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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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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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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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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 .

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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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Breech presentation

Highlights & basics, diagnostic approach, risk factors, history & exam, differential diagnosis.

Tx Approach

Emerging Tx

Complications.

PATIENT RESOURCES

Patient Instructions

Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.

Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.

Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.

Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.

Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.

Quick Reference

Key Factors

buttocks or feet as the presenting part

Fetal head under costal margin, fetal heartbeat above the maternal umbilicus.

Other Factors

subcostal tenderness

Pelvic or bladder pain.

Diagnostics Tests

1st Tests to Order

transabdominal/transvaginal ultrasound

Treatment options.

presumptive

<37 weeks' gestation

specialist evaluation

corticosteroid

magnesium sulfate

≥37 weeks' gestation not in labor

unsuccessful ECV with persistent breech

Classifications

Types of breech presentation

Baby's buttocks lead the way into the birth canal

Hips are flexed, knees are extended, and the feet are in close proximity to the head

65% to 70% of breech babies are in this position.

Baby presents with buttocks first

Both the hips and the knees are flexed; the baby may be sitting cross-legged.

One or both of the baby's feet lie below the breech so that the foot or knee is lowermost in the birth canal

This is rare at term but relatively common with premature fetuses.

Common Vignette

Epidemiology

33% of births less than 28 weeks' gestation

14% of births at 29 to 32 weeks' gestation

9% of births at 33 to 36 weeks' gestation

6% of births at 37 to 40 weeks' gestation.

Pathophysiology

Natasha Nassar, PhD
Christine L. Roberts, MBBS, FAFPHM, DrPH
Jonathan Morris, MBChB, FRANZCOG, PhD
John W. Bachman, MD
Rhona Hughes, MBChB
Brian Peat, MD
Lelia Duley, MBChB
Justus Hofmeyr, MD

Clinical exam

Palpation of the abdomen to determine the position of the baby's head

Palpation of the abdomen to confirm the position of the fetal spine on one side and fetal extremities on the other

Palpation of the area above the symphysis pubis to locate the fetal presenting part

Palpation of the presenting part to confirm presentation, to determine how far the fetus has descended and whether the fetus is engaged.

Ultrasound examination

Premature fetus.

Prematurity is consistently associated with breech presentation. [ 6 ] [ 9 ] This may be due to the smaller size of preterm infants, who are more likely to change their in utero position.

Increasing duration of pregnancy may allow breech-presenting fetuses time to grow, turn spontaneously or by external cephalic version, and remain cephalic-presenting.

Larger fetuses may be forced into a cephalic presentation in late pregnancy due to space or alignment constraints within the uterus.

small for gestational age fetus

Low birth-weight is a risk factor for breech presentation. [ 9 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] Term breech births are associated with a smaller fetal size for gestational age, highlighting the association with low birth-weight rather than prematurity. [ 6 ]

nulliparity

Women having a first birth have increased rates of breech presentation, probably due to the increased likelihood of smaller fetal size. [ 6 ] [ 9 ]

Relaxation of the uterine wall in multiparous women may reduce the odds of breech birth and contribute to a higher spontaneous or external cephalic version rate. [ 10 ]

fetal congenital anomalies

Congenital anomalies in the fetus may result in a small fetal size or inappropriate fetal growth. [ 9 ] [ 12 ] [ 14 ] [ 15 ]

Anencephaly, hydrocephaly, Down syndrome, and fetal neuromuscular dysfunction are associated with breech presentation, the latter due to its effect on the quality of fetal movements. [ 9 ] [ 14 ]

previous breech delivery

The risk of recurrent breech delivery is 8%, the risk increasing from 4% after one breech delivery to 28% after three. [ 16 ]

The effects of recurrence may be due to recurring specific causal factors, either genetic or environmental in origin.

uterine abnormalities

Women with uterine abnormalities have a high incidence of breech presentation. [ 14 ] [ 17 ] [ 18 ] [ 19 ]

female fetus

Fifty-four percent of breech-presenting fetuses are female. [ 14 ]

abnormal amniotic fluid volume

Both oligohydramnios and polyhydramnios are associated with breech presentation. [ 1 ] [ 12 ] [ 14 ]

Low amniotic fluid volume decreases the likelihood of a fetus turning to a cephalic position; an increased amniotic fluid volume may facilitate frequent change in position.

placental abnormalities

An association between placental implantation in the cornual-fundal region and breech presentation has been reported, although some studies have not found it a risk factor. [ 8 ] [ 20 ] [ 21 ] [ 22 ] [ 10 ] [ 14 ]

The association with placenta previa is also inconsistent. [ 8 ] [ 9 ] [ 22 ] Placenta previa is associated with preterm birth and may be an indirect risk factor.

Pelvic or vaginal examination reveals the buttocks and/or feet, felt as a yielding, irregular mass, as the presenting part. [ 26 ] In cephalic presentation, a hard, round, regular fetal head can be palpated. [ 26 ]

The Leopold maneuver on examination suggests breech position by palpation of the fetal head under the costal margin. [ 26 ]

The baby's heartbeat should be auscultated using a Pinard stethoscope or a hand-held Doppler to indicate the position of the fetus. The fetal heartbeat lies above the maternal umbilicus in breech presentation. [ 1 ]

Tenderness under one or other costal margin as a result of pressure by the harder fetal head.

Pain due to fetal kicks in the maternal pelvis or bladder.

breech position

Visualizes the fetus and reveals its position.

Used to confirm a clinically suspected breech presentation. [ 28 ]

Should be performed by practitioners with appropriate skills in obstetric ultrasound.

Establishes the type of breech presentation by imaging the fetal femurs and their relationship to the distal bones.

Transverse lie

Differentiating Signs/Symptoms

Fetus lies horizontally across the uterus with the shoulder as the presenting part.

Similar predisposing factors such as placenta previa, abnormal amniotic fluid volume, and uterine anomalies, although more common in multiparity. [ 1 ] [ 2 ] [ 29 ]

Differentiating Tests

Clinical examination and fetal auscultation may be indicative.

Ultrasound confirms presentation.

Treatment Approach

Breech presentation <37 weeks' gestation.

The UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ] The American College of Obstetricians and Gynecologists (ACOG) recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

Magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, and concurrent tocolysis. [ 34 ]

Breech presentation from 37 weeks' gestation, before labor

ECV is the initial treatment for a breech presentation at term when the patient is not in labor. It involves turning a fetus presenting by the breech to a cephalic (head-down) presentation to increase the likelihood of vaginal birth. [ 35 ] [ 36 ] Where available, it should be offered to all women in late pregnancy, by an experienced clinician, in hospitals with facilities for emergency delivery, and no contraindications to the procedure. [ 35 ] There is no upper time limit on the appropriate gestation for ECV, with success reported at 42 weeks.

There is no general consensus on contraindications to ECV. Contraindications include multiple pregnancy (except after delivery of a first twin), ruptured membranes, current or recent (<1 week) vaginal bleeding, rhesus isoimmunization, other indications for cesarean section (e.g., placenta previa or uterine malformation), or abnormal electronic fetal monitoring. [ 35 ] One systematic review of relative contraindications for ECV highlighted that most contraindications do not have clear empirical evidence. Exceptions include placental abruption, severe preeclampsia/HELLP syndrome, or signs of fetal distress (abnormal cardiotocography and/or Doppler flow). [ 36 ]

The procedure involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

The overall ECV success rate varies but, in a large series, 47% of women following an ECV attempt had a cephalic presentation at birth. [ 35 ] [ 38 ] Various factors influence the success rate. One systematic review found ECV success rates to be 68% overall, with the rate significantly higher for women from African countries (89%) compared with women from non-African countries (62%), and higher among multiparous (78%) than nulliparous women (48%). [ 39 ] Overall, the ECV success rates for nulliparous and multiparous non-African women were 43% and 73%, respectively, while for nulliparous and multiparous African women rates were 79% and 91%, respectively. Another study reported no difference in success rate or rate of cesarean section among women with previous cesarean section undergoing ECV compared with women with previous vaginal birth. However, numbers were small and further studies in this regard are required. [ 40 ]

Women's preference for vaginal delivery is a major contributing factor in their decision for ECV. However, studies suggest women with a breech presentation at term may not receive complete and/or evidence-based information about the benefits and risks of ECV. [ 41 ] [ 42 ] Although up to 60% of women reported ECV to be painful, the majority highlighted the benefits outweigh the risks (71%) and would recommend ECV to their friends or be willing to repeat for themselves (84%). [ 41 ] [ 42 ]

Cardiotocography and ultrasound should be performed before and after the procedure. Tocolysis should be used to facilitate the maneuver, and Rho(D) immune globulin should be administered to women who are Rhesus negative. [ 35 ] Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with ECV in some countries, but not yet available in the US). One Cochrane review of tocolytic beta stimulants demonstrates that these are less likely to be associated with failed ECV, and are effective in increasing cephalic presentation and reducing cesarean section. [ 43 ] There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended. The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48 to 72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. One systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of three, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

Planned cesarean section should be offered as the safest mode of delivery for the baby, even though it carries a small increase in serious immediate maternal complications compared with vaginal birth. [ 24 ] [ 25 ] [ 31 ] In the US, most unsuccessful ECV with persistent breech will be delivered via cesarean section.

A vaginal mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Breech presentation from 37 weeks' gestation, during labor

The first option should be a planned cesarean section.

There is a small increase in the risk of serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Planned cesarean section is safer for babies, but is associated with increased neonatal respiratory distress. The risk is reduced when the section is performed at 39 weeks' gestation. [ 64 ] [ 65 ] [ 66 ] For women undergoing a planned cesarean section, RCOG recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] ACOG does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

Undiagnosed breech in labor generally results in cesarean section after the onset of labor, higher rates of emergency cesarean section associated with the least favorable maternal outcomes, a greater likelihood of cord prolapse, and other poor infant outcomes. [ 23 ] [ 67 ] [ 49 ] [ 68 ] [ 69 ] [ 70 ] [ 71 ]

This mode of delivery may be considered by some clinicians as an option for women who are in labor, particularly when delivery is imminent. Vaginal breech delivery may also be considered, where suitable, when delivery is not imminent, maternal request is provided, senior and experienced staff are available, there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

Findings from one systematic review of 27 observational studies revealed that the absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7, and neonatal asphyxia in the planned vaginal delivery group were low at 0.3%, 0.7%, 0.7%, 2.4%, and 3.3%, respectively. However, the relative risks of perinatal mortality and morbidity were 2- to 5-fold higher in the planned vaginal than in the planned cesarean delivery group. Authors recommend ongoing judicious decision-making for vaginal breech delivery for selected singleton, term breech babies. [ 72 ]

ECV may also be considered an option for women with breech presentation in early labor, when delivery is not imminent, provided that the membranes are intact.

