face presentation at birth

Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

What makes labor easier for a face-first baby and you?

Balance the body and the baby will thank you by curling into position to aim, not their face, but the crown of their head.

Flexion is physiological. So support physiology and the baby will change their position. We may need a little physics.

In Labor with a Face or Brow Presentation

Back baby up!

Forward-leaning Inversion with a jiggle of the buttocks right through 1-2 contractions often backs baby up so they can tuck their chin. Then they can aim into the pelvis with an easier position.

Shake the Apples in Forward-leaning Inversion with hands

A little effort can make labor a lot easier!

Only after baby’s crown is first, then do Side-lying Release in labor.

Before Labor with a face or brow presentation

Face presentation may reflect a psoas/pelvic floor imbalance with a collapse in the front body.

Free the piriformis, strengthen the buttocks, lengthen the hamstrings, squat for lengthening the pelvic floor, don’t worry about strengthening the pelvic floor right now. Alignment, walking, stabilizing and lengthening will tone the pelvic floor. Use it by breathing with your whole body.

Before labor, it’s safe to do Side-lying Release when baby’s face-first head isn’t in the pelvis yet.

Free the way

The psoas is the upper guide, the pelvic floor is the lower guide. release spasms and lengthen both.

Make room for the baby by releasing muscles that spasm, lengthen ligaments that are shortened, and support the abdominal muscles by attending to the muscles that interact with them, don’t go directly to the front first.

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Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Illustration of the head-down, face-up position

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Illustration of the frank breech position

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

Illustration of a complete breech presentation

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

Down, with the back facing the birth canal.
Sideways, with one shoulder pointing toward the birth canal.
Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

An attempt to deliver the baby in the breech position is not successful.
You do not want to try to have the baby delivered vaginally in the breech position.
An attempt to move the baby into a head-down position is not successful.
You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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Medical Information

Delivery, Face Presentation, and Brow Presentation: Understanding Fetal Positions and Birth Scenarios

Introduction:.

During childbirth, the position of the baby plays a significant role in the delivery process. While the most common fetal presentation is the head-down position (vertex presentation), variations can occur, such as face presentation and brow presentation. This comprehensive article aims to provide a thorough understanding of delivery, face presentation, and brow presentation, including their definitions, causes, complications, and management approaches.

Delivery Process:

Normal Vertex Presentation: In a typical delivery, the baby is positioned head-down, with the back of the head (occiput) leading the way through the birth canal.
Engagement and Descent: Prior to delivery, the baby's head engages in the pelvis and gradually descends, preparing for birth.
Cardinal Movements: The baby undergoes a series of cardinal movements, including flexion, internal rotation, extension, external rotation, and restitution, which facilitate the passage through the birth canal.

Face Presentation:

Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head).
Causes: Face presentation can occur due to factors such as abnormal fetal positioning, multiple pregnancies, uterine abnormalities, or maternal pelvic anatomy.
Complications: Face presentation is associated with an increased risk of prolonged labor, difficulties in delivery, increased fetal malposition, birth injuries, and the need for instrumental delivery.
Management: The management of face presentation depends on several factors, including the progression of labor, the size of the baby, and the expertise of the healthcare provider. Options may include closely monitoring the progress of labor, attempting a vaginal delivery with careful maneuvers, or considering a cesarean section if complications arise.

Brow Presentation:

Definition: Brow presentation occurs when the baby's head is partially extended, causing the brow (forehead) to lead the way through the birth canal.
Causes: Brow presentation may result from abnormal fetal positioning, poor engagement of the fetal head, or other factors that prevent full flexion or extension.
Complications: Brow presentation is associated with a higher risk of prolonged labor, difficulty in descent, increased chances of fetal head entrapment, birth injuries, and the potential need for instrumental delivery or cesarean section.
Management: The management of brow presentation depends on various factors, such as cervical dilation, progress of labor, fetal size, and the presence of complications. Close monitoring, expert assessment, and a multidisciplinary approach may be necessary to determine the safest delivery method, which can include vaginal delivery with careful maneuvers, instrumental assistance, or cesarean section if warranted.

Delivery Techniques and Intervention:

Obstetric Maneuvers: In certain situations, skilled healthcare providers may use obstetric maneuvers, such as manual rotation or the use of forceps or vacuum extraction, to facilitate delivery, reposition the baby, or prevent complications.
Cesarean Section: In cases where vaginal delivery is not possible or poses risks to the mother or baby, a cesarean section may be performed to ensure a safe delivery.

Conclusion:

Delivery, face presentation, and brow presentation are important aspects of childbirth that require careful management and consideration. Understanding the definitions, causes, complications, and appropriate management approaches associated with these fetal positions can help healthcare providers ensure safe and successful deliveries. Individualized care, close monitoring, and multidisciplinary collaboration are crucial in optimizing maternal and fetal outcomes during these unique delivery scenarios.

Hashtags: #Delivery #FacePresentation #BrowPresentation #Childbirth #ObstetricDelivery

On the Article

Krish Tangella MD, MBA

Alexander Enabnit

Alexandra Warren

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What is brow presentation?

the size or shape of your pelvis
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Diagnosis and management of face presentation

PMID: 7005774

Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different from those of simple vertex presentation, there is no consistent alteration in the duration of labor in the absence of underlying CPD. When disproportion does not exist and gross anomalies are not present, the prognosis for spontaneous vaginal delivery is excellent. The majority of perinatal losses reported in face presentation have resulted from traumatic operative vaginal deliveries, specifically version and extraction and midforceps rotations. Recent experience at this institution with a limited series of face presentations demonstrates that, with careful intrapartum surveillance, delivery can be accomplished with no increase in risk to either mother or fetus.

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Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

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What to know if your baby is breech

What's a sunny-side up baby?

What happens to your baby right after birth

A newborn baby wrapped in a receiving blanket in the hospital.

How your twins’ fetal positions affect labor and delivery

illustration of twin babies head down in utero

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70. https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

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Management of Brow, Face, and Compound Malpresentations

Author: Meera Kesavan, MD

Mentor: Lisa Keder MD Editor: Daniel JS Martingano DO MBA PhD

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Fetal malpresentation, including brow, face, or compound presentations, complicates around 3-4% of all term births. Because these abnormal fetal presentations still are cephalic, many such cases result in vaginal deliveries, yet there are increased risks for adverse outcomes, including cesarean delivery resultant surgical complications, persistent malpresentation precluding vaginal delivery, and abnormal labor resulting in arrest of dilation or descent.

These fetal malpresentation are differentiated in the following ways:

In face presentations, the presenting part is the mentum, which is further divided based on its position, including mentum posterior, mentum transverse or mentum anterior positions. This typically occurs because of hyperextension of the neck and the occiput touching the fetal back. Mentum anterior malpresentations can potentially achieve vaginal deliveries, whereas mentum posterior malpresentations cannot.
In brow presentations, there is less extension of the fetal neck as in face presentations making the leading fetal part being the area between the anterior fontanelle and the orbital ridges. These presentations are uncommon and are managed similarly to face presentations. Brow presentation can be further described based on the position of the anterior fontanelle as frontal anterior, posterior, or transverse.
Compound presentation is defined as the leading fetal part, including a fetal extremity, alongside a cephalic or breech presentation. Management of compound presentations is expected (and often incidentally noted following delivery) because the extremity will often either retract as the head descends or will feasibly allow for delivery in its current position, with manipulation attempts to reduce the compound presentation usually avoided.

