Birth Presentations and Delivery

The world of pregnancy and labor has many unique terms, expressions – and decisions. From "Lamaze" and "epidural" to "dilation" and "episiotomy," the terms used by doctors, midwives and nurses can often get confusing. "Presentation" is one word doctors often use when speaking of an impending delivery. This term is important to the actual delivery process. Put simply, "presentation" is the position of the baby's body when progressing down the birth canal and entering the world or, in other words, how a baby presents itself during her entrance into the world.

"We refer to any presentation other than the normal as being 'fetal malpresentations,'" says Dr. David Michael, a specialist in obstetrics and gynecology at Mt. Sinai Hospital in Chicago. "The incidence of these malpresentations is only 5 percent of all births. Any deviation from the normal, big or small, is considered a malpresentation."

There are three components that indicate whether a baby is in a normal position or malpresentation. They include the fetal lie, which is the axis of the baby relative to that of the mother's; the presentation, which indicates what body part is closest to the pelvic outlet; and the flexion attitude, which refers to how the head of the baby is flexed. Each of these components has variations that indicate whether the baby is in a normal presentation position or is going to come through the birth canal in an unusual way.

As a mother lies on her back during delivery, her spine is vertical – or straight up and down. In relation malpresentation, the fetal lie indicates the position of the baby's spine in relation to the mother's at the time of delivery. The "normal" spinal position is called "cephalic," meaning it is in the same direction and angle as the mother's spine. When the baby is positioned at an angle so that the spine is off-center from the mother's, the baby is said to have an "oblique lie," meaning it is at an angle away from the mother's spine. If the baby is lying in a position in which the mother's and the baby's spines make a cross or a "T" shape, the baby is in a "transverse lie."

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