A woman presenting with a breech presentation <37 weeks is an area of clinical controversy. Optimal mode of delivery for preterm breech has not been fully evaluated in clinical trials, and the relative risks for the preterm infant and mother remain unclear. In the absence of good evidence, if diagnosis of breech presentation prior to 37 weeks' gestation is made, prematurity and clinical circumstances should determine management and mode of delivery.

Primary Options

12 mg intramuscularly every 24 hours for 2 doses

6 mg intramuscularly every 12 hours for 4 doses

The UK Royal College of Obstetricians and Gynaecologists recommends that corticosteroids should be offered to women between 24 and 34+6 weeks' gestation, in whom imminent preterm birth is anticipated. Corticosteroids should only be considered after discussion of risks/benefits at 35 to 36+6 weeks. Given within 7 days of preterm birth, corticosteroids may reduce perinatal and neonatal death and respiratory distress syndrome. [ 32 ]

The American College of Obstetricians and Gynecologists recommends a single course of corticosteroids for pregnant women between 24 and 33+6 weeks' gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations. It may also be considered for pregnant women starting at 23 weeks' gestation who are at risk of preterm delivery within 7 days. A single course of betamethasone is recommended for pregnant women between 34 and 36+6 weeks' gestation at risk of preterm birth within 7 days, and who have not received a previous course of prenatal corticosteroids. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended. A single repeat course of prenatal corticosteroids should be considered in women who are less than 34 weeks' gestation, who are at risk of preterm delivery within 7 days, and whose prior course of prenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. [ 33 ]

consult specialist for guidance on dose

external cephalic version (ECV)

There is no upper time limit on the appropriate gestation for ECV; it should be offered to all women in late pregnancy by an experienced clinician in hospitals with facilities for emergency delivery and no contraindications to the procedure. [ 35 ] [ 36 ]

ECV involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Cardiotocography and ultrasound should be performed before and after the procedure.

If ECV is successful, pregnancy care should continue as usual for any cephalic presentation. A systematic review assessing the mode of delivery after a successful ECV found that these women were at increased risk for cesarean section and instrumental vaginal delivery compared with women with spontaneous cephalic pregnancies. However, they still had a lower rate of cesarean section following ECV (i.e., 47%) compared with the cesarean section rate for those with a persisting breech (i.e., 85%). With a number needed to treat of 3, ECV is still considered to be an effective means of preventing the need for cesarean section. [ 46 ]

tocolytic agents

see local specialist protocol for dosing guidelines

Tocolytic agents include adrenergic beta-2 receptor stimulants such as albuterol, terbutaline, or ritodrine (widely used with external cephalic version [ECV] in some countries, but not yet available in the US). They are used to delay or inhibit labor and increase the success rate of ECV. There is no current evidence to recommend one beta-2 adrenergic receptor agonist over another. Until these data are available, adherence to a local protocol for tocolysis is recommended.

The Food and Drug Administration has issued a warning against using injectable terbutaline beyond 48-72 hours, or acute or prolonged treatment with oral terbutaline, in pregnant women for the prevention or prolonged treatment of preterm labor, due to potential serious maternal cardiac adverse effects and death. [ 44 ] Whether this warning applies to the subcutaneous administration of terbutaline in ECV is still unclear; however, studies currently support this use. The European Medicines Agency (EMA) recommends that injectable beta agonists should be used for up to 48 hours between the 22nd and 37th week of pregnancy only. They should be used under specialist supervision with continuous monitoring of the mother and unborn baby owing to the risk of adverse cardiovascular effects in both the mother and baby. The EMA no longer recommends oral or rectal formulations for obstetric indications. [ 45 ]

A systematic review found there was no evidence to support the use of nifedipine for tocolysis. [ 73 ]

There is insufficient evidence to evaluate other interventions to help ECV, such as fetal acoustic stimulation in midline fetal spine positions, or epidural or spinal analgesia. [ 43 ]

Rho(D) immune globulin

300 micrograms intramuscularly as a single dose

Nonsensitized Rh-negative women should receive Rho(D) immune globulin. [ 35 ]

The indication for its administration is to prevent rhesus isoimmunization, which may affect subsequent pregnancy outcomes.

Rho(D) immune globulin needs to be given at the time of external cephalic version and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

It is best administered as soon as possible after the procedure, usually within 72 hours.

Dose depends on brand used. Dose given below pertains to most commonly used brands. Consult specialist for further guidance on dose.

elective cesarean section/vaginal breech delivery

Mode of delivery (cesarean section or vaginal breech delivery) should be based on the experience of the attending clinician, hospital policies, maternal request, and the presence or absence of complicating factors. In the US, most unsuccessful external cephalic version (ECV) with persistent breech will be delivered via cesarean section.

Cesarean section, at 39 weeks or greater, has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, bleeding, infection, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Vaginal delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women undergoing a planned cesarean section, the UK Royal College of Obstetricians and Gynaecologists recommends an informed discussion about the potential risks and benefits of a course of prenatal corticosteroids between 37 and 38+6 weeks' gestation. Although prenatal corticosteroids may reduce admission to the neonatal unit for respiratory morbidity, it is uncertain if there is any reduction in respiratory distress syndrome, transient tachypnea of the newborn, or neonatal unit admission overall. In addition, prenatal corticosteroids may result in harm to the neonate, including hypoglycemia and potential developmental delay. [ 32 ] The American College of Obstetricians and Gynecologists does not recommend corticosteroids in women >37 weeks' gestation. [ 33 ]

It is best administered as soon as possible after delivery, usually within 72 hours.

Administration of postpartum Rho (D) immune globulin should not be affected by previous routine prenatal prophylaxis or previous administration for a potentially sensitizing event. [ 74 ]

≥37 weeks' gestation in labor: no imminent delivery

planned cesarean section

For women with breech presentation in labor, planned cesarean section at 39 weeks or greater has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

Continuous cardiotocography monitoring should continue until delivery. [ 24 ] [ 25 ]

vaginal breech delivery

This mode of delivery may be considered by some clinicians as an option, particularly when maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

For women with persisting breech presentation, planned cesarean section has, however, been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ]

ECV may also be considered an option for women with breech presentation in early labor, provided that the membranes are intact.

There is no upper time limit on the appropriate gestation for ECV. [ 35 ]

Involves applying external pressure and firmly pushing or palpating the mother's abdomen to coerce the fetus to somersault (either forward or backward) into a cephalic position. [ 37 ]

Relative contraindications include placental abruption, severe preeclampsia/HELLP syndrome, and signs of fetal distress (abnormal cardiotocography and/or abnormal Doppler flow). [ 35 ] [ 36 ]

Rho(D) immune globulin needs to be given at the time of ECV and should be given again postpartum to those women who give birth to an Rh-positive baby. [ 74 ]

≥37 weeks' gestation in labor: imminent delivery

cesarean section

For women with persistent breech presentation, planned cesarean section has been shown to significantly reduce perinatal mortality and neonatal morbidity compared with vaginal breech delivery (RR 0.33, 95% CI 0.19 to 0.56). [ 31 ] Although safer for these babies, there is a small increase in serious immediate maternal complications compared with vaginal birth (RR 1.29, 95% CI 1.03 to 1.61), as well as long-term risks for future pregnancies, including pulmonary embolism, infection, bleeding, damage to the bladder and bowel, slower recovery from the delivery, longer hospitalization, and delayed bonding and breast-feeding. [ 23 ] [ 31 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] [ 55 ] [ 56 ] [ 57 ] [ 58 ] Consider using antimicrobial triclosan-coated sutures for wound closure to reduce the risk of surgical site infection. [ 59 ]

This mode of delivery may be considered by some clinicians as an option, particularly when delivery is imminent, maternal request is provided, when senior and experienced staff are available, when there is no absolute contraindication to vaginal birth (e.g., placenta previa, compromised fetal condition), and with optimal fetal growth (estimated weight above the tenth centile and up to 3800 g). Other factors that make planned vaginal birth higher risk include hyperextended neck on ultrasound and footling presentation. [ 24 ]

It is best administered as soon as possible after the delivery, usually within 72 hours.

External cephalic version before term

Moxibustion, postural management, follow-up overview, perinatal complications.

Compared with cephalic presentation, persistent breech presentation has increased frequency of cord prolapse, abruptio placentae, prelabor rupture of membranes, perinatal mortality, fetal distress (heart rate <100 bpm), preterm delivery, lower fetal weight. [ 10 ] [ 11 ] [ 67 ]

complications of cesarean section

The long-term risks include potential compromise of future obstetric performance, increased risk of repeat cesarean section, infertility, uterine rupture, placenta accreta, placental abruption, and emergency hysterectomy. [ 60 ] [ 61 ] [ 62 ] [ 63 ] The evidence suggests that using sutures, rather than staples, for wound closure after cesarean section reduces the incidence of wound dehiscence. [ 59 ]

Emergency cesarean section, compared with planned cesarean section, has demonstrated a higher risk of severe obstetric morbidity, intra-operative complications, postoperative complications, infection, blood loss >1500 mL, fever, pain, tiredness, and breast-feeding problems. [ 23 ] [ 48 ] [ 50 ] [ 70 ] [ 81 ]

Key Articles

Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77. [Full Text]

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166. [Abstract] [Full Text]

Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. March 2017 [internet publication]. [Full Text]

Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184. [Abstract] [Full Text]

de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. [Abstract]

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Published by

American College of Obstetricians and Gynecologists

2016 (reaffirmed 2022)

Royal College of Obstetricians and Gynaecologists (UK)

National Institute for Health and Care Excellence (UK)

Topic last updated: 2024-03-05

Natasha Nassar , PhD

Associate Professor

Menzies Centre for Health Policy

Sydney School of Public Health

University of Sydney

Christine L. Roberts , MBBS, FAFPHM, DrPH

Research Director

Clinical and Population Health Division

Perinatal Medicine Group

Kolling Institute of Medical Research

Jonathan Morris , MBChB, FRANZCOG, PhD

Professor of Obstetrics and Gynaecology and Head of Department

Peer Reviewers

John W. Bachman , MD

Consultant in Family Medicine

Department of Family Medicine

Mayo Clinic

Rhona Hughes , MBChB

Lead Obstetrician

Lothian Simpson Centre for Reproductive Health

The Royal Infirmary

Brian Peat , MD

Director of Obstetrics

Women's and Children's Hospital

North Adelaide

South Australia

Lelia Duley , MBChB

Professor of Obstetric Epidemiology

University of Leeds

Bradford Institute of Health Research

Temple Bank House

Bradford Royal Infirmary

Justus Hofmeyr , MD

Head of the Department of Obstetrics and Gynaecology

East London Private Hospital

East London

South Africa

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

Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Vertex Position: What It Is, Why It's Important, and How to Get There

Jamie Grill / Getty Images

What Is the Vertex Position?