Risk factors for brow and face presentations include fetal CNS malformations, congenital or chromosomal anomalies, advanced maternal age, low birthweight, abnormal maternal pelvic anatomy (e.g. contracted pelvis, cephalopelvic disporotion, platypelloid pelvis, etc.) and nulliparity. non-Hispanic White women have the highest risk for malpresentation, whereas non-Hispanic Black women have the lowest risk.

Diagnosis usually is made during the second stage of labor while performing routine vaingla examinations and involves palpation of the abnormal leading fetal part (forehead, orbital ridge, orbits, nose, etc.) Obstetric ultrasound can additionally provide complimentary information to support these diagnoses and distinguish from other fetal malpresentations or malpositions. In face presentation, the mentum (chin) and mouth are palpable.

Management considerations for face, brow, and compounds presentations are unique with compound presentations having higher rates of vaginal delivery and lower complications as compared to either brow or face presentations.

For brow presentations, approximately 30-40% of brow presentations will convert to a face presentation, and about 20% will convert to a vertex presentation. Anterior positions have the possibility of vaginal deliveries and can be managed by usual labor management principles, whereas mentum posterior positions are indications for cesarean delivery.
For face presentations, the likelihood of vaginal delivery depends on the orientation of the mentum, with mentum anterior being most suitable for vaginal delivery. If the fetus is mentum posterior, flexion of the neck is precluded and results in the inability of fetal descent.
For compound presentations, management is expectant and manipulation of the leading extremities should be avoided. Most cases of compound presentation result in vaginal deliveries. For term deliveries, compound presentations with parts other than the hand are unlikely to result in safe vaginal delivery.

Labor management for brow and face presentation overall involves continuous fetal heart rate monitoring and repeat clinical assessments, given the increased potential of fetal complications as noted. Caution should be used with internal monitoring devices, which can cause ophthalmic injury or trauma to the presenting fetal parts, with the use of fetal scalp electrodes discouraged and intrauterine pressure catheters acceptable with appropriate clinical judgment and feasibility.

Midforceps, breech extraction, and manual manipulation are not recommended and increase the risk of maternal and neonatal morbidity.

Neonatal outcomes for both face and brow presentations include facial edema, bruising, and soft tissue trauma. Complications of compound presentation specifically include umbilical cord prolapse and injury to the presenting limb. With appropriate management, neonatal and maternal morbidity for face, brow, and compound presentations are low.

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Face Presentation

First Online: 02 August 2023

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Shubhra Agarwal 2 &
Suchitra Pandit 3

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Face presentation is defined as a cephalic presentation in which the presenting part is face and it occurs due to factors that lead to extension of of fetal head. It is a rare obstetric presentation and may not be encountered even in the entire carrier of an obstetrician.

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Shaffer BL. Face presentation: predictors and delivery route. Am J Obstet Gynecol. 2006;194:e10–2.

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Schwartz Z, Dgani R, Lancet M, Kessler I. Face presentation. Aust N Z J Obstet Gynaecol. 1986;26:172–6.

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Westgren M, et al. Face presentation in modern obstetrics-a study with special reference to fetal long term morbidity. Z Geburtshilfe Perinatol. 1984;188(2):87–9.

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Agarwal, S., Pandit, S. (2023). Face Presentation. In: Garg, R. (eds) Labour and Delivery. Springer, Singapore. https://doi.org/10.1007/978-981-19-6145-8_6

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What to know about baby’s position at birth

Having a baby is an exciting time, but it’s common to have some worries about labor and delivery. One thing that often causes mums-to-be concern is what position their baby will be in when the time comes for them to be born.

For a vaginal delivery, the baby must descend through the birth canal, passing through your pelvis to reach the vaginal opening. The position of the baby - or presentation of the fetus as it is also known - affects how quickly and easily the baby can be born. Some positions allow the baby to tuck their chin, and re-position and rotate their head to make their journey easier.

Here’s a guide to help you understand the language used to describe the position of babies and some tips for helping them into the ideal position for birth.

Position of the baby before birth

During pregnancy your baby has room to move about in your uterus or womb - twisting, turning, rolling, stretching and getting in some kicks. As your pregnancy progresses and they grow bigger there’s less room for them to move, but your baby should still move regularly until they are born, even during labor.

Sometime between 32 and 38 weeks of pregnancy, but usually around week 36, babies tend to move into a head down position. This allows their head to come out of your vagina first when they are born. Only about 3 to 4 percent of babies do not move into a head-first or cephalic presentation before birth.

What’s the ideal position of a baby for birth?

Occiput anterior is the ideal presentation for your baby to be in for a vaginal delivery.

Occiput anterior is a type of head-first or cephalic presentation for delivery of a baby. About 95 to 97 percent of babies position themselves in a cephalic presentation for delivery, often with the crown or top of their head - which is also known as the vertex - entering the birth canal first.

Usually when a baby is being born in a vertex presentation the back of the baby’s head, which is called the occiput, is towards the front or anterior of your pelvis and their back is towards your belly. Their chin is also typically in a flexed position, tucked into their chest.

Occiput anterior is the best and safest position for a baby to be born by a vaginal birth. It allows the smallest diameter of a baby’s head to descend into the birth canal first, making it easier for the baby to fit through your pelvis.

What other positions are babies born in?

Sometimes babies don’t position themselves in the ideal position for birth. These other positions are called abnormal positions. Listed below are the abnormal positions or presentations that some babies are born in.

Occiput posterior or back-to-back presentation

Occiput posterior position or back-to-back presentation occurs when the occiput - back of a baby’s head - is positioned towards your tailbone or back during delivery. Sometimes this presentation is also called “sunny side up” because babies born in this position enter the world facing up. About 5 percent of babies are delivered in the occiput posterior position.

Babies presenting in the occiput posterior position find it harder to make their way through the birth canal, which can lead to a longer labor. This presentation is three times more likely to end in a cesarean section (c-section) compared with babies presenting in the ideal, occiput anterior presentation.

Breech presentation

A breech presentation occurs when your baby’s buttock, feet or both are set to come out first at birth. About 3 to 4 percent of full-term babies are born in a breech position.

There are three types of breech presentation including:

Frank breech. Frank breech is the most common breech presentation, occurring in 50 to 70 percent of breech births. Babies in the Frank breech position have their hips flexed and their knees extended so that their legs are folded flat against their head. Their bottom is closest to the birth canal.
Footling or incomplete breech. Footling or incomplete breeches occur in 10 to 30 percent of breech births. An incomplete breech presentation is where just one of the baby’s knees is bent up. Their other foot and bottom are closest to the birth canal. In a footling breech presentation, one or both feet may be delivered first.
Complete breech. A complete breech presentation is less common, occurring in 5 to 10 percent of breech births. Babies in a complete breech position have both knees bent and their feet and bottom are closest to the birth canal.

A breech delivery can result in the baby’s head or shoulders becoming stuck because opening to the uterus (cervix) may not be stretched enough by the baby’s body to allow the head and shoulders to pass through. Umbilical cord prolapse can also occur. This is when the cord slips into the vagina before the baby is delivered. If the cord is pinched then the flow of blood and oxygen to the baby can be reduced.

