efficacy for the above approaches are not confirmed via medical studies and research.

A Word From Verywell

While most babies are in cephalic position at delivery, this is not always the case. If you have a breech baby, discuss the available options for the safest route of delivery or options to turn your baby with your doctor.