Why It's Important

When the Vertex Position Usually Occurs

How to Get Baby in This Position

Options if Baby Is Not in the Vertex Position

While you are pregnant, you may hear your healthcare provider frequently refer to the position or presentation of your baby, particularly as you get closer to your due date . What they are referring to is which part of your baby is presenting first—or which part is at the lower end of your womb or the pelvic inlet.

Consequently, when they tell you that your baby's head is down, that likely means they are in the vertex position (or another cephalic position). This type of presentation is the most common presentation in the third trimester. Here is what you need to know about the vertex position including how you might get your baby into that position before you go into labor .

The vertex position is a medical term that means the fetus has its head down in the maternal pelvis and the occipital (back) portion of the fetal skull is in the lowest position or presenting, explains Jill Purdie, MD, an OB/GYN and medical director at Northside Women’s Specialists , which is part of Pediatrix Medical Group.

When a baby is in the vertex position, their head is in the down position in the pelvis in preparation for a vaginal birth, adds Shaghayegh DeNoble, MD, FACOG , a board-certified gynecologist and a fellowship-trained minimally invasive gynecologic surgeon. "More specifically, the fetus’s chin is tucked to the chest so that the back of the head is presenting first."

Why the Vertex Position Is Important

When it comes to labor and delivery, the vertex position is the ideal position for a vaginal delivery, especially if the baby is in the occiput anterior position—where the back of the baby's head is toward the front of the pregnant person's pelvis, says Dr. DeNoble.

"[This] is the best position for vaginal birth because it is associated with fewer Cesarean sections , faster births, and less painful births," she says. "In this position, the fetus’s skull fits the birth canal best. In the occiput posterior position, the back of the fetus's head is toward the [pregnant person's] spine. This position is usually associated with longer labor and sometimes more painful birth."

Other fetal positions are sometimes less-than-ideal for labor and delivery. According to Dr. DeNoble, they can cause more prolonged labor, fetal distress, and interventions such as vacuum or forceps delivery and Cesarean delivery.

"Another important fact is that positions other than vertex present an increased risk of cord prolapse, which is when the umbilical cord falls into the vaginal canal ahead of the baby," she says. "For example, if the fetus is in the transverse position and the [pregnant person's] water breaks , there is an increased risk of the umbilical cord prolapsing through the cervix into the vaginal canal."

When it comes to your baby's positioning, obstetricians will look to see what part of the fetus is in position to present during vaginal birth. If your baby’s head is down during labor, they will look to see if the back of the head is facing your front or your back as well as whether the back of the head is presenting or rather face or brow, Dr. DeNoble explains.

"These determinations are important during labor, especially if there is consideration to the use of a vacuum or forceps," she says.

According to Dr. Purdie, healthcare providers will begin assessing the position of the baby as early as 32 to 34 weeks of pregnancy. About 75% to 80% of fetuses will be in the vertex presentation by 30 weeks and 96% to 97% by 37 weeks. Approximately 3% to 4% of fetuses will be in a non-cephalic position at term, she adds.

Typically, your provider will perform what is called Leopold maneuvers to determine the position of the baby. "Leopold maneuvers involve the doctor placing their hands on the gravid abdomen in several locations to find the fetal head and buttocks," Dr. Purdie explains.

If your baby is not in the vertex position, the next most common position would be breech, she says. This means that your baby's legs or buttocks are presenting first and the head is up toward the rib cage.

"The fetus may also be transverse," Dr. Purdie says. "The transverse position means the fetus is sideways within the uterus and no part is presenting in the maternal pelvis. In other words, the head is either on the left or right side of the uterus and the fetus goes straight across to the opposite side."

There is even a chance that your baby will be in an oblique position. This means they are at a diagonal within the uterus, Dr. Purdie says. "In this position, either the head or the buttocks can be down, but they are not in the maternal pelvis and instead off to the left or right side."

If your baby's head is not down, your provider will look to see if the buttocks are in the pelvis or one or two feet, Dr. DeNoble adds. "If the baby is laying horizontally, then the doctor needs to know if the back of the baby is facing downwards or upwards since at a Cesarean delivery it can be more difficult to deliver the baby when the back is down."

How to Get Baby Into the Vertex Position

One way you can help ensure that your baby gets into the vertex position is by staying active and walking, Dr. Purdie says. "Since the head is the heaviest part of the fetus, gravity may help move the head around to the lowest position."

If you already know that your baby is in a non-cephalic position and you are getting close to your delivery date, you also can try some techniques to encourage the baby to turn. For instance, Dr. Purdie suggests getting in the knee/chest position for 10 minutes per day. This has been shown to turn the baby around 60% to 70% of the time.

"In this technique, the mother gets on all fours, places her head down on her hands, and leaves her buttock higher than her head," she explains. "Again, we are trying to allow gravity to help us turn the fetus."

You also might consider visiting a chiropractor to try and help turn the fetus. "Most chiropractors will use the Webster technique to encourage the fetus into a cephalic presentation," Dr. Purdie adds.

There also are some home remedies, including using music, heat, ice, and incense to encourage the fetus to turn, she says. "These techniques do not have a lot of scientific data to support them, but they also are not harmful so can be tried without concern."

You also can try the pelvic tilt , where you lay on your back with your legs bent and your feet on the ground, suggests Dr. DeNoble. Then, you tilt your pelvis up into a bridge position and stay in this position for 10 minutes. She suggests doing this several times a day, ideally when your baby is most active.

"Another technique that has helped some women is to place headphones low down on the abdomen near the pubic bone to encourage the baby to turn toward the sound," Dr. DeNoble adds. "A cold bag of vegetables can be placed at the top of the uterus near the baby’s head and something warm over the lower part of the uterus to encourage the baby to turn toward the warmth. [And] acupuncture has also been used to help turn a baby into a vertex position."

If you are at term and your baby is not in the vertex position (or some type of cephalic presentation), you may want to discuss the option of an external cephalic version (ECV), suggests Dr. Purdie. This is a procedure done in the hospital where your healthcare provider will attempt to manually rotate your baby into the cephalic presentation.

"There are some risks associated with this and not every pregnant person is a candidate, so the details should be discussed with your physician," she says. "If despite interventions, the fetus remains in a non-cephalic position, most physicians will recommend a C-section for delivery."

Keep in mind that there are increased risks for your baby associated with a vaginal breech delivery. Current guidelines by the American College of Obstetricians and Gynecologists recommend a C-section in this situation, Dr. Purdie says.

"Once a pregnant person is in labor, it would be too late for the baby to get in cephalic presentation," she adds.

A Word From Verywell

If your baby is not yet in the vertex position, try not to worry too much. The majority of babies move into either the vertex position or another cephalic presentation before they are born. Until then, focus on staying active, getting plenty of rest, and taking care of yourself.

If you are concerned, talk to your provider about different options for getting your baby to move into the vertex position. They can let you know which tips and techniques might be right for your situation.

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Sayed Ahmed WA, Hamdy MA. Optimal management of umbilical cord prolapse . Int J Womens Health . 2018;10:459-465. Published 2018 Aug 21. doi:10.2147/IJWH.S130879

Hjartardóttir H, Lund SH, Benediktsdóttir S, Geirsson RT, Eggebø TM. When does fetal head rotation occur in spontaneous labor at term: results of an ultrasound-based longitudinal study in nulliparous women . Am J Obstet Gynecol . 2021;224(5):514.e1-514.e9. doi:10.1016/j.ajog.2020.10.054

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Kenfack B, Ateudjieu J, Ymele FF, Tebeu PM, Dohbit JS, Mbu RE. Does the advice to assume the knee-chest position at the 36th to 37th weeks of gestation reduce the incidence of breech presentation at delivery? Clinics in Mother and Child Health . 2012;9:1-5. doi:10.4303/cmch/C120601

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By Sherri Gordon Sherri Gordon, CLC is a published author, certified professional life coach, and bullying prevention expert.

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Catherine Nelson-Piercy

B Guy's and St Thomas’ Foundation Trust and Imperial College Health Care Trust, London, UK

Three-quarters of maternal deaths are in women with coexisting medical complications. It can be challenging to differentiate symptoms of normal pregnancy from pathological symptomatology, and physicians need to be mindful of special considerations in assessing and managing acute medical problems in pregnancy. This article focuses on women presenting with shortness of breath, chest pain and palpitations.

Symptoms of normal pregnancy can be difficult to differentiate from symptoms secondary to medical problems, and a careful history, examination and selected investigations are required
Three-quarters of maternal deaths are in women with coexisting medical complications
The vast majority of investigations and treatments should not be withheld in pregnancy
Women with medical problems in pregnancy should be managed with a multidisciplinary team approach

Introduction

Physicians participating in the acute medical take are likely to encounter pregnant women on the acute medical unit, or may be asked to give an opinion on the obstetric ward. Pregnancy does not usually alter acute presentations but there are some special considerations in clinical assessment and differential diagnosis.

The MBRACCE report into UK maternal deaths from 2009–2012 1 showed a decrease in mortality from obstetric causes. However, mortality rates from indirect causes (medical and psychiatric) have not altered over the past ten years. Nearly three-quarters of all women who died had a coexisting medical complication. The report recommends that physicians are appropriately trained in the care of pregnant women, and that women with medical disorders in pregnancy have access to coordinated obstetric and medical input.

This review discusses the approach to pregnant women presenting with common symptoms of shortness of breath, chest pain and palpitations.

Shortness of breath

A degree of breathlessness is a feature of normal pregnancy. The challenge for the clinician is identifying pathological symptomatology (Fig (Fig1). 1 ). From the history, women with physiological breathlessness of pregnancy typically describe an ‘air hunger’ at rest and particularly when talking, which may be relieved by activity.

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Common and important causes of symptoms in pregnancy. 2 ACS = acute coronary syndrome; GORD = gastro–oesophageal reflux disease; PE = pulmonary embolism; PPCM = peripartum cardiomyopathy; SVT = supraventricular tachycardia.

In the examination, features such as tachycardia may be within normal limits (see Box 1). A useful bedside test is to monitor oxygen saturations with a pulse oximeter on exercise, for example climbing stairs. This allows the clinician to evaluate the degree of breathlessness with gentle exertion, and monitor oxygen saturations. While there is no widely accepted formal protocol for this, it is a reassuring feature if oxygen saturations do not decrease on exercise.