If an exam reveals your baby is sitting in a breech position and you’re past 36 weeks of pregnancy then external cephalic version (ECV) might be attempted to improve your chances of having a vaginal birth. ECV is performed by a qualified healthcare professional and it involves them pressing their hands on the outside of your belly to try and turn the baby.

Most babies found to be in a breech position are delivered by c-section because studies indicate that a vaginal delivery is about three times more likely to cause serious harm to the baby.

Brow and face presentations

Babies can also arrive brow- or face-first. A brow presentation results in the widest part of your baby’s head trying to fit through your pelvis first. This is a rare presentation, affecting about 1 in every 500 to 1400 births.

Instead of flexing and tucking their chin, babies presenting brow-first slightly extend their head and neck in the same way they would if they were looking up.

If your baby stays in a brow presentation it’s highly unlikely that they will be able to make their way through your pelvis. If your cervix is fully dilated then your doctor may be able to use their hand or ventouse - a vacuum cup - to move your baby’s head into a flexed position. If there are signs that your baby is becoming distressed or labor isn’t progressing then a c-section may be recommended.

More than half of the babies presenting brow-first, however, flex their head during early labor and move into a better position that allows labor to progress. Although, some babies tip their head back further and present face-first.

A face presentation is another rare position for a baby to be born in, occurring in only 1 in every 600 to 800 births.

Almost three quarters of babies presenting face-first can be delivered vaginally, especially if the baby’s chin is near your pubic bone, although labor may be prolonged.

Some baby’s presenting face-first may need to be delivered by c-section, particularly if their chin is near your tailbone, your labor is not progressing or your baby’s heart rate is causing concern.

Shoulder presentation

If your baby is lying sideways across your uterus - in a transverse lie - their shoulder can present first. Shoulder presentation occurs in less than 1 percent of deliveries. Virtually all babies in a shoulder presentation will need to be delivered by c-section. If labor begins while the baby is in this position then the shoulder will become stuck in the pelvis and the labor will not progress.

What factors can influence the position of my baby?

A number of factors can influence the position of your baby during labor and delivery, including:

If you have been pregnant before
The size and shape of your pelvis
Having an abnormally shaped uterus
Having growths in your uterus, such as fibroids
Having placenta previa - the placenta covers some or all of the cervix
A premature birth
Having twins or multiple babies
Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid
Abnormalities that prevent the baby tucking their chin to their chest

How do I tell what position my baby is in?

Your midwife or your obstetrician-gynecologist (OB-GYN) should be able to tell you the position of your baby by feeling your belly, using an ultrasound scan or conducting a pelvic exam.

You might also be able to tell the position of the baby from their movements.

If your baby is in a back-to-back position your belly may feel more squishy and their kicks are likely to be felt or seen around the middle of your belly. You may also notice that instead of your belly poking out there is a dip around your belly button.

If your baby is in the ideal occiput anterior presentation you’re likely to feel the firm, rounded surface of your baby’s back on one side of your belly and feel kicks up under your ribs.

How do I get my baby into the best position for birth?

Here are some tips to try to encourage your baby to engage in the ideal position for birth:

Remain upright, but lean forward to create more space in your pelvis for your baby to turn.
Sit with your back as straight as possible and your knees lower than your hips. Placing a cushion under your bottom and one behind your back may make this position more comfortable. Avoid sitting with your knees higher than your pelvis.
When you read a book, sit on a dining room chair and rest your elbows on the table. Lean forward slightly with your knees apart. Avoid crossing your knees.
If pelvic girdle pain is not an issue, try sitting facing backwards with your arms resting on the back of a chair.
Watch TV kneeling on the floor leaning over a big bean bag.
Go for a swim.
Sit on a birth ball or swiss ball - they can be used both before and during labor.
Lie down on your side rather than your back. Place a pillow between your knees for comfort.
Try moving about on all fours. Try wiggling your hips or arching your back before straightening your spine again.
During Braxton Hicks (practice contractions), use a forward leaning posture
During contractions, stay on your feet, lean forwards and rock your hips from side to side and up and down to get your bottom wiggling as you walk

Remember to attend your antenatal appointments and contact your midwife or OB-GYN if you have any questions or concerns about the position of your baby.

Article references

MedlinePlus . Your baby in the birth canal. Available at: https://medlineplus.gov/ency/article/002060.htm . [Accessed May 19, 2022].
NHS Inform. How your baby lies in the womb. August 17, 2021. Available at: https://www.nhsinform.scot/ready-steady-baby/labour-and-birth/getting-ready-for-the-birth/how-your-baby-lies-in-the-womb . [Accessed May 19, 2022].
The American College of Obstetricians and Gynecologists (ACOG). If Your Baby is Breech. November 2020. Available at: https://www.acog.org/womens-health/faqs/if-your-baby-is-breech . [Accessed May 19, 2022].
MedlinePlus. Breech - series - Types of breech presentation. March 12, 2020. Available at: https://medlineplus.gov/ency/presentations/100193_3.htm . [Accessed May 19, 2022].
Medscape . Breech Presentation. January 20, 2022. Available at: https://emedicine.medscape.com/article/262159-overview . [Accessed May 19, 2022].
Physicians & Midwives. Which Way is Up? What Your Baby’s Position Means for Your Delivery. November 15, 2012. Available at: https://physiciansandmidwives.com/what-your-babys-position-means-for-delivery/ . [Accessed May 19, 2022].
BabyCentre. What is brow presentation? Available at: https://www.babycentre.co.uk/x564026/what-is-brow-presentation . [Accessed May 19, 2022].
NCT. Bay position in the womb before birth. Available at: https://www.nct.org.uk/labour-birth/getting-ready-for-birth/baby-positions-womb-birth . [Accessed May 19, 2022].
NHS Forth Valley. Ante Natal Advice for Optimal Fetal Positioning. 2020. Available at: https://nhsforthvalley.com/wp-content/uploads/2014/01/Ante-Natal-Advice-for-Optimal-Fetal-Positioning.pdf . [Accessed May 19, 2022].

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Face Presentation and Birth Injury

Normally, children are born head-first with the chin tucked towards the chest (vertex presentation). In a face presentation, the chin is not tucked and the neck is hyperextended. This can inhibit the engagement of the head and complicate the labor process. In some cases, a baby in face presentation can be delivered vaginally, but in other cases vaginal delivery is difficult and dangerous. Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby. If they suspect an abnormal presentation, they can confirm with an ultrasound and take action to properly handle the delivery of a baby in the face presentation. This includes additional monitoring and in some cases requires a C-Section. Because ventilation issues are more common in babies with face presentation, staff should be ready to intubate immediately after delivery (1).

