Types of Malpresentation

The position of a baby at the end of a pregnancy is an important part of how the delivery will go. Although most babies enter the pelvis head first, with their chin tucked against their chests, some do not. Malpresentation is the term that some health professionals use when a baby is in the wrong position for birth.

Several of the more common types of malpresentation are:

Sunny Side Up
Some babies present in an occiput posterior position, more commonly known as “sunny side up.” In this situation, a baby has her head down with her nose and chin facing upward toward your front rather than your backside. During labor they frequently are rotated by either uterine forces during contractions or maternal forces during pushing. Some, however, never rotate and are delivered looking upward. Women with occiput posterior presentations may experience more back pain, slower labor, or spend more time pushing than when the baby is facing your back.

Breech Presentation
A breech presentation is when a baby’s bottom or feet, instead of her head, are in position to come out first. If a baby is breech, the provider may try to adjust her position before the mom goes into labor by pressing on her abdomen with ultrasound guidance. Regional anesthesia may be offered. If adjusting the baby’s position doesn’t work, a vaginal delivery may still be possible, or depending on the circumstances, a Cesarean section may be required.

Abnormal Lie
“Abnormal lie” is when a baby is lying the wrong way in her mother’s womb. The correct position is when the baby’s spine is up and down, or longitudinal. Occasionally, a baby will be lying across, in a “transverse” lie. In this case, the provider will try to turn the baby to a longitudinal lie, or a Cesarean delivery will be required.

Face Or Brow Presentation
If a baby’s head is partially extended on her neck, her brow or face will present first. This is called “face or brow presentation.” This is a relatively rare type of malpresentation, and usually results in a longer labor. A baby that presents this way usually will have a swollen and bruised head after she’s born. The swelling and bruises will disappear within a few days, if not sooner. A baby with a face or brow presentation may need to be delivered by Cesarean section.

Compound Presentation
Compound presentation is when a baby’s hand or leg is presented next to the baby’s head or bottom. This often isn’t apparent until the mom begins to push. The majority of babies who present this way are delivered vaginally, although some will require a Cesarean section.

Shoulder Dystocia
Shoulder dystocia is the term for when the baby’s shoulder gets stuck in the birth canal after the baby’s head has emerged. This problem is hard to predict, but when it occurs it is an obstetric emergency. The provider will usually have you change position and maneuver the baby to release the shoulder. Most of the time the maneuver is successful, the baby is then delivered vaginally, and there’s no significant harm to you or your baby. In some cases, when the shoulder is freed up, the baby may be injured. Rarely is a Cesarean section needed.