Normal results of commonly requested investigations in pregnancy are detailed in Table 1. Asthma is common and has a variable course in pregnancy. Acute severe asthma should be managed vigorously with the same drug treatments, including magnesium, steroids and theophyllines, as outside of pregnancy. There are extensive safety data for all these drugs in pregnancy, and guidelines stress the importance of not withholding steroids, in particular, 5 chest X-rays (CXR) should not be withheld where indicated. Continuous fetal monitoring should be used for women over 24-weeks gestation with acute severe asthma. Intensivists should be involved early. Acute asthma attacks are very rare in labour, perhaps due to higher circulating levels of endogenous steroids. 5

Bacterial pneumonia is no more common in pregnancy, but there is an increased susceptibility to viral pneumonias including Varicella zoster and influenza. CXR should not be withheld if pneumonia is suspected, and treatment with antivirals should be initiated for women with pneumonia secondary to flu viruses. The flu vaccine is recommended for all pregnant women. In the most recent MBRACCE report, influenza was the cause of death in 1 in 11 maternal mortalities. More than half of these deaths could have been prevented by vaccination.

Pulmonary embolism (PE) remains the commonest direct cause of maternal mortality and should be suspected in women with sudden-onset breathlessness and pleuritic pain or collapse. It should be investigated, as outlined in Fig Fig2. 2 . It is notoriously difficult to diagnose or exclude on clinical grounds alone, and many women will undergo imaging. The prevalence of ultimately diagnosed PE in pregnant women undergoing imaging for suspected PE is low at 1.4–4.2%. 7 D-dimer is not validated in pregnancy, 6 therefore it is unhelpful in enabling clinicians to target their imaging appropriately. However, the presence of risk factors is helpful in risk stratifying pregnant women with suspected PE. Those with pre-existing risk factors (age >35 years, raised body mass index, previous venous thromboembolism (VTE), varicose veins, cardiac disease or recent hospital admission) and pregnancy-related risk factors (multiparity, in vitro fertilisation, pre-eclampsia, antenatal/postpartum haemorrhage, caesarean section or hyperemesis gravidarum) are more likely to develop VTE in pregnancy or postpartum. 7 A V/Q scan should be requested in preference to a computed tomography pulmonary angiography (CTPA) in women with a normal CXR, because the radiation dose to maternal lung and breast is reduced. The fetal radiation exposure associated with CTPA and V/Q is approximately 0.1 mGy and 0.5 mGy respectively, although quoted figures vary depending on the imaging protocol used. 6 These doses are well below the 50 mGy maximum recommended exposure in pregnancy. 2

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Algorithm for the investigation and initial management of suspected PE in pregnancy and the puerperium. Reproduced with permission. 6 CTPA = computerised tomography pulmonary angiogram; CXR = chest X-ray; DVT = deep vein thrombosis; ECG = electrocardiogram; FBC = full blood count; LFT = liver function test; LMWH = low-molecular-weight heparin; PE = pulmonary embolism; U&E = urea and electrolytes.

In women diagnosed with massive PE in pregnancy, intravenous unfractionated heparin is the first-line treatment of choice. In those with massive PE associated with circulatory collapse and risk of imminent arrest, thrombolysis should be considered. It is potentially life-saving, and should not be withheld. Thrombolysis is increasingly used for submassive PE with high clot burden to reduce the risk of chronic pulmonary hypertension. There is no increased risk of haemorrhage compared with outside pregnancy. 8 The approach to thrombolysing a pregnant woman should be multidisciplinary, with involvement of obstetrics, intensivists, experienced physicians and radiologists. Alternative therapeutic options used successfully in pregnancy include catheter-directed thrombolytic therapy, or thoracotomy and surgical embolectomy.

An echocardiogram is key in diagnosing valvular heart disease. While many women will have pre-existing diagnoses, they may only become symptomatic in the latter stages of pregnancy. First presentation of valvular heart disease is seen most in the migrant population. Women have a poorer pregnancy outcome if they fall into New York Heart Association class III and IV, regardless of the nature of the lesion. 2 Women with regurgitant lesions and normal left ventricular function are low risk. Those with stenotic lesions and impaired left ventricular function are higher risk. Women with pre-existing heart disease should be offered pre-pregnancy counseling and be monitored closely through their pregnancy. Those with mechanical heart valves need expert management of their anticoagulation.

Box 1. Normal cardiorespiratory examination findings in pregnancy.

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Pregnant women are more susceptible to pulmonary oedema. Clinicians need to look for and address underlying causes such as underlying cardiac disease, pregnancy-induced hypertension and fluid overload. 9

Chest pain is not part of normal pregnancy, although symptoms such as ankle swelling, breathlessness and tachycardia may be normal. The differential diagnosis for chest pain in pregnancy is outlined in Table 1.

On examination, many healthy pregnant women will have ejection systolic murmurs (see Box 1). Diastolic murmurs should always be considered pathological. The interpretation of common investigations for chest pain in pregnancy is outlined in Table 1.

Gastro-oesophageal reflux is diagnosed on the basis of the history and is very common, affecting two-thirds of women, particularly in the third trimester. It is due to the effect of progesterone on the lower oesophageal sphincter and the mechanical effect of the enlarging uterus. 10 If symptoms are associated with vomiting or abdominal tenderness, then the diagnosis should be questioned. Treatment with antacids, H 2 -receptor antagonists and proton pump inhibitors is safe in pregnancy, following lifestyle advice.

Normal findings in pregnancy for common investigations for breathlessness, chest pain and palpitations. 3,4

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Pneumothorax can occur at any gestation, but should be considered as a cause of chest pain following a vaginal delivery. Management is the same as outside pregnancy.

Cardiac disease is the single most common cause of maternal death in the UK and a high index of suspicion is needed. 1 The incidence of acquired heart disease is increasing due to older age at first pregnancy and a higher prevalence of cardiovascular risk factors, such as hypertension, diabetes and obesity. 11 Acute coronary syndromes are predominantly due to atherosclerotic disease, but there is an increased incidence of coronary artery dissection and thrombosis compared with the non-pregnant population. Percutaneous coronary intervention should not be withheld in pregnancy.

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction (left ventricular ejection fraction <45%) towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. 12 Ejection fraction is less than 45% and no alternative cause of cardiomyopathy is identified. PPCM is more prevalent in women who are older, multiparous, hypertensive and Afro-Caribbean. The mainstay of treatment for PPCM is conventional pharmacological therapy for heart failure, such as diuretics, vasodilators and beta-blockers, and delivery of the baby. Anticoagulation is given to women with severely impaired left ventricular function, and some require antiarrhythmics. In the postpartum period, angiotensin-converting enzyme inhibitors are given. Many women recover within three to six months of diagnosis, but the prognosis is variable.

Aortic dissection is characterised by severe ‘tearing’ chest pain, often associated with systolic hypertension. This can be diagnosed with a chest CT scan.

Palpitations

Pregnant women may become more aware of their own heart beating in pregnancy due to sinus tachycardia and increased cardiac output. An increase in pulse rate of 10–20 bpm, particularly by the third trimester, is within normal limits. Women may experience a ‘thump’ from normal beats after a compensatory pause that follows ventricular ectopics. 13 Those who report persistent or severe symptoms should be investigated.

The approach to identifying arrhythmias in pregnancy is to correctly diagnose the arrhythmia, check for underlying heart disease associated with the arrhythmia, then exclude systemic disease. 14 If a woman with palpitations has a history or examination suggesting previous heart surgery, family history of sudden cardiac death or valvular heart disease, then this places her in a higher risk group.

Supraventricular tachycardias are common. Management is the same as outside of pregnancy, and vagotonic manoevres and adenosine can be used to reveal the underlying rhythm. Calcium channel blockers, such as verapamil and beta-blockers, are safe. Direct-current cardioversion can be performed with fetal monitoring and obstetric anaesthetic input.

Thyrotoxicosis should be excluded as a cause of tachycardia, because untreated hyperthyroidism can cause fetal complications, such as growth restriction, prematurity and stillbirth, as well as maternal complications of pre-eclampsia, congestive cardiac failure and thyroid storm. 15 When interpreting thyroid function tests, clinicians should use trimester-specific reference ranges (see Table 1). Severe hyperemesis gravidarum (HG) can cause transient biochemical hyperthyroidism due to the thyroid-stimulating hormone (TSH)-like effects of the beta subunits of human chorionic gonadotropin. This occurs in over 60% of pregnancies with severe HG. Differentiation from first presentation of Graves’ disease requires thorough clinical assessment. Negative TSH-receptor antibodies also support a diagnosis of HG.

Phaeochromocytoma should be considered in women with palpitations associated with severe atypical hypertension, headache, glucose intolerance and anxiety. A high index of suspicion is needed to make the diagnosis. Phaeochromocytoma is associated with maternal mortality of up to 50% at the time of labour or induction of general anaesthesia, 16 and fetal mortality of approximately 26% in undiagnosed cases and 11% in diagnosed cases. 17 In the last MBRRACE triennium, there were two deaths caused by phaeochromocytoma. Investigation is the same as outside pregnancy.

Women with pre-existing medical conditions who become pregnant and those who develop medical complications in pregnancy require a coordinated approach involving senior physicians and obstetricians. Physicians are experienced in assessing patients with chest pain, palpitations and/or breathlessness, and can make a valuable contribution to the care of pregnant women presenting with them provided they avoid errors of omission.

What moms need to know about c-sections

Dr. Courtney Martin stands bedside with pregnant patient

In maternal healthcare, cesarean sections are often necessary due to complications during labor or delivery. Courtney Martin, DO, medical director of quality improvement at Loma Linda University Children's Hospital, outlines common reasons for cesarean deliveries, including fetal distress, prolonged labor, breech presentation, placenta previa, or previous cesarean deliveries where vaginal birth after cesarean isn't feasible.

Recovery from cesarean sections typically requires a longer hospital stay and increased discomfort compared to vaginal delivery. Martin advises mothers to prioritize rest, avoid heavy lifting, and maintain proper wound care. While most women fully recover from a cesarean, there are potential implications for future pregnancies, such as scar tissue leading to complications like placenta accreta or uterine rupture. Women with a history of cesarean delivery need to discuss their options with their healthcare provider when planning future pregnancies.

Misconceptions

Martin says there is a belief that choosing a cesarean represents taking the "easy way out." Martin clarifies that not all cesareans are avoidable and refutes the notion that doctors prefer cesarean deliveries over vaginal births.

"Reducing unnecessary cesareans promotes a patient-centered approach to childbirth, ensuring that interventions are only utilized when medically necessary and allowing women to have more control over their birth experiences. Overall, avoiding unnecessary cesareans is essential for promoting the health and well-being of both mothers and babies, minimizing risks, and preserving future reproductive options," Martin said.

A planned cesarean allows for careful scheduling and preparation, often resulting in a smoother experience for the mother and medical team. This is often done for a repeat cesarean, malpresentation of the baby, or abnormal placental location. An emergency cesarean is performed when there's an immediate threat to the health or life of the mother or baby. Timely intervention is crucial for ensuring the best possible outcomes for both.