Risk factors and causes of face presentation

Conditions that may increase the likelihood of a face presentation include the following (1, 2, 3, 4):

Prematurity
Very low birth weight
Fetal macrosomia (large baby)
Cephalopelvic disproportion, or CPD (a mismatch in size between the mother’s pelvis and the baby’s head)
Anencephaly (a birth defect in which the baby is missing part of the brain and skull)
Severe hydrocephalus with enlargement of the head
Anterior neck mass
Multiple nuchal cords (umbilical cord wrapped around baby’s neck more than once)
Maternal pelvis abnormalities
Maternal obesity
Multiparity (the mother has previously given birth)
Polyhydramnios (too much amniotic fluid)
Previous cesarean delivery

Diagnosing face presentation

Face presentation is diagnosed late in the first or second stage of labor by vaginal examination. The distinctive facial features of the chin, mouth, nose, and cheekbones can be felt. Face presentation is sometimes confused with breech presentation (because both are characterized by soft tissues with an orifice), which is why it is imperative that a very skilled physician be present during any potentially risky delivery or malpresentation . Diagnosis can be confirmed by an ultrasound, which reveals a deflexed/hyperextended neck (1).

Face presentation and delivery

There are three types of face presentation:

Mentum anterior (MA) . In this position, the chin is facing the front of the mother, and will be the presenting part of the face. Babies in mentum anterior position are usually delivered vaginally, although in some cases a C-section may be necessary.
Mentum posterior (MP) . In this position, the chin is facing the mother’s back. The baby’s head, neck, and shoulders enter the pelvis at the same time, and the pelvis is usually not large enough to accommodate this (however, the baby may spontaneously rotate into mentum anterior position) . Typically, a C-section is indicated, but there are certain circumstances under which vaginal delivery may be attempted (e.g. the mother is multiparous, the infant in face presentation is relatively small compared to her other children, fetal monitoring is reassuring, and the baby is progressing in labor). Regardless, the medical team should be prepared to perform a prompt C-section if there are any complications.
Mentum transverse (MT) . In this position, the baby’s chin is facing the side of the birth canal. Doctors may recommend a trial of labor under certain circumstances, but they should promptly proceed to a C-section if there are issues. If labor is progressing and the fetal heart monitor is reassuring when face presentation is present, physician intervention may not be necessary since many MP and MT positions convert to MA. Oxytocin (Pitocin) augmentation may be used in a face presentation with a normal fetus and abnormally slow progress, as long as fetal heart rate patterns remain reassuring (although there are certain risks associated with this drug, including uterine tachysystole ). Of course, in any face presentation, if progress in dilation and descent ceases despite adequate contractions, delivery must occur by C-section.

There is an increased risk of trauma to the baby when the face presents first, and the physician should not internally manipulate (try to rotate) the baby. In addition, the physician must not use vacuum extractors or manual extraction (grasping the baby with hands) to pull the baby from the uterine cavity. Furthermore, midforceps ( forcep extraction when the baby’s station is above +2 cm, but the head is engaged) should never be used. Outlet forceps should only be used by experienced physicians who understand the circumstances under which this is appropriate (1).

Abnormalities of the fetal heart rate occur more frequently with face presentation. In one study, 59% of infants in face presentation had variable heart decelerations, and 24% had late decelerations. Of the babies who were born live, 37% had 1-minute Apgar scores lower than 7, and 13% had 5-minute Apgar scores lower than 7. The majority of the low 5-minute Apgar scores were babies that had been in mentum posterior position (5).

For these reasons, it is crucial that babies are continuously monitored during labor, ideally with an external heart monitoring device. An internal device may cause facial or eye injuries if improperly placed. If internal monitoring is needed, the electrode should be cautiously placed over a bony structure such as the forehead, jaw or cheekbone to minimize the risk of trauma (1).

It is always critical that doctors obtain a mother’s informed consent , which means discussing delivery options (vaginal, C-section, enhanced with oxytocin, etc.) with her and explaining the potential risks and benefits of each. Failure to do so constitutes negligence.

Complications and side effects of face presentation

Complications associated with face presentation include the following:

Prolonged labor
Facial trauma
Facial edema (fluid build up in the face, often caused by trauma)
Skull molding (abnormal head shape that results from pressure on the baby’s head during childbirth)
Respiratory distress /difficulty in ventilation due to airway trauma and edema
Spinal cord injury
Abnormal fetal heart rate patterns
Low Apgar score

A baby may be at increased risk of complications if forceps or oxytocin are used during labor. Forceps can cause traumatic injury to the head, and oxytocin can deprive a baby of oxygen due to uterine tachysystole/hyperstimulation (strong, frequent contractions). Hyperstimulation increases pressure on the blood vessels in the womb, which can deprive the baby of oxygen-rich blood.

Trauma to the head and decreased oxygenation can cause permanent brain damage, such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP) , as well as fetal deaths.

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Standards of care, medical malpractice, and face presentation

Informed consent must be given during all medical procedures. This means that when a mother has a baby with face presentation, she must be given the option of a C-section versus a vaginal birth. One of the reasons a mother may opt for a C-section is to avoid the extensive facial bruising/trauma that is common in babies with face presentation. In addition to thoroughly explaining the risks and benefits of each type of delivery method, the physician must explain and obtain consent from the mother if forceps or oxytocin are used.

Because there are many complications associated with face presentation, it is essential that the baby be closely monitored and that delivery is handled by a physician with experience in this area. Furthermore, the physician must quickly proceed to a C-section delivery if there are any signs of fetal distress , labor is not progressing, or the baby fails to convert (rotate) to MA position. In addition, once a face presentation is diagnosed, the physician must check for pelvic adequacy. When the pelvis is inadequate (contracted/small), a C-section is recommended (1).

Since respiratory problems can occur in babies with face presentation, equipment and staff to perform intubation of the baby (placement of a breathing tube) should be readily available at the time of delivery.

Failure to follow any of these standards of care is negligence. If this negligence results in injury to the baby, it is medical malpractice .

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Julien, S., Lockwood, C. J., & Barss, V. A. (2014). Face and brow presentations in labor. Up to date.
Duff, P. (1981). Diagnosis and management of face presentation. Obstetrics and gynecology, 57(1), 105-112.
S. BHAL NJ DAVIES T. CHUNG, P. (1998). A population study of face and brow presentation. Journal of Obstetrics and Gynaecology, 18(3), 231-235.
Shaffer, B. L., Cheng, Y. W., Vargas, J. E., Laros Jr, R. K., & Caughey, A. B. (2006). Face presentation: predictors and delivery route. American journal of obstetrics and gynecology, 194(5), e10-e12.
Benedetti, T. J., Lowensohn, R. I., & Truscott, A. M. (1980). Face presentation at term. Obstetrics and gynecology, 55(2), 199-202.

The above information is intended to be an educational resource. It is not meant to be, and should not be interpreted as, medical advice.

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What emerged in two interviews with Trump , and conversations with more than a dozen of his closest advisers and confidants, were the outlines of an imperial presidency that would reshape America and its role in the world. To carry out a deportation operation designed to remove more than 11 million people from the country, Trump told me, he would be willing to build migrant detention camps and deploy the U.S. military, both at the border and inland. He would let red states monitor women’s pregnancies and prosecute those who violate abortion bans. He would, at his personal discretion, withhold funds appropriated by Congress, according to top advisers. He would be willing to fire a U.S. Attorney who doesn’t carry out his order to prosecute someone, breaking with a tradition of independent law enforcement that dates from America’s founding. He is weighing pardons for every one of his supporters accused of attacking the U.S. Capitol on Jan. 6, 2021, more than 800 of whom have pleaded guilty or been convicted by a jury. He might not come to the aid of an attacked ally in Europe or Asia if he felt that country wasn’t paying enough for its own defense. He would gut the U.S. civil service, deploy the National Guard to American cities as he sees fit, close the White House pandemic-preparedness office, and staff his Administration with acolytes who back his false assertion that the 2020 election was stolen.

