During pregnancy, there are several factors that can potentially lead to complications for the mother, the fetus, or both. One of these factors is the fetus’s position in the womb. The most common position – the cephalic position – is also generally considered the safest under most circumstances. Any other position is classified as “abnormal” and can potentially increase the risks for the mother and the child.
It is important to emphasize that an abnormal fetal presentation is not inherently dangerous. In many cases, the fetus will move into the cephalic position as it develops during pregnancy, and no ill effects will result. It is also very possible – and relatively common – for a fetus to go through the birth canal in an abnormal presentation without any complications. However, an abnormal presentation can be dangerous, and doctors have a duty to affirmatively address any and all potential risks when an abnormal presentation occurs.
In order to understand the potential risks associated with abnormal presentation, it is first necessary to understand when an abnormal presentation occurs. Once you understand why a presentation is abnormal, it is much easier to understand the risk factors associated with the fetus’s orientation in the womb.
As we mentioned in the introduction, fetuses typically present in the cephalic position. If all other presentations are considered abnormal, then this would be the “normal” or most-common way in which a fetus is oriented during gestation. As the Cleveland Clinic explains:
“Ideally for labor, the baby is positioned head-down, facing the mother’s back with the chin tucked to its chest and the back of the head ready to enter the pelvis. This position is called the cephalic presentation. Most babies settle into this position within the 32nd to 36th weeks of pregnancy.”
In this presentation, the fetus is ideally positioned to move through the mother’s birth canal without complications, such as an arm becoming contorted or a shoulder getting stuck behind the mother’s pelvic bone. While it is still certainly possible for complications to occur – particularly if the fetus is abnormally large or if delivery becomes prolonged – cephalic presentation is generally the safest and least-difficult way for a child to be born.
If a fetus is not in the cephalic position, then this is considered to be an abnormal presentation. The types of abnormal presentations include:
In many cases, an abnormal presentation can either be “full” or “incomplete.” A full abnormal presentation occurs as described in the list above, while an incomplete abnormal presentation involves some sort of variation, such as only one leg being extended in the case of an incomplete footling breech.
Additionally, some types of abnormal presentations are further broken down based on more minute characteristics of the fetus’s position. For example, a face presentation can be either (i) mentum anterior, in which the chin is facing forward, (ii) mentum posterior, in which the chin is facing the mother’s back, or (iii) mentum transverse, in which the chin is facing to one side.
While individual forms of abnormal presentation can carry some specific risks, there is also a long list of potential complications associated with abnormal presentation generally. These potential complications are largely linked to additional challenges the fetus faces in entering and passing through the birth canal. For example, some of the most common risks associated with abnormal presentation include:
With modern medical knowledge and technology, abnormal presentation is easy to diagnose. As a result, a doctor’s first duty is to determine when a fetus is presenting abnormally and to discuss the associated risks with the mother promptly. At this stage, the doctor should also assess the likelihood of the fetus transitioning to the cephalic position before the mother goes into labor, taking into consideration the fetus’s size, the mother’s expected due date, and other pertinent factors.
In some cases, it will be possible to manually manipulate the fetus in order to place it into the cephalic position. When this is the case, the mother’s doctor should generally take this step, unless there are countervailing considerations that warrant a different approach. If it is not possible to manually manipulate the fetus, then the doctor should make a determination as to whether some other form of intervention is required and consult with the mother as necessary.
Depending on the specific type of abnormal presentation at issue, it may be necessary for the doctor to recommend a cesarean section (C-section) delivery or to induce labor in order to mitigate the risks of a delayed or prolonged vaginal delivery. If the decision is made to move forward with vaginal delivery, then both the mother and the fetus should be carefully monitored throughout, and appropriate testing should be performed promptly following delivery in order to diagnose any injuries or complications that may require treatment.
If a doctor fails to take appropriate steps to prevent injuries or complications due to an abnormal presentation, then the doctor can be held liable for malpractice. Unfortunately, birth injuries caused by medical negligence and malpractice are not uncommon, and many new parents find themselves in a situation in which they need to take legal action. If your child presented abnormally and suffered a traumatic injury, brain injury, or other complication as a result, we strongly recommend that you consult with an attorney about your family’s legal rights.
At Berkowitz Hanna, we have decades of experience helping parents in Connecticut recover financial compensation for birth injuries caused by malpractice. To schedule a free, no-obligation consultation with one of our attorneys, call us directly or contact us online today.