Preventive Measures at LLUCH

Acknowledging the importance of preventing unnecessary cesarean sections, particularly among women who have not given birth, have reached 37 weeks gestation, aren't pregnant with twins, and the baby is not in breech or transverse positions, or Nulliparous, Term, Singleton, Vertex (NTSV).

Encouraging vaginal birth through evidence-based practices, education, and informed decision-making supports safer outcomes, preserves future reproductive options, and aligns with women's birth preferences and values and is a core value of the care provided in the San Manuel Maternity Pavilion at LLUCH.

Loma Linda University Children's Hospital and Loma Linda University Medical Center–Murrieta have been recognized as part of the U.S. News & World Report's 2024 High Performing Hospital for Maternity Care. This distinction is based on their national performance in various rankings, including low newborn complications, fewer early deliveries, and reduced c-section rates.

Visit us online for more information on maternity care services at Children’s Hospital or LLUMC-Murrieta .

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Key facts about the abortion debate in America

A woman receives medication to terminate her pregnancy at a reproductive health clinic in Albuquerque, New Mexico, on June 23, 2022, the day before the Supreme Court overturned Roe v. Wade, which had guaranteed a constitutional right to an abortion for nearly 50 years.

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

A bar chart showing that the Supreme Court’s decision to overturn Roe v. Wade draws more strong disapproval among Democrats than strong approval among Republicans

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

A line graph showing public views of abortion from 1995-2022

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

A line graph showing that the partisan gap in views of whether abortion should be legal remains wide

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

A bar chart showing that there are deep religious divisions in views of abortion

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

A table showing that there are wide religious and partisan differences in views of the morality of abortion

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally acceptable in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue.

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

Religion & Abortion

What the data says about abortion in the U.S.

Support for legal abortion is widespread in many countries, especially in europe, nearly a year after roe’s demise, americans’ views of abortion access increasingly vary by where they live, by more than two-to-one, americans say medication abortion should be legal in their state, most latinos say democrats care about them and work hard for their vote, far fewer say so of gop, most popular.

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ABOUT PEW RESEARCH CENTER Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

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Apr 24 2024 12:00pm - Apr 24 2024 1:00pm

EHS Seminar: Environmental Exposures and Adverse Pregancy Outcomes

Dr. Emily DeFranco joined the University of Kentucky College of Medicine in January 2024 as the chair of the Department of Obstetrics and Gynecology. She is a highly regarded expert in her field with an extensive research background as evidenced by hundreds of peer-reviewed publications and national scientific presentations. In this presentation, she will review her experience with multiple different studies involving environmental exposures and adverse pregnancy outcomes.

Pregnant Workers Fairness Act Final Regulations Released

The Equal Employment Opportunity Commission (EEOC) released the text of the final regulations and interpretative guidance implementing the Pregnant Workers Fairness Act (PWFA) on April 15, 2024. The final regulations are expected to be formally published in the April 19, 2024, Federal Register and will be effective 60 days later.

The EEOC received more than 100,000 public comments, including comments from Jackson Lewis, in response to the Commission’s notice of the proposed regulations issued on Aug. 11, 2023 . Although largely unchanged from the proposed regulations, the final regulations provide important clarifications and insights into how the EEOC will enforce the law. Discussed below are some key points employers need to know about the final regulations.

Key PWFA Requirements

The PWFA, which went into effect on June 27, 2023, requires employers with at least 15 employees and other covered entities to provide reasonable accommodations to a qualified employee’s or applicant’s known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless the accommodation will cause undue hardship on the operation of the employer’s business.

Qualified Employee

Under the PWFA, an employee has two ways to establish they are a “qualified employee”:

Like under the Americans With Disabilities Act (ADA), “an employee or applicant who, with or without reasonable accommodation, can perform the essential functions of the employment position” is qualified.
If an employee (or applicant) cannot perform all essential job functions even with reasonable accommodation, the employee can be qualified for accommodations under the PWFA if: (a) the inability to perform an essential job function is for a temporary period; (b) the essential job function(s) could be performed in the near future; and (c) the inability to perform the essential function(s) can be reasonably accommodated. The Act, however, does not define “temporary” or “in the near future.” Several commentors raised concerns about the EEOC’s definition of these terms in the proposed regulations.

Like the proposed regulations, the final regulations state that “temporary” means “lasting for a limited time, not permanent, and may extend beyond ‘in the near future.’” Unlike the proposed regulations, however, the final regulations state that assessing whether all essential job functions can be performed in the near future depends on the circumstances:

For a current pregnancy, “in the near future” is generally defined as 40 weeks from the start of the temporary suspension of an essential function.
For conditions other than a current pregnancy, “in the near future” is not defined as any particular length of time. However, the preamble to the final regulations explains that an employee who needs indefinite leave cannot perform essential job functions “in the near future.”

The final regulations explain that employers should consider whether an employee will be able to perform the essential functions “in the near future” each time an employee asks for an accommodation that requires suspension of an essential job function.

Ultimately, whether an employee is “qualified” involves a fact-sensitive evaluation whether the temporary suspension of essential job functions can be reasonably accommodated by the employer. This is significantly different from the ADA reasonable accommodation obligation and may involve, as the final regulations state, removing essential job functions and other arrangements including, but not limited to, requiring the employee perform the remaining job functions and other functions assigned by the employer, temporarily transferring the employee to another job or assigning the employee to light or modified duty, or allowing the employee to participate in an employer’s light or modified duty program.

Accommodations Only Required for Individual With Limitation

The EEOC explains that the regulations do not require employers to provide accommodations to an employee when an employee’s partner, spouse, or family member — not the employee themselves — has a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions. For clarity, the EEOC revised the final regulations’ definition of “limited” to state the limitation must be the specific employee.

Known Limitations

Employers are only obligated under the PWFA to accommodate an individual’s “known limitation.”

A “limitation” is defined as a “physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, of the specific employee in question.” The condition may be “modest, minor, and/or episodic, and does not need to meet the definition of “disability” under the ADA.

It becomes “known” to the employer when the employee or the employee’s representative has communicated the limitation to the employer. An employee’s representative may include a family member, friend, healthcare provider, union representative, or other representative.

The limitation may be communicated to a supervisor, a manager, someone who has supervisory authority for the employee or who regularly directs the employee’s tasks (or the equivalent in the case of an applicant), human resources personnel, or other appropriate official or by following the steps in the employer’s policy to request an accommodation.

This communication need not be in any specific format and may also be oral.

Pregnancy, Childbirth, Related Medical Conditions

Although the EEOC acknowledged receiving many comments on the scope of the proposed definition of “pregnancy, childbirth or related medical conditions,” it made no substantive changes to the definition in the final regulations.

“Pregnancy” and “childbirth” are still defined as including current pregnancy, past pregnancy, potential or intended pregnancy (which can include infertility, fertility treatments and the use of contraception), labor, and childbirth (including vaginal and cesarean delivery).

The term “related medical conditions” continues to be defined as conditions that are “related to, are affected by, or arise out of pregnancy or childbirth.” The regulations provide the following non-exhaustive list of examples: termination of pregnancy, including by miscarriage, stillbirth, or abortion; lactation and conditions related to lactation; menstruation; postpartum depression, anxiety or psychosis; vaginal bleeding; preeclampsia; pelvic prolapse; preterm labor; ectopic pregnancy; gestational diabetes; cesarean or perineal wound infection; maternal cardiometabolic disease; endometriosis; changes in hormone levels; and many other conditions.

The final regulations also reference related medical conditions that are not unique to pregnancy or childbirth, such as chronic migraine headaches, nausea or vomiting, high blood pressure, incontinence, carpal tunnel syndrome, and many other medical conditions. These conditions are covered by the PWFA only if the condition relates to pregnancy or childbirth or are exacerbated by pregnancy or childbirth, although the ADA or other civil rights statutes may apply.

Documentation

The final PWFA regulations continue to provide for a “reasonableness” standard in evaluating the circumstances under which an employer may request documentation from an employee. The final regulations, however, modify the definition of “reasonable documentation.” An employer may only request the “minimum documentation” necessary to confirm the employee has a physical or mental condition related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions (a limitation) and describe the adjustment or change at work due to the limitation.

In addition to stating when an employer can ask for documentation, the PWFA regulations add a paragraph regarding an employee’s self-confirmation of their pregnancy status. It provides that an employer must accept as sufficient an employee’s self-confirmation when: (1) the pregnancy is obvious; or (2) an employee seeks one of the “predictable assessment” accommodation requests set forth in the regulations (discussed below).

The final PWFA regulations make clear the circumstances where it is not reasonable to seek supporting documentation. These circumstances include when: (1) the limitation and adjustment or change needed is obvious and the employee provides self-confirmation; (2) the employer has sufficient information to determine whether the employee has a qualifying limitation and needs an adjustment or change due to the limitation; (3) when the employee is pregnant a “predictable assessment”; (4) the reasonable accommodation relates to a time and/or place to pump or to nurse during work hours, and the employee provides self-confirmation; or (5) the requested accommodation is available to employees without known limitations under the PWFA pursuant to a policy or practice without submitting supporting documentation.

Importantly, the same prohibitions on disability-related inquiries and medical examinations as well as the protection of medical information enforced under the ADA apply with equal force to documentation collected under the PWFA. Employers should ensure they continue to limit inquiries to only those that are job-related and consistent with business necessity. Employers should also treat all documentation relating to a PWFA accommodation request like they treat ADA documentation — maintain it confidentially and separate from an employee’s personnel file.

Reasonable Accommodations

The PFWA requires employers to provide reasonable accommodations, which the final regulations define to be generally consistently with the ADA except for temporarily excusing or eliminating the performance of an essential job function. Otherwise, the rule provides that a reasonable accommodation is a modification or adjustment that is “reasonable on its face, i.e., ordinarily or in the run of cases” if it appears to be “feasible” or “plausible.” An accommodation also must be effective in meeting the qualified employee’s needs to remove a work-related barrier and provide an employee with equal employment opportunity to benefit from all privileges of employment.

The final regulations include examples of requests that may be reasonable. These include schedule changes due to morning sickness or to treat medical issues following delivery, adjustments to accommodate restrictions for lifting or requests for light duty, time and/or space to pump or nurse during work hours, or time off to recover from childbirth.

Lactation Accommodations

The EEOC’s final regulations require reasonable accommodation for lactation beyond what may be required under the Providing Urgent Maternal Protection for Nursing Mothers Act (PUMP Act). The PUMP Act generally requires reasonable break time and space shielded from view and free from intrusion for a nursing mother to express breast milk. The final PWFA regulations provide a non-exhaustive list of examples of accommodations relating to lactation, including space for pumping that is in reasonable proximity to a sink, running water, and refrigeration for storing milk.