Trump remains the same guy, with the same goals and grievances. But in person, if anything, he appears more assertive and confident. “When I first got to Washington, I knew very few people,” he says. “I had to rely on people.” Now he is in charge. The arranged marriage with the timorous Republican Party stalwarts is over; the old guard is vanquished, and the people who remain are his people. Trump would enter a second term backed by a slew of policy shops staffed by loyalists who have drawn up detailed plans in service of his agenda, which would concentrate the powers of the state in the hands of a man whose appetite for power appears all but insatiable. “I don’t think it’s a big mystery what his agenda would be,” says his close adviser Kellyanne Conway. “But I think people will be surprised at the alacrity with which he will take action.”

Read More: Read the Full Transcripts of Donald Trump's Interviews With TIME

The courts, the Constitution, and a Congress of unknown composition would all have a say in whether Trump’s objectives come to pass. The machinery of Washington has a range of defenses: leaks to a free press, whistle-blower protections, the oversight of inspectors general. The same deficiencies of temperament and judgment that hindered him in the past remain present. If he wins, Trump would be a lame duck—contrary to the suggestions of some supporters, he tells TIME he would not seek to overturn or ignore the Constitution’s prohibition on a third term. Public opinion would also be a powerful check. Amid a popular outcry, Trump was forced to scale back some of his most draconian first-term initiatives, including the policy of separating migrant families. As George Orwell wrote in 1945, the ability of governments to carry out their designs “depends on the general temper in the country.”

Every election is billed as a national turning point. This time that rings true. To supporters, the prospect of Trump 2.0, unconstrained and backed by a disciplined movement of true believers, offers revolutionary promise. To much of the rest of the nation and the world, it represents an alarming risk. A second Trump term could bring “the end of our democracy,” says presidential historian Douglas Brinkley, “and the birth of a new kind of authoritarian presidential order.”

Trump steps onto the patio at Mar-a-Lago near dusk. The well-heeled crowd eating Wagyu steaks and grilled branzino pauses to applaud as he takes his seat. On this gorgeous evening, the club is a MAGA mecca. Billionaire donor Steve Wynn is here. So is Speaker of the House Mike Johnson , who is dining with the former President after a joint press conference proposing legislation to prevent noncitizens from voting. Their voting in federal elections is already illegal, and extremely rare, but remains a Trumpian fixation that the embattled Speaker appeared happy to co-sign in exchange for the political cover that standing with Trump provides.

At the moment, though, Trump’s attention is elsewhere. With an index finger, he swipes through an iPad on the table to curate the restaurant’s soundtrack. The playlist veers from Sinead O’Connor to James Brown to The Phantom of the Opera. And there’s a uniquely Trump choice: a rendition of “The Star-Spangled Banner” sung by a choir of defendants imprisoned for attacking the U.S. Capitol on Jan. 6, interspersed with a recording of Trump reciting the Pledge of Allegiance. This has become a staple of his rallies, converting the ultimate symbol of national unity into a weapon of factional devotion.

The spectacle picks up where his first term left off. The events of Jan. 6 , during which a pro-Trump mob attacked the center of American democracy in an effort to subvert the peaceful transfer of power, was a profound stain on his legacy. Trump has sought to recast an insurrectionist riot as an act of patriotism. “I call them the J-6 patriots,” he says. When I ask whether he would consider pardoning every one of them, he says, “Yes, absolutely.” As Trump faces dozens of felony charges, including for election interference, conspiracy to defraud the United States, willful retention of national-security secrets, and falsifying business records to conceal hush-money payments, he has tried to turn legal peril into a badge of honor.

In a second term, Trump’s influence on American democracy would extend far beyond pardoning powers. Allies are laying the groundwork to restructure the presidency in line with a doctrine called the unitary executive theory, which holds that many of the constraints imposed on the White House by legislators and the courts should be swept away in favor of a more powerful Commander in Chief.

Read More: Fact-Checking What Donald Trump Said In His Interviews With TIME

Nowhere would that power be more momentous than at the Department of Justice. Since the nation’s earliest days, Presidents have generally kept a respectful distance from Senate-confirmed law-enforcement officials to avoid exploiting for personal ends their enormous ability to curtail Americans’ freedoms. But Trump, burned in his first term by multiple investigations directed by his own appointees, is ever more vocal about imposing his will directly on the department and its far-flung investigators and prosecutors.

In our Mar-a-Lago interview, Trump says he might fire U.S. Attorneys who refuse his orders to prosecute someone: “It would depend on the situation.” He’s told supporters he would seek retribution against his enemies in a second term. Would that include Fani Willis , the Atlanta-area district attorney who charged him with election interference, or Alvin Bragg, the Manhattan DA in the Stormy Daniels case, who Trump has previously said should be prosecuted? Trump demurs but offers no promises. “No, I don’t want to do that,” he says, before adding, “We’re gonna look at a lot of things. What they’ve done is a terrible thing.”

Trump has also vowed to appoint a “real special prosecutor” to go after Biden. “I wouldn’t want to hurt Biden,” he tells me. “I have too much respect for the office.” Seconds later, though, he suggests Biden’s fate may be tied to an upcoming Supreme Court ruling on whether Presidents can face criminal prosecution for acts committed in office. “If they said that a President doesn’t get immunity,” says Trump, “then Biden, I am sure, will be prosecuted for all of his crimes.” (Biden has not been charged with any, and a House Republican effort to impeach him has failed to unearth evidence of any crimes or misdemeanors, high or low.)

Read More: Trump Says ‘Anti-White Feeling’ Is a Problem in the U.S .

Such moves would be potentially catastrophic for the credibility of American law enforcement, scholars and former Justice Department leaders from both parties say. “If he ordered an improper prosecution, I would expect any respectable U.S. Attorney to say no,” says Michael McConnell, a former U.S. appellate judge appointed by President George W. Bush. “If the President fired the U.S. Attorney, it would be an enormous firestorm.” McConnell, now a Stanford law professor, says the dismissal could have a cascading effect similar to the Saturday Night Massacre , when President Richard Nixon ordered top DOJ officials to remove the special counsel investigating Watergate. Presidents have the constitutional right to fire U.S. Attorneys, and typically replace their predecessors’ appointees upon taking office. But discharging one specifically for refusing a President’s order would be all but unprecedented.

Trump’s radical designs for presidential power would be felt throughout the country. A main focus is the southern border. Trump says he plans to sign orders to reinstall many of the same policies from his first term, such as the Remain in Mexico program, which requires that non-Mexican asylum seekers be sent south of the border until their court dates, and Title 42 , which allows border officials to expel migrants without letting them apply for asylum. Advisers say he plans to cite record border crossings and fentanyl- and child-trafficking as justification for reimposing the emergency measures. He would direct federal funding to resume construction of the border wall, likely by allocating money from the military budget without congressional approval. The capstone of this program, advisers say, would be a massive deportation operation that would target millions of people. Trump made similar pledges in his first term, but says he plans to be more aggressive in a second. “People need to be deported,” says Tom Homan, a top Trump adviser and former acting head of Immigration and Customs Enforcement. “No one should be off the table.”

