When the moment of birth arrives, the baby positions itself in various ways in the uterus, with the most common and well-known being the cephalic position1. According to obstetric specialists, this is the most recommended position for vaginal birth, as well as the most common. Present in 90% of cases, the baby naturally assumes the cephalic position. Much is discussed about the ideal positions for birth and those that only favor cesarean delivery.

There are positions that can make natural birth more difficult, but they do not necessarily require a cesarean. In Brazil, cesarean births reach 40%. According to research conducted by Nascer Brasil, 28% of women decide on a cesarean birth at the beginning of pregnancy.

Who Should Decide the Ideal Position?

The decision for the best birth should be assessed by the obstetrician, taking into account the positioning and health conditions of both the mother and the baby. The healthiest approach is to wait for the onset of labor and then see if the baby’s position and other conditions require a cesarean or a vaginal delivery.

Cephalic Position is the Most Recommended for Vaginal Birth

In this position, the baby is head down, which is the healthiest for natural or vaginal delivery. It is naturally assumed by most babies, happening in up to 90% of cases. The cephalic position can be considered flexed or deflexed. Flexed is when the baby fits the top of the head perfectly into the birth canal. Deflexed is when the entire head, not just the top, is presented. Both favor vaginal birth. The only position that requires a cesarean is the second-degree deflexed position, when part or all of the face is turned toward the birth canal.

Understand the Main Positions at the Time of Birth

Pelvic position

Generally, the baby is sitting with the head up2. Some claim that this position only allows for cesarean birth, but this is not a rule. With the baby sitting, vaginal delivery becomes more difficult, but not impossible; it depends on the obstetrician’s assessment.

Transverse position

The baby lies horizontally, occupying the entire space of the uterus3. Some doctors can modify the baby’s posture and help the child move into the cephalic position as the due date approaches. When the time of birth arrives and the baby is still in the transverse position, a cesarean is required.

When Cesarean is Mandatory:

  • When the baby is positioned transversely and does not turn before delivery;
  • In cases of premature placental abruption;
  • If the umbilical cord appears in the birth canal before the baby;
  • In some cases where the mother has heart disease;
  • When the mother is HIV positive with a high viral load;
  • Cases of high blood pressure should be individually assessed by the obstetrician.

Myths About the Baby’s Position at Birth

  • Cesarean is always required for breech babies;
  • It is impossible to turn the baby;
  • Babies that are “too large” can only be delivered by cesarean.

What Makes it Hard for the Baby to Assume the Cephalic Position? (h3)

A scientific study shows that the chances of cephalic positioning occurring spontaneously after 36 weeks of pregnancy are up to 25%. Other complications can arise and make it harder for the baby to assume the cephalic position, such as: low amount of amniotic fluid, short umbilical cord, first pregnancies, and possible fetal or uterine anomalies.

IMPORTANT: When the fetus is healthy and active, and there is an adequate amount of amniotic fluid, cephalic presentation tends to occur earlier in pregnancy and is considered the best position both for vaginal birth and for the baby’s comfort within the uterus.

Other abnormal situations can also hinder the baby’s movement, such as lesions that occupy space in the uterus, like fibroids. Complications must always be evaluated, as conditions like anencephaly and hydrocephalus can make it harder for the baby to assume the cephalic position.