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Fetal Dystocia: Normal and Abnormal Fetal Positions Prior to Childbirth

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  • 0:05 Dystocia
  • 1:51 Abnormal Presentations
  • 4:17 Breech Presentations
  • 5:46 Lesson Summary
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Lesson Transcript
Instructor: Heather Adewale

Heather has taught reproductive biology and has researched neuro, repro and endocrinology. She has a PhD in Zoology/Biology.

While the majority of births proceed without too many complications, occasionally some births don't go quite as planned. Learn about some of the more common types of complications in this lesson on difficult births and fetal dystocia.

Dystocia

While the birth of a new baby is a miracle, a wondrous occasion, it is not without its difficulties. For many, the birth process, while painful, is often trouble free. However, sometimes things don't go quite as planned. About 20% of births encounter some sort of difficulty relating to fetal size or position. Here, we'll look at some of the more common types of abnormal or difficult births, also referred to as dystocia. Dystocia usually results from one of two problems:

  1. Babies who are not in the correct position for delivery
  2. Those that are larger than normal and have difficulty fitting through the mother's birth canal

If lucky, dystocia is diagnosed ahead of time through physical examination or an ultrasound. However, sometimes it's not discovered until after the mother has already gone into labor.

The normal birth position for babies
Cephalic Presentation

To understand what an abnormal position for delivery is, we should probably first talk about the normal position for delivery. In most births, the baby enters the mother's birth canal head first. This is called a cephalic presentation, and it's the safest position for a baby to be born. The most common and safest position meets the following criteria:

  • Head enters the birth canal first
  • Face is backward, towards the mother's spine
  • The arms are crossed
  • The chin and neck are bent forward, down towards the chest

This position provides the least amount of resistance as the baby travels down the birth canal.

Abnormal Presentations

Unfortunately, sometimes the baby enters the birth canal incorrectly, whether that means feet first, face up, shoulder first or any other position. In those cases, the baby is said to display abnormal fetal presentation. There are several different types of abnormal presentations, but we're only going to look at some of the more well-known positions.

First, let's look at what can happen if the baby enters the birth canal head first, but facing the wrong way. This can lead to some of the more common presentations. First, if the baby is facing forward, towards the mother's belly instead of towards her spine, then the head and neck of the baby cannot extend properly. Often times, the baby turns around on its own or with the assistance of the doctor prior to delivery.

Second, face presentation is when the face of the baby is positioned to come out first, instead of the top of the baby's head. This position can be a little more complicated and dangerous, because it can cause the baby's neck to bend the wrong way.

Shoulder dystocia is the most dangerous presentation.
Shoulder Dystocia

Third, is shoulder dystocia. This is a less common, but more dangerous form of presentation. This is when the baby's shoulder gets stuck against the pubic bone of the mother, allowing the head to enter the birth canal, but not the shoulders. This often occurs when the baby is turned sideways and can lead to breathing difficulties, because their chest is compressed against the birth canal. Most cases of shoulder dystocia occur with larger babies, and the various techniques used to assist the baby out of the birth canal can often lead to shoulder or nerve damage in the baby.

Now, what about when the baby hasn't turned? When they are not facing head down? This type of problem can lead to a breech, or transverse presentation. When the baby appears to be lying down horizontally, across the mother's uterus, it is said to be in a transverse position. If the baby cannot be rotated, or if its shoulder is lodged in the birth canal, similar to shoulder dystocia, then vaginal delivery is not recommended, and the baby may have to be delivered surgically.

Breech Presentations

Other presentations that often result in surgical delivery are breech presentations. A breech presentation is when the baby's buttocks enter the birth canal before the head. If the baby's arms and legs are still crossed, in what is called a complete breech position, it may look possible to deliver the baby this way. However, babies in all types of breech positions are likely to encounter some serious problems.

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