Read More: The Story Behind TIME's 'If He Wins' Trump Cover

For an operation of that scale, Trump says he would rely mostly on the National Guard to round up and remove undocumented migrants throughout the country. “If they weren’t able to, then I’d use [other parts of] the military,” he says. When I ask if that means he would override the Posse Comitatus Act—an 1878 law that prohibits the use of military force on civilians—Trump seems unmoved by the weight of the statute. “Well, these aren’t civilians,” he says. “These are people that aren’t legally in our country.” He would also seek help from local police and says he would deny funding for jurisdictions that decline to adopt his policies. “There’s a possibility that some won’t want to participate,” Trump says, “and they won’t partake in the riches.”

As President, Trump nominated three Supreme Court Justices who voted to overturn Roe v. Wade, and he claims credit for his role in ending a constitutional right to an abortion. At the same time, he has sought to defuse a potent campaign issue for the Democrats by saying he wouldn’t sign a federal ban. In our interview at Mar-a-Lago, he declines to commit to vetoing any additional federal restrictions if they came to his desk. More than 20 states now have full or partial abortion bans, and Trump says those policies should be left to the states to do what they want, including monitoring women’s pregnancies. “I think they might do that,” he says. When I ask whether he would be comfortable with states prosecuting women for having abortions beyond the point the laws permit, he says, “It’s irrelevant whether I’m comfortable or not. It’s totally irrelevant, because the states are going to make those decisions.” President Biden has said he would fight state anti-abortion measures in court and with regulation.

Trump’s allies don’t plan to be passive on abortion if he returns to power. The Heritage Foundation has called for enforcement of a 19th century statute that would outlaw the mailing of abortion pills. The Republican Study Committee (RSC), which includes more than 80% of the House GOP conference, included in its 2025 budget proposal the Life at Conception Act, which says the right to life extends to “the moment of fertilization.” I ask Trump if he would veto that bill if it came to his desk. “I don’t have to do anything about vetoes,” Trump says, “because we now have it back in the states.”

Presidents typically have a narrow window to pass major legislation. Trump’s team is eyeing two bills to kick off a second term: a border-security and immigration package, and an extension of his 2017 tax cuts. Many of the latter’s provisions expire early in 2025: the tax cuts on individual income brackets, 100% business expensing, the doubling of the estate-tax deduction. Trump is planning to intensify his protectionist agenda, telling me he’s considering a tariff of more than 10% on all imports, and perhaps even a 100% tariff on some Chinese goods. Trump says the tariffs will liberate the U.S. economy from being at the mercy of foreign manufacturing and spur an industrial renaissance in the U.S. When I point out that independent analysts estimate Trump’s first term tariffs on thousands of products, including steel and aluminum, solar panels, and washing machines, may have cost the U.S. $316 billion and more than 300,000 jobs, by one account, he dismisses these experts out of hand. His advisers argue that the average yearly inflation rate in his first term—under 2%—is evidence that his tariffs won’t raise prices.

Since leaving office, Trump has tried to engineer a caucus of the compliant, clearing primary fields in Senate and House races. His hope is that GOP majorities replete with MAGA diehards could rubber-stamp his legislative agenda and nominees. Representative Jim Banks of Indiana, a former RSC chairman and the GOP nominee for the state’s open Senate seat, recalls an August 2022 RSC planning meeting with Trump at his residence in Bedminster, N.J. As the group arrived, Banks recalls, news broke that Mar-a-Lago had been raided by the FBI. Banks was sure the meeting would be canceled. Moments later, Trump walked through the doors, defiant and pledging to run again. “I need allies there when I’m elected,” Banks recalls Trump saying. The difference in a second Trump term, Banks says now, “is he’s going to have the backup in Congress that he didn’t have before.”

Trump’s intention to remake America’s relations abroad may be just as consequential. Since its founding, the U.S. has sought to build and sustain alliances based on the shared values of political and economic freedom. Trump takes a much more transactional approach to international relations than his predecessors, expressing disdain for what he views as free-riding friends and appreciation for authoritarian leaders like President Xi Jinping of China, Prime Minister Viktor Orban of Hungary, or former President Jair Bolsonaro of Brazil.

That’s one reason America’s traditional allies were horrified when Trump recently said at a campaign rally that Russia could “do whatever the hell they want” to a NATO country he believes doesn’t spend enough on collective defense. That wasn’t idle bluster, Trump tells me. “If you’re not going to pay, then you’re on your own,” he says. Trump has long said the alliance is ripping the U.S. off. Former NATO Secretary-General Jens Stoltenberg credited Trump’s first-term threat to pull out of the alliance with spurring other members to add more than $100 billion to their defense budgets.

But an insecure NATO is as likely to accrue to Russia’s benefit as it is to America’s. President Vladimir Putin’s 2022 invasion of Ukraine looks to many in Europe and the U.S. like a test of his broader vision to reconstruct the Soviet empire. Under Biden and a bipartisan Congress, the U.S. has sent more than $100 billion to Ukraine to defend itself. It’s unlikely Trump would extend the same support to Kyiv. After Orban visited Mar-a-Lago in March, he said Trump “wouldn’t give a penny” to Ukraine. “I wouldn’t give unless Europe starts equalizing,” Trump hedges in our interview. “If Europe is not going to pay, why should we pay? They’re much more greatly affected. We have an ocean in between us. They don’t.” (E.U. nations have given more than $100 billion in aid to Ukraine as well.)

Trump has historically been reluctant to criticize or confront Putin. He sided with the Russian autocrat over his own intelligence community when it asserted that Russia interfered in the 2016 election. Even now, Trump uses Putin as a foil for his own political purposes. When I asked Trump why he has not called for the release of Wall Street Journal reporter Evan Gershkovich, who has been unjustly held on spurious charges in a Moscow prison for a year , Trump says, “I guess because I have so many other things I’m working on.” Gershkovich should be freed, he adds, but he doubts it will happen before the election. “The reporter should be released and he will be released,” Trump tells me. “I don’t know if he’s going to be released under Biden. I would get him released.”

America’s Asian allies, like its European ones, may be on their own under Trump. Taiwan’s Foreign Minister recently said aid to Ukraine was critical in deterring Xi from invading the island. Communist China’s leaders “have to understand that things like that can’t come easy,” Trump says, but he declines to say whether he would come to Taiwan’s defense.

Trump is less cryptic on current U.S. troop deployments in Asia. If South Korea doesn’t pay more to support U.S. troops there to deter Kim Jong Un’s increasingly belligerent regime to the north, Trump suggests the U.S. could withdraw its forces. “We have 40,000 troops that are in a precarious position,” he tells TIME. (The number is actually 28,500.) “Which doesn’t make any sense. Why would we defend somebody? And we’re talking about a very wealthy country.”

Transactional isolationism may be the main strain of Trump’s foreign policy, but there are limits. Trump says he would join Israel’s side in a confrontation with Iran. “If they attack Israel, yes, we would be there,” he tells me. He says he has come around to the now widespread belief in Israel that a Palestinian state existing side by side in peace is increasingly unlikely. “There was a time when I thought two-state could work,” he says. “Now I think two-state is going to be very, very tough.”

