Medically Reviewed by: Dr. Veena Shinde (M.D, D.G.O, PG – Assisted Reproductive Technology (ART) from Warick, UK) Mumbai, India
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Author:
Khushboo Kirale
- >> Post Created: February 11, 2022
- >> Last Updated: May 2, 2024
Vertex Position - Table of Contents
As you approach the due date for your baby’s delivery, the excitement and apprehensions are at their peak! What probably adds to the anxieties are the medical terms describing the baby, its ‘position’ and ‘presentation.’ Let’s strike that out from the list now!
In simple words, ‘position’ of the baby is always in reference to the mother; on what side of the mother’s pelvis does the baby lean more (left or right) and if the baby is facing the mother’s spine or belly (anterior or posterior) – for eg.: Left Occiput Anterior, Right Occiput Anterior, Right Occiput Posterior and so on.
On the other hand, ‘presentation’ is the body part of baby (head, shoulder, feet, and buttocks) that will enter the mother’s pelvic region first at the beginning of labor.
As ‘presentation’ depends on the ‘position’ of the baby, the terms cannot be used interchangeably, which is often mistakenly done. If you are told by your doctor that your baby is in a head-down position, which means its head will enter the pelvic region first, then it means the baby is in ‘vertex’ presentation or even sometimes loosely referred to as vertex position of baby though its conceptually incorrect however it means the same.
With this article, we aim to explain how exactly vertex presentation affects your labor and delivery.
Understanding Vertex Presentation
If your baby is in the head-down position by the third trimester, then you are one of the 95% mothers who have a vertex baby or a vertex delivery. When the baby enters the birth canal head first, then the top part of the head is called the ‘vertex.’
In exact medical terms, we give you the definition of vertex presentation by the American College of Obstetrics and Gynecologists (ACOG)– “a fetal presentation where the head is presenting first in the pelvic inlet.”
Besides vertex presentation (also sometimes referred to as vertex position of baby or vertex fetal position also), the other occasional presentations (non-vertex presentations) include –
- Breech – baby’s feet or buttocks are down and first to enter the mother’s pelvic region. Head is near the mother’s ribs
- Transverse – baby’s shoulder, arm or even the trunk are the first to enter the pelvis, as the baby is laying on the side and not in a vertical position
It is common that babies turn to a particular position (hence, affecting the presentation) by 34 -36 weeks of pregnancy. Nevertheless, some babies have ‘unstable lies’; – wherein the baby keeps changing positions towards the end of the pregnancy and not remaining in any one position for long.
Should you be worried if the baby is in vertex presentation?
Absolutely not! The vertex presentation is not only the most common, but also the best for a smooth delivery. In fact, the chances of a vaginal delivery are better if you have a vertex fetal position.
By 36 weeks into pregnancy, about 95% of the babies position themselves to have the vertex presentation. However, if your baby hasn’t come into the vertex fetal position by this time, then you can talk to your doctor about the options.
You may be suggested a cephalic version procedure also known as the version procedure /external cephalic version (ECV procedure) – which is used to turn the baby/ fetus from a malpresentation – like breech, oblique or transverse (which occur just about 3-4% times) to the cephalic position (head down).
This is how your doctor will try to turn your baby manually by pushing on your belly to get the baby into the vertex presentation. But it is necessary for you to know that this procedure does involve some risk and is successful only 60-70% of the time.
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Risks of Vertex position of baby: Can there be any complications for the baby in the vertex presentation?
As discussed above, the vertex fetal position/presentation is the best for labor and delivery, but there can be some complications as the baby makes its way through the birth canal. One such complication can arise if the baby is on the larger side. The baby can face difficulty while passing through the birth canal even if it is in the head-down position because of the size.
Babies who weigh over 9 to 10 pounds are called ‘macrosomic’ or even referred to as fetal macrosomia, and they are at a higher risk of getting their shoulders stuck in the birth canal during delivery, despite being in the head-down position.
In such cases, to avoid birth trauma for the baby, the American College of Obstetricians and Gynecologists (ACOG) suggests that cesarean deliveries should be limited to estimated fetal weights of at least 11 pounds in women without diabetes and about 9 pounds in women with diabetes.
In case of fetal macrosomia, your doctor will monitor your pregnancy more often and work out a particular birth plan for you subject to your age (mothers age) and size of your baby.
How will I deliver a baby in the vertex fetal position?
Even unborn human babies can astonish you if you observe the way they make their way through the birth canal during delivery.
A vertex baby may be in the optimal position (head-down first in pelvis) for labor and delivery, but it does its own twisting and turning while passing through the birth canal to fit through. In humans, unlike other mammals, the ratio of the baby’s head to the space in the birth canal is quite limited.
