While I was pregnant with my fourth baby, I learned that she was in the breech position. That meant my baby was facing with her feet pointing down, instead of the normal head down position.
In official medical lingo, the head down position for a baby is called a vertex position, while babies that have their feet or body pointed down instead of their head are considered to be in a breech position.
In my case, I had to work very hard to turn my breech baby into the correct head down, vertex position she needed to be in for delivery. If you have heard your doctor talking about your baby being in a vertex position, you may have wondered what exactly that means for the rest of your pregnancy, labor, and delivery. Here's what you need to know.
What Is the Vertex Position?
The vertex position is the position your baby needs to be in for you to give birth vaginally.
Most babies get into a vertex, or head down, position near the end of your pregnancy, between 33 and 36 weeks. Even babies who are breech up until the very end of pregnancy can turn at the last minute. Typically, once a baby is head down and low enough in your pelvis, they’ll stay put.
As the American College of Obstetricians and Gynecologists (ACOG) explains, the vertex position is when a baby is positioned to come head down through a woman's vagina during birth. Although there are different, more specific positions that the baby's head can take during the actual delivery process, if your baby's head is pointing down toward your vagina, you're in good shape.
How Will I Deliver a Baby in the Vertex Position?
Even though a baby is head down at the start of delivery, as they move through the birth canal they’ll actually do quite a bit of twisting and turning to fit through. Unlike other mammals, who have straight, wide birth canals where the babies can just pretty much drop straight through, the ratio of the human head to the space in the birth canal is a very tight squeeze.
To fit through, the baby has to flex and turn their head in different positions. It's actually pretty amazing when you think about what the baby has to go through. How does the baby know what to do?
Are There Any Complications for a Baby in the Vertex Position?
Even for babies who are in a vertex position, there may be some complications that come up as your baby moves through the birth canal. For example, babies that are on the large side, despite being in the head down position, may encounter difficulty passing through the birth canal.
Babies who are over 9 pounds and 4 ounces (4,500 grams) are considered "macrosomic." That’s simply a medical term for big babies. Babies who are that big are more at risk for getting their shoulders stuck during delivery, even though they are head down. In cases of macrosomia, your doctor may monitor you more frequently. And depending on your baby's age and size, he will work out an individualized birth plan for you.
To avoid potential birth trauma, ACOG recommends that cesarean delivery be limited to estimated fetal weights of at least 5,000 grams in women without diabetes and at least 4,500 grams in women with diabetes.
What Should I Talk to My Doctor About?
As you approach your due date, be sure to ask your doctor the following questions.
Is My Baby in the Vertex Position?
Ask your doctor if they’re confident that your baby is in the vertex position.
Most care providers are able to use their hands to feel what position your baby is in. This is a technique called Leopold's maneuvers. Essentially, they use physical landmarks to feel what position the baby is in. But if they aren't able to accurately determine what position your baby is in with their hands, they can schedule an ultrasound to confirm the position.
Is There Any Risk of My Baby Turning?
Some women whose baby is in the correct vertex position may still be at risk of having a baby who turns at the last minute. Women who have extra amniotic fluid (polyhydramnois) may be at risk for having a vertex positioned baby turn breech at the last minute. Talk to your doctor about the risk of your baby turning and if there is anything you can do help your baby stay in the correct position until D-day.
What Can I Do to Have a Healthy Delivery?
No matter what position your little one happens to be in, be sure to have an honest discussion with your doctor about how to best get your baby in the position that matters the most: safely into your arms.