Yet even his support for Israel is not absolute. He’s criticized Israel’s handling of its war against Hamas, which has killed more than 30,000 Palestinians in Gaza, and has called for the nation to “get it over with.” When I ask whether he would consider withholding U.S. military aid to Israel to push it toward winding down the war, he doesn’t say yes, but he doesn’t rule it out, either. He is sharply critical of Israeli Prime Minister Benjamin Netanyahu, once a close ally. “I had a bad experience with Bibi,” Trump says. In his telling, a January 2020 U.S. operation to assassinate a top Iranian general was supposed to be a joint attack until Netanyahu backed out at the last moment. “That was something I never forgot,” he says. He blames Netanyahu for failing to prevent the Oct. 7 attack, when Hamas militants infiltrated southern Israel and killed nearly 1,200 people amid acts of brutality including burning entire families alive and raping women and girls. “It happened on his watch,” Trump says.

On the second day of Trump’s New York trial on April 17, I stand behind the packed counter of the Sanaa Convenience Store on 139th Street and Broadway, waiting for Trump to drop in for a postcourt campaign stop. He chose the bodega for its history. In 2022, one of the store’s clerks fatally stabbed a customer who attacked him. Bragg, the Manhattan DA, charged the clerk with second-degree murder. (The charges were later dropped amid public outrage over video footage that appeared to show the clerk acting in self-defense.) A baseball bat behind the counter alludes to lingering security concerns. When Trump arrives, he asks the store’s co-owner, Maad Ahmed, a Yemeni immigrant, about safety. “You should be allowed to have a gun,” Trump tells Ahmed. “If you had a gun, you’d never get robbed.”

On the campaign trail, Trump uses crime as a cudgel, painting urban America as a savage hell-scape even though violent crime has declined in recent years, with homicides sinking 6% in 2022 and 13% in 2023, according to the FBI. When I point this out, Trump tells me he thinks the data, which is collected by state and local police departments, is rigged. “It’s a lie,” he says. He has pledged to send the National Guard into cities struggling with crime in a second term—possibly without the request of governors—and plans to approve Justice Department grants only to cities that adopt his preferred policing methods like stop-and-frisk.

To critics, Trump’s preoccupation with crime is a racial dog whistle. In polls, large numbers of his supporters have expressed the view that antiwhite racism now represents a greater problem in the U.S. than the systemic racism that has long afflicted Black Americans. When I ask if he agrees, Trump does not dispute this position. “There is a definite antiwhite feeling in the country,” he tells TIME, “and that can’t be allowed either.” In a second term, advisers say, a Trump Administration would rescind Biden’s Executive Orders designed to boost diversity and racial equity.

Trump’s ability to campaign for the White House in the midst of an unprecedented criminal trial is the product of a more professional campaign operation that has avoided the infighting that plagued past versions. “He has a very disciplined team around him,” says Representative Elise Stefanik of New York. “That is an indicator of how disciplined and focused a second term will be.” That control now extends to the party writ large. In 2016, the GOP establishment, having failed to derail Trump’s campaign, surrounded him with staff who sought to temper him. Today the party’s permanent class have either devoted themselves to the gospel of MAGA or given up. Trump has cleaned house at the Republican National Committee, installing handpicked leaders—including his daughter-in-law—who have reportedly imposed loyalty tests on prospective job applicants, asking whether they believe the false assertion that the 2020 election was stolen. (The RNC has denied there is a litmus test.) Trump tells me he would have trouble hiring anyone who admits Biden won: “I wouldn’t feel good about it.”

Policy groups are creating a government-in-waiting full of true believers. The Heritage Foundation’s Project 2025 has drawn up plans for legislation and Executive Orders as it trains prospective personnel for a second Trump term. The Center for Renewing America, led by Russell Vought, Trump’s former director of the Office of Management and Budget, is dedicated to disempowering the so-called administrative state, the collection of bureaucrats with the power to control everything from drug-safety determinations to the contents of school lunches. The America First Policy Institute is a research haven of pro-Trump right-wing populists. America First Legal, led by Trump’s immigration adviser Stephen Miller, is mounting court battles against the Biden Administration.

The goal of these groups is to put Trump’s vision into action on day one. “The President never had a policy process that was designed to give him what he actually wanted and campaigned on,” says Vought. “[We are] sorting through the legal authorities, the mechanics, and providing the momentum for a future Administration.” That includes a litany of boundary-pushing right-wing policies, including slashing Department of Justice funding and cutting climate and environmental regulations.

Read More: Fact-Checking What Donald Trump Said in His 2024 Interviews With TIME

Trump’s campaign says he would be the final decision-maker on which policies suggested by these organizations would get implemented. But at the least, these advisers could form the front lines of a planned march against what Trump dubs the Deep State, marrying bureaucratic savvy to their leader’s anti-bureaucratic zeal. One weapon in Trump’s second-term “War on Washington” is a wonky one: restoring the power of impoundment, which allowed Presidents to withhold congressionally appropriated funds. Impoundment was a favorite maneuver of Nixon, who used his authority to freeze funding for subsidized housing and the Environmental Protection Agency. Trump and his allies plan to challenge a 1974 law that prohibits use of the measure, according to campaign policy advisers.

Another inside move is the enforcement of Schedule F, which allows the President to fire nonpolitical government officials and which Trump says he would embrace. “You have some people that are protected that shouldn’t be protected,” he says. A senior U.S. judge offers an example of how consequential such a move could be. Suppose there’s another pandemic, and President Trump wants to push the use of an untested drug, much as he did with hydroxychloroquine during COVID-19. Under Schedule F, if the drug’s medical reviewer at the Food and Drug Administration refuses to sign off on its use, Trump could fire them, and anyone else who doesn’t approve it. The Trump team says the President needs the power to hold bureaucrats accountable to voters. “The mere mention of Schedule F,” says Vought, “ensures that the bureaucracy moves in your direction.”

It can be hard at times to discern Trump’s true intentions. In his interviews with TIME, he often sidestepped questions or answered them in contradictory ways. There’s no telling how his ego and self-destructive behavior might hinder his objectives. And for all his norm-breaking, there are lines he says he won’t cross. When asked if he would comply with all orders upheld by the Supreme Court, Trump says he would.

But his policy preoccupations are clear and consistent. If Trump is able to carry out a fraction of his goals, the impact could prove as transformative as any presidency in more than a century. “He’s in full war mode,” says his former adviser and occasional confidant Stephen Bannon. Trump’s sense of the state of the country is “quite apocalyptic,” Bannon says. “That’s where Trump’s heart is. That’s where his obsession is.”

These obsessions could once again push the nation to the brink of crisis. Trump does not dismiss the possibility of political violence around the election. “If we don’t win, you know, it depends,” he tells TIME. “It always depends on the fairness of the election.” When I ask what he meant when he baselessly claimed on Truth Social that a stolen election “allows for the termination of all rules, regulations and articles, even those found in the Constitution,” Trump responded by denying he had said it. He then complained about the “Biden-inspired” court case he faces in New York and suggested that the “fascists” in America’s government were its greatest threat. “I think the enemy from within, in many cases, is much more dangerous for our country than the outside enemies of China, Russia, and various others,” he tells me.