The final regulations add nursing during working hours (as distinct from pumping) to the list of potentially reasonable accommodations. In the comments explaining this addition, the EEOC cautioned that accommodations for nursing mothers during work hours address situations where the employee and child are in close proximity in the normal course of business, such as where the employee works from home or where the employer offers on-site daycare. The EEOC stated this is not intended to create a right to proximity to nurse because of an employee’s preference.

Predictable Assessments

Like the proposed regulations, the final regulations recognize four “predictable assessments” that will not impose an undue hardship in “virtually all cases”:

Allowing an employee to carry or keep water near to enable them to drink;
Permitting an employee to take additional restroom breaks as needed;
Allowing an employee whose work requires standing to sit and whose work requires sitting to stand as needed; and
Allowing an employee to take breaks to eat and drink as needed.

Despite stating the predictable assessments above will not “in virtually all cases” impose an undue hardship, the EEOC clarified this does not mean such requests are reasonable per se. The EEOC recognized that in certain industries, these predictable assessments may cause an undue hardship. Accordingly, employers may still conduct an individualized assessment of a predictable assessment accommodation request. However, the final regulations make clear that any such individualized assessment should be particularly simple and straightforward.

Many individuals and organizations that submitted comments on the proposed regulations suggested the addition of other types of predictable assessment accommodations, including dress code modifications, minor workstation modifications, proximity to a restroom, permitting eating and drinking at a workstation, rest breaks, and personal protective equipment. Although noting agreement with the commenters and stating that employers should be able to provide such requests with “little difficulty,” the EEOC declined to expand the list of predictable assessments beyond the four originally listed that in “virtually all cases” will be considered reasonable and will not pose an undue hardship. In response to comments objecting to predictable assessments based on different challenges by industry, the EEOC guidance recognizes that an employer in certain industries may assert an accommodation request otherwise deemed to be a predictable assessment causes the employer an undue hardship and may deny the request.

Undue Hardship

The EEOC adopted the same standard for undue hardship in the final regulations as was in the proposed regulations. When an employee can perform all their essential job functions, the EEOC stated that undue hardship has the same meaning as under the ADA and generally means significant difficulty or expense for the employer’s operation. If an employee cannot perform all essential functions and the accommodation is temporary suspension of an essential job function, the employer needs to consider the ADA definition of undue hardship and the following relevant factors: (1) the length of time the employee or applicant will be unable to perform the essential function(s); (2) whether there is work for the employee to accomplish by allowing the employee to perform all the other functions of the job, transferring the employee to a different position, or otherwise; (3) the nature of the essential function, including its frequency; (4) whether the covered entity has temporarily suspended the performance of essential job functions for other employees in similar positions; (5) whether there are other employees, temporary employees, or third parties who can perform or be temporarily hired to perform the essential function(s); and (6) whether the essential function(s) can be postponed or remain unperformed for any length of time and for how long.

EEOC Interpretative Guidance

The EEOC’s final regulations include an appendix entitled “Appendix A to Part 1636—Interpretative Guidance on the Pregnant Workers Fairness Act” (Interpretative Guidance). The Interpretative Guidance, which becomes part of the final regulations, has the same force and effect as the final regulations.

The Interpretative Guidance addresses the major provisions of the PWFA and its regulations and explains the main concepts pertaining to an employer’s legal requirements under the PWFA to make reasonable accommodations for known limitations (physical or mental conditions related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions). It represents the EEOC’s interpretation of the PWFA and, as stated in comments to the final regulations, the EEOC will be guided by the Interpretive Guidance when enforcing the PWFA. The Interpretative Guidance includes many examples and other practical guidance illustrating common workplace scenarios and how the PWFA applies.

Remedies, Enforcement

The final regulations’ remedies and enforcement are the same as proposed. Remedies under the PWFA mirror those under Title VII of the Civil Rights Act and include injunctive and other equitable relief, compensatory and punitive damages, and attorney’s fees. Employers that demonstrate good faith efforts to work with employees to identify and make reasonable accommodations have an affirmative defense to money damages.

PWFA’s Relationship to Other Federal, State, Local Laws

The final regulations provide that the PWFA does not invalidate or limit the powers, remedies, or procedures available under any federal, state, or local law that provides greater or equal protection for individuals affected by pregnancy, childbirth, or related medical conditions. About 40 states and cities have laws protecting employees and applicants from discrimination due to pregnancy, childbirth, and related medical conditions. Accordingly, employers should evaluate whether state and/or local law may provide greater rights and obligations than the PWFA. To the extent such laws provide greater obligations, the PWFA final regulations require employers to comply with both the PWFA and analogous state and local law.

Jackson Lewis invites you to a complimentary webinar on the PWFA final regulations on May 10 at 1:00 p.m. ET.

If you have any questions about the PWFA, the implications of the final regulations for your organization, or the many state and local laws, please contact a Jackson Lewis attorney.

© 2024 Jackson Lewis P.C. This material is provided for informational purposes only. It is not intended to constitute legal advice nor does it create a client-lawyer relationship between Jackson Lewis and any recipient. Recipients should consult with counsel before taking any actions based on the information contained within this material. This material may be considered attorney advertising in some jurisdictions. Prior results do not guarantee a similar outcome.

Focused on labor and employment law since 1958, Jackson Lewis P.C.'s 950+ attorneys located in major cities nationwide consistently identify and respond to new ways workplace law intersects business. We help employers develop proactive strategies, strong policies and business-oriented solutions to cultivate high-functioning workforces that are engaged, stable and diverse, and share our clients' goals to emphasize inclusivity and respect for the contribution of every employee. For more information, visit https://www.jacksonlewis.com .

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RFK Jr. rarely mentions abortion — and sends mixed signals when he does

For many Americans, November’s presidential election is about one issue: abortion . President Biden hopes that a pro-abortion rights message will carry him to reelection, and Donald Trump regularly brags about his role in ending Roe v. Wade , the Supreme Court decision that protected abortion rights nationwide.

Robert F. Kennedy Jr. , the long-shot independent hopeful with a famous family name whose candidacy has centered heavily on his skepticism of vaccines, barely mentions abortion. When he does, he often sends mixed signals.

Kennedy has said he believes the decision to seek an abortion should be left to women and their doctors. But he has held just one campaign event focused on abortion, an October visit to an Atlanta facility founded by Angela Stanton King — an antiabortion and criminal justice reform activist and former Trump supporter whom the ex-president pardoned for her role in a car-theft ring. In the months that followed Kennedy’s appearance at Stanton King’s facility, which aims to persuade women to carry their pregnancies to term, he has repeated her false and inflammatory claims that abortion providers systematically target Black women.

Kennedy has avoided taking a concrete stance on the nation’s patchwork of abortion bans and U.S. House Republicans’ efforts to pass federal restrictions , calling abortion a “culture war issue” used to divide people. He has said that “every abortion is a tragedy” but has few plans to take on the issue in the White House.

Kennedy mentioned abortion just twice in the 11 speeches and campaign events that appear on his YouTube page. He mentioned the word “vaccine” 10 times. On X, he has mentioned the word “abortion” five times since the start of last year. He posted the word “vaccine” 64 times in the same period.

“He’s trying to avoid what’s probably the most salient issue right now,” said Roy Behr, the author of “Third Parties in America: Citizen Response to Major Party Failure.”

Kennedy’s ambiguity on abortion — an issue that many voters say is a major motivator for them this race — may not hurt him in November. Kennedy, the nephew of a former president and son of a former U.S. attorney general, has appealed to a politically diverse group of supporters with nuanced views, including some who identify as conservative but are weary of Trump and others who describe themselves as liberals unenthused with Biden. Outlining a clearer abortion position could hurt his standing with one or more of those groups.

Kennedy doesn’t focus on abortion in speeches because it is a divisive issue, his campaign told The Washington Post.

“Mr. Kennedy does not want to add fuel to the fire,” campaign spokeswoman Stefanie Spear wrote in an email, citing issues including chronic disease, infrastructure, disarmament and farming practices that protect the environment. “These issues also have the potential to unify the country, unlike abortion, which is fundamentally divisive. So, Mr. Kennedy makes his position plain, but does not dwell on the subject.”

Spear said Kennedy, who has not previously shared his thoughts on Arizona’s state Supreme Court decision to revive a near-total ban on abortion earlier this month, opposes the ruling. She said he also disagreed with Trump’s proposal to leave abortion restrictions up to the states.

After The Post inquired about Kennedy’s abortion position, the campaign added an abortion policy page to its website, proposing “a massive subsidized daycare initiative” paid for by funds Kennedy would reroute from Ukraine war aid. The page doesn’t provide any more information about how Kennedy would respond to abortion bans in states.

Twelve percent of voters, including two-thirds of Democrats, say abortion is the “most important issue” in their 2024 vote, according to a KFF poll last month. Down the ballot, voters have signaled their disapproval of strict bans on abortion, supporting statewide referendums and candidates that would protect or expand abortion access.

This election marks the first time that many voters will be able to weigh in post- Roe , and Kennedy’s opponents could use his near-silence on abortion rights to cast doubt on his commitment to them, Democratic pollster Nancy Zdunkewicz said. New stories of women in dangerous, difficult circumstances who are unable to get abortions resonate with voters, she argued.

“It’s all way too real for people in a way that it just wasn’t before,” Zdunkewicz said.

Kennedy is likely to attract voters who agree with him on vaccines and feel disaffected with the two major political parties, but will face more difficulty attracting people who aren’t interested in one of his primary concerns such as vaccine safety, said Bernard Tamas, a political science professor at Valdosta State University in Georgia and author of “The Demise and Rebirth of American Third Parties.”

“I don’t think that very many people are going to make decisions for or against Kennedy based on abortion,” he said.

Kennedy’s lone campaign stop focused on abortion was an October visit to Auntie Angie’s House, a center for pregnant women in a Black community in Atlanta run by Stanton King. When Trump pardoned Stanton King, he cited her advocacy for people reentering society after being released from prison.

The interaction with Stanton King appeared to leave an impression on Kennedy, who has since repeated her inaccurate claim that Black women are systematically coerced into getting abortions at least three times . In a virtual discussion with Stanton King in February , Kennedy repeated that disinformation that Black women receive a vast majority of abortions and most abortion clinics are in Black communities .

Kennedy’s campaign says he “misspoke” when he referred to the percent of Black women receiving abortions, but neither of the claims he repeated is correct, according to multiple research studies.

More than 6 in 10 abortion clinics were located in predominantly White neighborhoods and about 1 in 10 clinics were in predominantly Black neighborhoods, according to a 2014 report from the Guttmacher Institute, a research and advocacy group that favors abortion rights. The group told The Post that post-Roe abortion bans in states with large Black populations have likely led to fewer clinics in Black neighborhoods since that analysis was completed.

