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Malpresentation

10-minute read

If your waters break and you have been told that your baby is not in a head-first position, seek medical help immediately.

Key facts

  • Malpresentation is when your baby is not in a head-first position towards the birth canal as birth approaches.
  • The most common type of malpresentation is breech — when your baby’s bottom or feet are facing towards the birth canal.
  • A procedure called external cephalic version can be used to try and turn a breech baby into a head-first position after 36 weeks of pregnancy.
  • Most babies with malpresentation are born by caesarean, but some doctors or midwives may be able to help you birth a breech baby vaginally.
  • There is a serious risk of cord prolapse if your waters break and your baby is not in a head-first position.

What is presentation and malpresentation?

‘Presentation’ describes how your baby is facing down the birth canal. The ‘presenting part’ is the part of your baby’s body that is against the cervix.

The ideal presentation is head-first, where the crown (top) of the baby’s head is against the cervix, and the chin tucked is into the baby’s chest. This is called ‘vertex presentation’.

If your baby is in any other position, it’s called ‘malpresentation’. Malpresentation can mean your baby’s face, brow, buttocks, foot, back, shoulder, arms or legs or the umbilical cord are against the cervix.

It’s safest for your baby’s head to come out first. If any other body part enters the birth canal first, there is a higher risk of complications for both you and your baby. Malpresentation increases the chance that you will have a more complex vaginal birth or need a caesarean.

If my baby is not head-first, what position could they be in?

Malpresentation is caused by your baby’s position (‘lie’). There are different types of malpresentation.

Breech presentation

This is when your baby is lying with their bottom or feet facing down. Sometimes, one foot may enter the birth canal first (called a ‘footling presentation’).

Breech presentation is the most common type of malpresentation.

Face presentation

This is when your baby is head-first, but stretching their neck, so their face is pressed against the cervix.

Transverse lie

This is when your baby is lying sideways. Their back, shoulders, arms or legs may be first to enter the birth canal.

Oblique lie

This is when your baby is lying diagonally. No particular part of their body is against the cervix.

Unstable lie

This is when your baby continually changes their position after 36 weeks of pregnancy.

Cord presentation

This is when the umbilical cord is against the cervix, between your baby and the birth canal. It can happen in any situation where your baby’s presenting part is not sitting snugly in your pelvis. It can become a medical emergency if it leads to cord prolapse (when the cord comes down the birth canal before your baby, potentially reducing blood flow to your baby).

Illustration of Malpresentation.
Illustration of ideal presentation and two types of malpresentation.

What is malposition?

‘Position’ refers to which direction your baby is facing.

If your baby is head-first, the best position for labour is with their face is towards your back.

If your baby is head-first, but facing the front of your body (posterior position) or facing your side (transverse or lateral position) this is called malposition. It means your labour may take longer and you might feel more pain in your back. Babies who are malpositioned may move into a better position before or during labour.

What causes malpresentation?

Often, no cause is found, but malpresentation is more likely:

  • a low-lying placenta
  • too much or too little amniotic fluid
  • an abnormally shaped uterus or problems with the uterus, such as large fibroids
  • many previous pregnancies, making the muscles of the uterus less stable
  • carrying twins or more

Often, no cause is found.

What is the chance I will have a malpresentation?

Many babies maintain a breech position during pregnancy. They usually turn head-first as pregnancy progresses. More than 9 in 10 babies in Australia are in a head-first position at birth.

You are more likely to have a malpresentation if:

  • this is your first baby
  • you've had a breech presentation in a past pregnancy
  • you go into labour prematurely

How is malpresentation diagnosed?

Your doctor or midwife can diagnose malpresentation by examining your abdomen and feeling the baby’s position. If they aren’t sure, it can be confirmed with an ultrasound.

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Can my baby’s position be changed?

If your baby is still in a breech position when you are 36 weeks pregnant, it’s less likely that they will turn head-first on their own. Your obstetrician may recommend a procedure called an called external cephalic version (ECV) to try and gently turn your baby to a head-first position.

Some people try different postures, acupuncture or moxibustion to correct malpresentation, but there is limited evidence that this work. Although if moxibustion is done before 37 weeks of pregnancy there is some evidence to suggest that this may reduce the chance of your baby being breech at birth. It’s a good idea to talk to your maternity care provider before trying alternative therapies to understand what is right for you.

Will I need a caesarean if my baby has a malpresentation?

Most babies with a malpresentation close to birth are born by caesarean. If your baby is breech, you may be able to have a vaginal birth, but it’s important that you are cared for in a hospital that can offer you and your baby specialised care. Ask your doctor or midwife for advice.

If your baby is breech, an elective (planned) caesarean is safer for your baby than a vaginal birth in the short term. However, in the longer term their health will be similar, on average, regardless of how they were born.

A vaginal birth is safer for you than an elective caesarean. However, about 4 in 10 people planning a vaginal breech birth end up needing an emergency caesarean. If this happens to you, the risk of complications will be higher than an elective caesarean.

Your doctor can talk to you about your options. Whether it’s safe for you to try a vaginal birth will depend on many factors, such as:

  • your baby’s size
  • the position of your baby
  • whether you’ve had a caesarean in the past
  • the expertise of your doctor and the services available at your hospital

What are the risks if I have my baby when it’s not head-first?

This will vary based on your individual circumstance. Talk to your maternity care provider about what your baby’s position means for your pregnancy, labour and birth. This will help you make informed decision that are right for you.

If your waters break when your baby is not head-first, there is a risk of cord prolapse. This is a medical emergency.

If you feel your waters break and you have been told that your baby is not in a head-first position, seek medical help immediately.

Vaginal breech birth

Risks to your baby can include:

Caesarean

Risks to you include:

  • excessive blood loss
  • blood clots
  • infection in the wound
  • problems with the anaesthetic
  • damage to other organs nearby, such as your bladder
  • a higher chance of complications in future pregnancies
  • a longer recovery time than after a vaginal birth

Risks to your baby include:

  • trouble with breathing — this is temporary
  • getting a small cut during the surgery by accident

Will I have a malpresentation in my future pregnancies?

If you had a malpresentation in one pregnancy, you have a higher chance of it happening again. If you’re worried, it may help to talk to your doctor or midwife.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: May 2024


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Need more information?

Breech pregnancy

When a baby is positioned bottom-down late in pregnancy, this is called the breech position. Find out about 3 main types and safe birthing options.

Read more on Pregnancy, Birth & Baby website

Breech Presentation at the End of your Pregnancy

Breech presentation occurs when your baby is lying bottom first or feet first in the uterus (womb) rather than the usual head first position. In early pregnancy, a breech position is very common.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

Read more on WA Health website

External Cephalic Version for Breech Presentation - Pregnancy and the first five years

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

Read more on NSW Health website

Presentation and position of baby through pregnancy and at birth

Presentation and position refer to where your baby’s head and body is in relation to your birth canal. Learn why it’s important for labour and birth.

Read more on Pregnancy, Birth & Baby website

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

Read more on Pregnancy, Birth & Baby website

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