Are you wondering how to tell if baby is head down?  There are 3 main methods used to know how to tell if baby is head down:

1. 1. Leopold’s maneuvers

1. 1. The location of the baby’s heartbeat

1. Ultrasound

At some point in the last trimester, your baby is going to settle into his favorite position for birth.  Most babies will move to a head down position by around 28–30 weeks of pregnancy, and 97% will be head down at birth.  This is ideal for moms planning a vaginal birth, since it’s the position most likely to lead to a safe and uncomplicated labor and birth (1).

However, some babies stay in a breech position or transverse lie past 34 weeks of pregnancy.  If attempts to turn the baby aren’t successful, chances are baby will be born through a cesarean birth.  With that in mind, it’s understandable that many moms want to know how to tell if baby is head down.  Between weeks 28 and 38 of your pregnancy, your doctor or midwife will start to check your baby’s position during each prenatal visit.

How to Tell If Baby Is Head Down #1:  Leopold’s Maneuvers

Leopold’s maneuvers are a technique where your doctor or midwife will feel for your baby’s position by pressing her hands into your abdomen and feeling the baby.  It’s done in 4 steps:

1. First, your doctor will begin by pressing around the top of your uterus–an area known as the fundus.  If baby is head down, your doctor will feel a bottom.  Baby’s bottom is soft with small bones protruding out.  If, on the other hand, baby is in a breech position, a head will be felt.  The head is hard, firm, and will move independent of baby’s body.
2. Second, your doctor will feel for the location of your baby’s back.  She’ll place her hands on the side of your abdomen as she explores baby’s position.  Baby’s back will feel firm and smooth.  The back will connect with a firm mass near the pelvis.  Hands and feet are found on the other side, and will feel small and knobby.
3. Third, your doctor will try to feel for the round head lying just above the pubic bone.  If the head is down but isn’t engaged in the pelvis yet, it may be gently pushed back and forth.
4. Fourth, your doctor will place both hands on your lower abdomen and move gently down the sides of the uterus towards your pelvis.  This allows her to feel whether or not your baby’s head is well flexed and tucked into the chest.

After all 4 maneuvers are done, your doctor will have a fairly accurate picture of your baby’s position.  With that said, it takes a lot of practice to get good at this technique.  It’s also difficult to do on a mom who is overweight or has lots of amniotic fluid.  So, unfortunately it’s not 100% accurate.

How to Tell If Baby Is Head Down #2:  Location of Heartbeat

The location of your baby’s heartbeat can also be very telling about whether or not your baby is head down.  If the head is down towards the pelvis, it makes sense that baby’s heartbeat would be found just above the pelvis, below the belly button.

With that said, the location of the heartbeat is also not entirely reliable.  If a doppler is used to assess the heart tones, it may pick up the beat far from the heart.  Additionally, since water carries sound, excess amniotic fluid can skew the results.

In the picture above, the dots show the general location of baby’s heartbeat in relation to the most common head down positions.  Here’s a brief explanation of the abbreviations:

• Right (R) or left (L) side of the pelvis
• Occiput (O) is a fancy word that describes the back of baby’s head.  It means that the head is the body part pointing downward into the pelvis.
• Anterior (A) or posterior (P) help you know whether the baby’s head is pointing towards the front (A) or back (P) of the pelvis.

How to Tell If Baby Is Head Down #3:  Ultrasound

Ultrasounds allow your caregiver to clearly view your baby inside the uterus.  So, if you want to know how to tell if baby is head down with 100% accuracy, an ultrasound is the best option.  Ultrasounds aren’t routinely performed to tell the baby’s position, so it would likely only be used only if both Leopold’s maneuvers and the location of the heartbeat suggest that baby may not be head down.

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References:

(1) Ladewig, P., London, M., & Davidson, M.  (2006).  Contemporary Maternal-Newborn Nursing Care, 6th edition.  Pearson Education Inc.  Upper Saddle River, NJ.  p 392, 426-428.

(2)  The American College of Obstetricians and Gynecologists.  (2017).  Frequently Asked Questions Special Procedures: Ultrasound Exams.  Retrieved from https://www.acog.org/Patients/FAQs/Ultrasound-Exams.