Stanton King told The Post she did not ask Kennedy during his visit when he believes life begins, whether he would sign an abortion ban or his thoughts on the abortion restrictions passed in neighboring states. But Stanton King came away with the belief that Kennedy could do a better job than the major party candidates in bridging the partisan divide, and she later joined his campaign as an adviser. She said she appreciated Kennedy’s promise to invest the same amount of federal resources that are committed to abortion services in social safety net programs for new mothers who need aid.

Many of Kennedy’s rare comments about abortion have come during media interviews, providing a patchy view of his policy and personal beliefs.

At the Iowa State Fair in August 2023, Kennedy said he would support a federal ban on abortion after 15 weeks of gestation , then said he would not “personally” restrict abortion but added, “I think the states have a right to protect a child once the child becomes viable, and that right, it increases.” (His campaign later clarified that he would not sign a ban.)

In an interview with PBS News in November, Kennedy said he didn’t know what Biden could do to help protect women’s access to abortions.

In a video released the same day as Biden’s State of the Union address, in which the president called for Congress to restore Roe , Kennedy didn’t mention abortion rights at all.

Biden’s allies have emphasized the president’s efforts to expand access to contraception, abortion medication and emergency abortion care and point out the stark contrast with Trump’s work to restrict abortion access. When Kerry Kennedy, Kennedy’s sister, endorsed Biden along with more than a dozen other members of her family at a campaign rally Thursday, she cited Biden’s support for abortion rights as one of the main reasons to back him.

Kennedy’s running mate, Nicole Shanahan, funded research into the longevity of women’s reproductive health and criticized in vitro fertilization as “one of the biggest lies that’s being told about women’s health today.” In a lengthy post on X on April 9, after Arizona’s state Supreme Court decision, Shanahan wrote she “can hold both beliefs,” suggesting bans are “coercive” and “wrong” but that women should carry pregnancies to term unless the mother or baby’s health is at risk.

Most voters who have already said they plan to vote for Kennedy said he talks about abortion enough.

Mike Roy, a retired Air Force lieutenant colonel in Annapolis, Md., said he is voting for Kennedy because he believes the independent can keep America out of other countries’ wars, close the Southern border and more aggressively regulate polluters. Abortion is not a top issue for the 46-year-old, but he agrees with Kennedy that women should have the right to choose the procedure. Still, he sees little point in Kennedy focusing on the topic.

“I don’t think he needs to talk about it more,” Roy said. “It’s such a polarizing issue and the theme of the campaign is to heal the divide.”

Lori Spencer, a Kennedy campaign volunteer in Oklahoma City who voted for the libertarian candidates in the past two presidential elections, disagrees. The 54-year-old was once a loyal Democratic voter but she left the party in 1996 after she felt as though its leaders weren’t keeping their promises, arguing that Democrats could have protected Roe when they had the chance. Biden is no different, she believes.

“He talks the talk, but he doesn’t walk the walk,” she said.

Spencer said Kennedy might benefit from talking about abortion rights more and appealing more to voters like her who believe the government should not be involved in medical decisions.

“I personally would like to see him be more vocal about his pro-choice beliefs,” Spencer said. “But he’ll talk about it when asked and he’ll give you a clear answer. I don’t think there’s any ambiguity or misunderstanding of his position. He’s very clear. So I’m happy enough with that.”

Kennedy’s campaign has also used his abortion position to appeal to conservative voters. Rita Palma, who worked for Kennedy gathering ballot access signatures in New York, told voters this month that the candidate’s position was comparable to Trump’s. Palma was later fired after being caught on video saying Kennedy could help Trump win.

“Bobby believes and I heard this out of his own mouth: ‘Every abortion is a tragedy,’” she said in the video. “He’s definitely not, you know, 100 percent pro-life. But none of the candidates are. Even Trump is saying that they have to find that, quote-unquote sweet spot in order to win elections.” Palma declined to comment for this story.

Even Kennedy has acknowledged he doesn’t know what he would do on abortion once in the White House. When a Post reporter asked him in February how he would protect abortion access and reproductive rights if he were elected president, he replied: “I don’t know, you tell me. What should I be doing?”

Voters should be shown what 'abortion looks like at every stage of pregnancy,' Sen. Ron Johnson says

MADISON — Voters weighing their position should be shown what abortion looks like at every stage of pregnancy, U.S. Sen. Ron Johnson told reporters Monday.

The Republican senator's comments came as Democratic Vice President Kamala Harris visited La Crosse to rally voters around abortion as the race for the presidency remains tight in this battleground state. Johnson advocated, as he has before, that the issue should be decided via referendum.

"We need to understand, first of all, what an abortion looks like at every stage of pregnancy. We've not had that discussion, which is why I recommended a referendum to ask that question: at what point does society have the responsibility to protect life?" Johnson told reporters.

"But leading up to that referendum, we should have an education campaign that describes what life looks like inside the womb at different stages. You know, what babies could experience when they're viable — but also, as abhorrent as it would be, what does an abortion look like — at four weeks and eight weeks and 12 weeks?"

The vice president's latest Wisconsin visit reflects Democrats' efforts to make abortion a key factor in motivating turnout for President Joe Biden, including among voters in purple areas or even the traditionally red Milwaukee suburbs.

Women affected by abortion bans in other states campaigned for Biden in Waukesha County last week , and Harris brought a similar message to the area in January . Biden administration officials have also made frequent trips to Milwaukee and Madison this year, both Democratic strongholds.

"There is a clear line between where we are now and who is to blame," Harris said in La Crosse . "The former president (Donald Trump) was very clear with his intention — he would fill and appoint three members of the U.S. Supreme Court with the intention that they would overturn the protections of (Roe v. Wade)."

Johnson told reporters he wished the Republican-led state Senate would have approved a bill p assed by Assembly Republicans asking voters whether Wisconsin should ban abortions after 14 weeks of pregnancy. With voters’ approval, it would have banned abortions 14 weeks after "probable fertilization" except in situations where the mother's life or health would be endangered without the procedure — a measure that would have reduced the timeframe for legal abortions in Wisconsin by six weeks.

The effort deployed a seldom-used process by which a law passed by the Legislature and signed by the governor can be enacted only with voters' approval. Had the Senate approved the Assembly bill as Johnson alluded to Monday there would have been virtually no chance Gov. Tony Evers would have signed it and sent the question to voters in a statewide referendum.

Wisconsin Republicans have struggled to combat the political effects of the 2022 U.S Supreme Court ruling overturning Roe v. Wade, which effectively put back into place a law that had been interpreted for more than a century to ban all abortions except when the mother would die without one. Abortion has become a central issue in races in Wisconsin since.

In the latest Marquette University Law School poll released last week , 24% of Democratic voters said they consider abortion their most important issue in deciding who to vote for, followed by the economy. For independent and Republican voters, 5% of those groups saw abortion as their top issue.

While abortion was the leading issue among Democratic participants, the economy was the No. 1 issue for all respondents in the survey, followed by immigration and abortion policy. Voters saw Biden better at handling abortion and health care, and Trump better on the economy and immigration.

A majority of registered voters in Wisconsin, 54%, also said they strongly or somewhat favor a national ban on abortion after 15 weeks of pregnancy with exceptions for rape, incest and the life and health of the mother.

In the same poll, 64% of voters said they believe abortion should be legal in all or most cases, while 35% said it should be illegal in all or most cases.

"I don't think the mainstream media is honest when it comes to which political party holds the extreme position on abortion. The extreme position, I think the vast majority of Americans agree with this, is abortion unlimited up to the moment of birth. That is the extreme position," Johnson said.

A recent Kaiser Family Foundation analysis found that abortions at or after 21 weeks represent 1% of all abortions in the U.S., while 96% occurred at or before 15 weeks gestation. The analysis found that 3% occurred from 16 to 20 weeks gestation.

"Discussions on this topic are often fraught with misinformation; for example, intense public discussions have been sparked after several presidential candidates claimed there were abortions occurring ' moments before birth ' or even ' after birth .' In reality, these scenarios do not occur, nor are they legal, in the United States," the report noted.

According to the same report, "Reasons individuals seek abortions later in pregnancy include medical concerns such as fetal anomalies or maternal life endangerment, as well as barriers to care that cause delays in obtaining an abortion."

Many fetal abnormalities are not identifiable until the 20-week ultrasound.

Two years ago, Johnson suggested voters should be able to weigh in on the question , "At what point does society have the responsibility to protect the life of an unborn child?" with options ranging from banning abortion at the moment of conception, to each month of pregnancy up until the eighth month or "never."

In a memo published during his 2022 reelection campaign, Johnson said he would oppose imposing penalties on mothers and supports exceptions in the case of rape, incest or the life of the mother. He also said he “fully” supports in vitro fertilization and contraception, and would “never” vote to prevent a woman from receiving life-saving care in the case of a miscarriage or ectopic pregnancy, or to prevent a woman from crossing state lines to access medical treatment, “including an abortion procedure.”

The Oshkosh Republican previously supported legislation in 2011 declaring the right to life starts at fertilization and has repeatedly co-sponsored federal legislation that would ban abortion 20 weeks after fertilization.

Hope Karnopp of the Milwaukee Journal Sentinel contributed from La Crosse.

Jessie Opoien can be reached at [email protected].

Arizona GOP wants to undercut proposed abortion ballot measure with Legislature referrals

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A document circulated Monday by a Republican legislative staffer explains how lawmakers could weaken support for an anticipated pro-abortion ballot measure by crafting competing proposals.

The potential plan would attempt to manipulate voters in several ways, such as trying to get better placement on the ballot and offering a 14-week ban that's "disguised as a 15-week law."

Its distribution follows last week's explosive ruling by the state Supreme Court that upheld a strict abortion ban from Arizona's territorial days. But the 24-slide presentation intended for Republican legislators doesn't address a possible repeal of the ban that may come up for a vote during floor sessions planned for April 17.

It suggests referring three other measures to the ballot.

It's "more likely that the AAA Initiative will fail if vote is split (dilutes vote)," says the presentation, which is titled "Legislative Strategies for Regulating Abortion (Amidst a Radical Ballot Initiative and Court Chaos.)"

Linley Wilson, the state House's general counsel, emailed the presentation to lawmakers and others Monday, then recalled it. House spokesman Andrew Wilder said the email was sent accidentally.

"I've publicly stated that we are looking at options to address this subject, and this is simply part of that," said House Speaker Ben Toma. "It was unfortunate that this was accidentally distributed outside of the caucus; the phrasing would have been different as would what is highlighted as part of the proposal."

Calli Jones, a spokeswoman for Senate Democrats, said the leaked presentation appears to reveal what has been the Republicans' plan all along: to try and foil the ballot initiative. She also questioned how serious the document is, since it closes with a meme of Seth Myers saying, "Boom. Easy as that."

