Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation
Occiput Posterior (OP)
In occiput posterior position, your baby's head is down, but it is facing the mother's front instead of her back.
It is safe to deliver a baby facing this way. But it is harder for the baby to get through the pelvis. If a baby is in this position, sometimes it will rotate around during labor so that the head stays down and the body faces the mother's back (OA position).
The mother can walk, rock, and try different delivery positions during labor to help encourage the baby to turn. If the baby does not turn, labor can take longer. Sometimes, the provider may use forceps or a vacuum device to help get the baby out. If the baby stays in the OP position during labor, you have a higher risk of needing to deliver your baby by cesarean delivery (C-section).
A baby in the transverse position is sideways. Often, the shoulders or back are over the mother's cervix. This is also called the shoulder, or oblique, position.
The risk for having a baby in the transverse position increases if you:
- Go into labor early
- Have given birth 3 or more times
- Have placenta previa
Unless your baby can be turned into head-down position, a vaginal birth will be too risky for you and your baby. A doctor will deliver your baby by cesarean birth (C-section).
Less Common Presentations
With the brow-first position, the baby's head extends backward (like looking up), and the forehead leads the way. This position may be more common if this is not your first pregnancy.
- Your provider rarely detects this position before labor. An ultrasound may be able to confirm a brow presentation.
- More likely, your provider will detect this position while you are in labor during an internal exam.
With face-first position, the baby's head is extended backwards even more than with brow first position.
- Most of the time, the force of contractions causes the baby to be in face-first position.
- It is also detected when labor does not progress.
In some of these presentations, a vaginal birth is possible, but labor will generally take longer. After delivery, the baby's face or brow will be swollen and may appear bruised. These changes will go away over the next few days.
Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.
Thorp JM, Grantz KL. Clinical aspects of normal and abnormal labor. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 43.
Vora S, Dobiesz VA. Emergency childbirth. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 56.
Last reviewed on: 10/5/2020
Reviewed by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.