Toward the end of our conversation at Mar-a-Lago, I ask Trump to explain another troubling comment he made: that he wants to be dictator for a day. It came during a Fox News town hall with Sean Hannity, who gave Trump an opportunity to allay concerns that he would abuse power in office or seek retribution against political opponents. Trump said he would not be a dictator—“except for day one,” he added. “I want to close the border, and I want to drill, drill, drill.”

Trump says that the remark “was said in fun, in jest, sarcastically.” He compares it to an infamous moment from the 2016 campaign, when he encouraged the Russians to hack and leak Hillary Clinton’s emails. In Trump’s mind, the media sensationalized those remarks too. But the Russians weren’t joking: among many other efforts to influence the core exercise of American democracy that year, they hacked the Democratic National Committee’s servers and disseminated its emails through WikiLeaks.

Whether or not he was kidding about bringing a tyrannical end to our 248-year experiment in democracy, I ask him, Don’t you see why many Americans see such talk of dictatorship as contrary to our most cherished principles? Trump says no. Quite the opposite, he insists. “I think a lot of people like it.” — With reporting by Leslie Dickstein, Simmone Shah, and Julia Zorthian

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IMAGES

Face presentation in delivery room: what is strategy?
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Face Presentation
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COMMENTS

Delivery, Face and Brow Presentation
The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The most common ...
Fetal Presentation, Position, and Lie (Including Breech Presentation
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.. In brow presentation, the neck is moderately arched so that the brow presents first.. Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor.
Face Presentation
The baby's face may be bruised for a couple days after the birth. The brow presentation may cause a redness but only occasionally will cause a bruise. Mobility of the pelvis and the freedom of maternal movements often help bring the face-first baby down through the pelvis with good strong, uterine surges.
Face and Brow Presentation
In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin. The fetal chin (mentum) is the point designated for reference during an ...
Face and brow presentations in labor
The vast majority of fetuses at term are in cephalic presentation. Approximately 5 percent of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face ( figure 1A-B ), or brow ( figure 2) [ 1 ]. Diagnosis and management of face and brow presentations will be reviewed here.
Fetal presentation before birth
When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.
Management of face presentation, face and lip edema in a primary
Introduction. Face presentation is a rare unanticipated obstetric event characterized by a longitudinal lie and full extension of the foetal head on the neck with the occiput against the upper back [1-3].Face presentation occurs in 0.1-0.2% of deliveries [3-5] but is more common in black women and in multiparous women [].Studies have shown that 60 per cent of face presentations have one or ...
Delivery, Face Presentation, and Brow Presentation ...
Face Presentation: Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head). Causes: Face presentation can occur due to factors such as abnormal fetal positioning, multiple pregnancies, uterine abnormalities, or maternal pelvic anatomy.
Fetal Positions For Birth: Presentation, Types & Function
Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth parent's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left. This is called left occiput anterior or right ...
What is brow presentation?
Brow presentation is a rare complication, which affects only one in every 500 to one in every 1,400 births. So the chances of it happening are low. If a brow presentation is picked up in early labour, your baby may still flex her head in time for the birth. Alternatively, she may tip her head further back and be born face first.
Diagnosis and management of face presentation
Abstract. Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different ...
Fetal presentation: Breech, posterior, transverse lie, and more
Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery. Here are the many possibilities for fetal presentation and position in the womb.
Managing Face Presentation In Delivery
The incidence of face presentation is reported to be between 1 in 500 deliveries to 1 in 1400 deliveries. It happens when the baby's head is very extended backwards. Fortunately, it was a mento-anterior face presentation as a mento-posterior face presentation usually needs a Caesarean section. Also, that it was her third vaginal delivery and ...
Management of Brow, Face, and Compound Malpresentations
In face presentation, the mentum (chin) and mouth are palpable. Management considerations for face, brow, and compounds presentations are unique with compound presentations having higher rates of vaginal delivery and lower complications as compared to either brow or face presentations. For brow presentations, approximately 30-40% of brow ...
Face presentation
In birth: Face presentation. When the child's head becomes bent back (extended) so that it enters and passes through the pelvis face first, the condition is known as a face, or cephalic, presentation. The chin is then the leading pole and follows the same course that is… Read More
Face Presentation
A type of cephalic presentation in which the presenting part is the face, the area between chin and glabella. The incidence varies from 1 in 500 to 1 in 1000 deliveries. Primary face presentation is rare. Secondary face presentation caused by extension of head during labor is common. Thus, the diagnosis is usually made during active phase of ...
Pediatrics: Face presentation at birth
What is face presentation and what mark does it leave on the baby?
Vertex Presentation: Position, Birth & What It Means
Vertex Presentation. A vertex presentation is the ideal position for a fetus to be in for a vaginal delivery. It means the fetus is head down, headfirst and facing your spine with its chin tucked to its chest. Vertex presentation describes a fetus being head-first or head down in the birth canal.
What to know about baby's position at birth
A face presentation is another rare position for a baby to be born in, occurring in only 1 in every 600 to 800 births. Almost three quarters of babies presenting face-first can be delivered vaginally, especially if the baby's chin is near your pubic bone, although labor may be prolonged.
Face Presentation
Face presentation is a malpresentation of the fetus. It occurs when the baby's face presents first through the birth canal. In this demonstration, nurse Andr...
Face Presentation Birth: Is it Dangerous? Birth Injuries Legal Help
Face Presentation Causes & Risk Factors. These conditions may increase the likelihood of a face presentation birth: A Very Big Baby (Fetal Macrosomia): Larger babies may have trouble fitting into the birth canal in the standard position, leading to alternative presentations. Prematurity: Premature infants are more likely to have non-standard presentations, including face presentation, because ...
Face Presentation
Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby.
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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Position and Presentation of the Fetus

Occiput posterior position

Breech presentation

Other presentations

What makes labor easier for a face-first baby and you?

In Labor with a Face or Brow Presentation

Before Labor with a face or brow presentation

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Medical Information

Delivery, Face Presentation, and Brow Presentation: Understanding Fetal Positions and Birth Scenarios

Delivery Process:

Face Presentation:

Brow Presentation:

Delivery Techniques and Intervention:

Conclusion:

On the Article

Krish Tangella MD, MBA

Alexander Enabnit

Alexandra Warren

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For Patients

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What is brow presentation?

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Forceps and ventouse (assisted birth)

Where to go next

Diagnosis and management of face presentation

Publication types

Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation and position

Head down, facing down (anterior position)

Head down, facing up (posterior position)

Frank breech

Complete breech

Incomplete breech

Single footling breech

Double footling breech

Transverse lie

Oblique lie

What to know if your baby is breech

What's a sunny-side up baby?

What happens to your baby right after birth

How your twins’ fetal positions affect labor and delivery

Where to go next

Face presentation

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Management of Brow, Face, and Compound Malpresentations

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Face Presentation

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What to know about baby’s position at birth

Position of the baby before birth

What’s the ideal position of a baby for birth?

What other positions are babies born in?

Occiput posterior or back-to-back presentation

Breech presentation

Brow and face presentations

Shoulder presentation