Senate President Warren Petersen said he hasn't discussed the plan yet with fellow Republican senators.

Both GOP leaders told The Arizona Republic last week that potential ballot measures were under discussion that would limit abortions or put restrictions on the procedure to offer alternatives to the abortion measure, which they consider too permissive.

"My idea was to give people a chance to also vote for life," Petersen said.

The anti-abortion Center for Arizona Policy is conducting a legal analysis of the GOP proposal, said the group's president, Cathi Herrod, who added the center has "no position yet" on it.

Plan aims to thwart support for abortion measure

Abortion rights supporters backing the Arizona for Abortion Access initiative said earlier this month they've gathered more than 500,000 signatures for the measure already , well above the 383,000 needed by July to qualify for the ballot. They aim to gather 800,000 signatures to withstand legal challenges.

Last week's court ruling sparked even more interest in the measure, which would create a "fundamental right" to obtain an abortion anytime before viability — the point at which a fetus would have a significant chance of surviving outside the womb. Fetal viability is typically at about 23 or 24 weeks of gestation.

The act, as submitted to the state, would also prevent the state from enacting, adopting or enforcing any law that denies, restricts or interferes with an abortion that, "in the good faith judgment of a treating health care professional, is necessary to protect the life or physical or mental health of the pregnant individual."

The leaked plan focuses on measures Republicans could refer to the ballot with simply majority votes and no signature necessary by Democratic Gov. Katie Hobbs.

The first measure would allegedly "compliment" the Abortion Access initiative by limiting it, giving voters "something other than the extreme abortion-on-demand" initiative. Most importantly, the presentation states, the additional measure envisioned by Republicans would protect the Legislature's "authority to 'enact laws rationally related to promoting and preserving life and to protecting the health and safety of pregnant women.'"

Republicans could choose a "short title" for the measure like "Protecting Pregnant Women and Safe Abortions Act," Wilson suggested in the presentation.

That's "Phase One." It could be implemented with or without the second phase, which would be to "send voters two other options that conflict with AAA initiative."

The presentation suggests two referrals, the "15-week Reproductive Care and Abortion Act" and the "Heartbeat Protection Act," both of which allow abortions to save a mother's life.

The "15-week" proposal would only allow abortions legally for 14 weeks, the document explains, because it disallows abortions at the beginning of the 15th week of pregnancy.

The "heartbeat" referral measure would disallow abortions after six weeks of pregnancy, but unlike the 15-week proposal, it allows an exception for rape and incest cases.

If legislators approve a ballot measure and transmit it to the Secretary of State's Office before the Abortion Access group files its signatures, voters would see the Republicans' offering "first on the ballot," the document states.

The overall plan "puts Democrats in a defensive position to argue against partial birth abortions, discriminatory abortions, and other basic protections," it says.

Measures face possible GOP pushback

Political strategist Chuck Coughlin pointed to polling in the wake of the 2022 primary election that showed Arizonans don’t want lawmakers making policies that affect abortion rights.

The poll found 62% of likely voters believe that reproductive rights should be protected, and that the government should not interfere in decisions between a woman and her doctor.

Coughlin said attempts to confuse voters or dilute the impact of the Arizona for Abortion Access initiative will not make a major dent in support for the initiative, given those findings.

“I don’t think it’s necessarily confusing to people,” he said. "The initiative has emerged as the leading message on abortion rights. Initiative supporters may have to run a campaign to reinforce the perception."

As for competing referrals passing the Legislature, he is doubtful, given the split views on how strict abortion controls should be.

“How are you going to get that past the Freedom Caucus?” he asked. That group of conservative Republicans have applauded the court’s decision and said they don’t see a need to loosen restrictions.

Reach the reporter at [email protected] or 480-276-3237. Follow him on X @raystern .

Reporter Stacey Barchenger contributed to this article

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IMAGES

Pregnancy stages on Behance
Multifetal Gestation and Malpresentation
9 Stages of Pregnancy
Gestation
Stages of gestation
PPT

VIDEO

The Perinatal Psychopharmacology Survival Guide
Gestation period in human is
Birth Injuries pptx(Paediatrics & Neonatology/O&G)
Gestation Meaning
Understanding Calving Ease EBVs
Managing the Valuable Brood Female for Maximal Fertility and Success

COMMENTS

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 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.
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 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.
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 ...
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 Baby: Causes, Complications, Turning & Delivery
Breech is common in early pregnancy and most babies will move to a head-first position by 36 weeks of pregnancy. This head-first position is called vertex presentation and is the safest position for birth. Advertisement. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.
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.
If Your Baby Is Breech
In the last weeks of pregnancy, a fetus 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 fetus's buttocks, feet, or both are in place to come out first during birth. This happens in 3-4% of full-term births.
Obstetric Examination
Lie. Facing the patient's head, place hands on either side of the top of the uterus and gently apply pressure. Move the hands and palpate down the abdomen. One side will feel fuller and firmer - this is the back. Fetal limbs may be palpable on the opposing side. Fig 2 - Assessing fetal lie and presentation.
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 ...
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.
Abnormal Presentation
Fetal presentation means the part of the fetus that is "presenting" at the cervix: Cephalic presentation means head first. ... Transverse lie occurs frequently in early pregnancy, when it is of no consequence. At 16 weeks gestation, about half of all pregnancies will be transverse lie. This number steadily falls as pregnancy advances and the ...
Fetal presentation: how twins' positioning affects 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.
Breech presentation
Breech presentation is common in early pregnancy and decreases with advancing gestational age, as most babies turn spontaneously to a cephalic presentation before birth. [ 3 ] [ 4 ] The prevalence at term in singleton pregnancies is 3% to 4% of all births.
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.
What Is Vertex Position?
According to Dr. Purdie, healthcare providers will begin assessing the position of the baby as early as 32 to 34 weeks of pregnancy. About 75% to 80% of fetuses will be in the vertex presentation by 30 weeks and 96% to 97% by 37 weeks. Approximately 3% to 4% of fetuses will be in a non-cephalic position at term, she adds.
Full article: Changes in fetal presentation in the preterm period and
This study aimed to clarify the transition of fetal presentation during pregnancy and to propose practical strategy to predict final fetal presentation. Methods . During the period of 2 years, fetal presentations were analyzed using ultrasonography during the prenatal visits at and after 22 weeks of gestation in a single facility. The ...
Acute presentation of the pregnant patient
Pregnancy does not usually alter acute presentations but there are some special considerations in clinical assessment and differential diagnosis. The MBRACCE report into UK maternal deaths from 2009-2012 1 showed a decrease in mortality from obstetric causes.
What Are Compound Presentations?
A prenatal presentation known as a compound presentation occurs when one extremity develops concurrently with the part of the fetus that is closest to the birth canal. A fetal hand or arm typically presents with the head during compound presentations. A presentation is considered compound when one or more limbs prolapse together with the head ...
What moms need to know about c-sections
In maternal healthcare, cesarean sections are often necessary due to complications during labor or delivery. Courtney Martin, DO, medical director of quality improvement at Loma Linda University Children's Hospital, outlines common reasons for cesarean deliveries, including fetal distress, prolonged labor, breech presentation, placenta previa, or previous cesarean deliveries where vaginal ...
Key facts about abortion views in the U.S.
A woman receives medication to terminate her pregnancy at a reproductive health clinic in Albuquerque, New Mexico, on June 23, 2022, the day before the Supreme Court overturned Roe v. Wade, which had guaranteed a constitutional right to an abortion for nearly 50 years. (Gina Ferazzi/Los Angeles Times via Getty Images)
EHS Seminar: Environmental Exposures and Adverse Pregancy Outcomes
She is a highly regarded expert in her field with an extensive research background as evidenced by hundreds of peer-reviewed publications and national scientific presentations. In this presentation, she will review her experience with multiple different studies involving environmental exposures and adverse pregnancy outcomes.
Pregnant Workers Fairness Act Final Regulations Released
The Equal Employment Opportunity Commission (EEOC) released the text of the final regulations and interpretative guidance implementing the Pregnant Workers Fairness Act (PWFA) on April 15, 2024. The final regulations are expected to be formally published in the April 19, 2024, Federal Register and will be effective 60 days later.
and sends mixed signals when he does
At the Iowa State Fair in August 2023, Kennedy said he would support a federal ban on abortion after 15 weeks of gestation, then said he would not "personally" restrict abortion but added ...
Ron Johnson says voters should be shown 'what abortion looks like'
A recent Kaiser Family Foundation analysis found that abortions at or after 21 weeks represent 1% of all abortions in the U.S., while 96% occurred at or before 15 weeks gestation. The analysis ...
Arizona abortion: Republicans seek to undercut ballot measure
But the 24-slide presentation intended for Republican legislators doesn't address a possible repeal of the ban that may ... Fetal viability is typically at about 23 or 24 weeks of gestation. ...
State Bans on Abortion Throughout Pregnancy
41 STATES HAVE ABORTION BANS IN EFFECT WITH ONLY LIMITED EXCEPTIONS. 14 states have a total abortion ban.; 27 states have abortion bans based on gestational duration.. 7 states ban abortion at or before 18 weeks' gestation.; 20 states ban abortion at some point after 18 weeks.; 9 STATES AND THE DISTRICT OF COLUMBIA DO NOT RESTRICT ABORTION BASED ON GESTATIONAL DURATION.
EU Leaders Urge 'Paradigm Shift' to Reverse European Decline
That has led some capitals to push for fast-tracking policy prescriptions that have been long in the gestation — like bringing European markets closer together — as well as finding a way to ...

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Abnormal Fetal lie, Malpresentation and Malposition

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Abnormal Fetal Lie

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How your twins’ fetal positions affect labor and delivery

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

Head down, head down (vertex, vertex)

Head down, bottom down (vertex, breech)

Head down, sideways (vertex, transverse)

Bottom down, bottom down (breech, breech)

Bottom down, sideways (breech, transverse)

Sideways, sideways (transverse, transverse)

32 weeks pregnant with twins

28 weeks pregnant with twins

36 weeks pregnant with twins

24 weeks pregnant with twins

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Breech presentation

Emerging Tx

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Quick Reference

buttocks or feet as the presenting part

subcostal tenderness

transabdominal/transvaginal ultrasound

<37 weeks' gestation

≥37 weeks' gestation not in labor

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Epidemiology

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Clinical exam

Ultrasound examination

small for gestational age fetus

nulliparity

fetal congenital anomalies

previous breech delivery

uterine abnormalities

female fetus

abnormal amniotic fluid volume

placental abnormalities

Transverse lie

Treatment Approach

Breech presentation from 37 weeks' gestation, before labor

Breech presentation from 37 weeks' gestation, during labor

≥37 weeks' gestation in labor: no imminent delivery

≥37 weeks' gestation in labor: imminent delivery