The baby has to flex and turn its head in different positions to fit through and ultimately arrive in this world. And it does so successfully! It is a wonder how they know how to do this so naturally.
And to answer the question ‘how will I deliver a baby in the vertex position?’ – Simply NATURALLY i.e. vaginal delivery. Don’t worry, follow your doctor’s instructions, do your breathing and PUSH.
FAQs to keep ready: How can my doctor help me prepare as I approach my due date?
As your due date nears, apart from bodily discomfort, you may experience nervousness about the big day. Your doctor can help by clearing your doubts and putting you at ease. You can ask them the following questions to understand the process better.
Q1) How will I know if my baby is in vertex fetal position?
A doctor can confidently tell you whether or not your baby is in the vertex presentation. Many medical professionals will be able to determine your baby’s position merely by using their hands; this is called ‘Leopold’s maneuvers.’
However, in case they aren’t very confident about the baby’s position even after this, then an ultrasound can confirm the exact position of the baby.
You can also understand this through belly mapping. You are sure to feel the kicks towards the top of your stomach and head (distinct hard circular feel) towards your pelvis.
Q2)Is there any risk of my vertex baby turning and changing positions?
Yes, in case of some women, the baby who has a vertex presentation may turn at the last moment.
What may cause this? Women who have extra amniotic fluid (polyhydramnios) have increased chances of a vertex baby turning into a breech baby at the last minute.
Discuss this with your doctor to understand what are the chances this might happen to you and what all you can do to keep the baby in the vertex presentation for delivery.
Q3) Is there need to be worried if my baby has a breech presentation?
Not really! There are loads of exercises which you which can help you get your baby in the right position.
Then there are the ECV (external cephalic version) procedure which can help in changing the position of your baby into the desired vertex position. Speak with your doctor.
Having a baby in breech position just before labor will require you to have a C-section. Let your doctor guide you. But there is nothing to worry about.
Q4) What may cause babies to come into breech position?
A few circumstances may cause the baby to come into breech position even after 36 weeks into pregnancy.
- If you are carrying twins or multiple babies, in which case there is limited space for each baby to move around.
- Low levels of amniotic fluid which restricts the free movement of the baby or even high levels of amniotic fluid that does not permit the baby to remain in any one position.
- If there are abnormalities in the uterus or other conditions like low-lying placenta or large fibroids in the lower part of the uterus.
Chances of breech babies are higher in births that are pre-term as the baby does not get enough time to flip into a head-down position – cephalic position – vertex presentation (vertex position of baby/ vertex fetal position).
Q5) Can a baby turn from breech position to vertex presentation?
Yes, a baby can turn from a breech position to vertex position/ vertex fetal position over time with exercises and sometimes through ECV.
If an ultrasound has confirmed you have a breech baby, then you can do the following to turn it to a vertex baby. Try the following –
- Do not underestimate the wonders of daily walks of about 45-60 mins when it comes to bringing your baby in vertex presentation from breech presentation.
- Talk to your doctor about certain exercises that can help turn your baby in the head-down position. Exercises like ‘high bridge’ or ‘cat and camel’ can help here. We recommend you to learn and try this only in the presence of a professional.
- External Cephalic Version (ECV) is a way to manually maneuver the baby to vertex presentation. It is done with the help of an ultrasound and generally after 36 weeks into pregnancy. However, it has the success rate of just 50%. Discuss the risks, if any, with your gynecologist before opting for this procedure.
There are a couple of other unscientific methods that may not be safe to try –
- Light: Placing a torch near your vagina may guide the baby toward the light, and hence, get it in the vertex presentation.
- Music: Playing music near your belly’s bottom may urge the baby to move itself in the head-down position.
Q6) What all can I do to ensure I have a healthy delivery?
A healthy delivery requires the mother to be active, eating well, and staying happy. For any apprehensions regarding labor and delivery, do not hesitate to talk to your doctor and clarify your doubts.
Your doctor can help you understand your baby’s position and presentation, and then based on that they can plan your delivery to ensure your baby’s birth will happen in the safest possible way.
Try and maintain a healthy lifestyle which will also help in overall of your child and placenta health.
Key Takeaway
Yes, vertex presentation or vertex position of baby and vertex delivery are very common, normal, safe, and the best for labor and delivery of the baby. There is probability of complications sometimes, but that is only subject to certain conditions that we discussed above.
However, understand that any other baby position is also safe. The only thing with other positions and presentations is that the chances of a cesarean delivery goes up. Nevertheless, know what matters at the end of it all is a happy and healthy baby in your arms!
Happy pregnancy!
Khushboo Kirale
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