“This process allows medical professionals to not only make a birth weight estimate but also address any underlying problems that may occur down the road,” explains Mackenzie Schutz, RN. Knowing if the baby is head down is important at the end of pregnancy in order to plan for a safe delivery. These maneuvers get their name from the influential 19th-century German obstetrician and gynecologist Christian Gerhard Leopold, who discussed and propagated their use among other physicians. They may also be called Leopold maneuvers. Learn more about Leopold’s maneuvers, including why, when, and how they are performed during pregnancy.
How Are Leopold’s Maneuvers Performed?
There are four distinct maneuvers, each with a different technique.
Fundal grip: A healthcare provider palpates the upper abdomen with both hands to feel for the fetus’s head, trunk, and bottom in order to get an idea of its size and position.Pawlik’s grip: A provider uses their fingers and thumb to feel what part of the fetus is in the lower abdomen, just above the birth canal, to see if they’re in the right position. This maneuver assesses fetal weight and amniotic fluid volume.Pelvic grip: A provider moves their fingers towards the pelvis, then slides their hands over the side of the uterus to determine where the fetus’s brow is located.Umbilical grip: A provider applies deep pressure with the palm of one hand while using the other hand to feel the uterus. This allows them to identify the location of the fetus’s back and small parts.
Why Are They Performed?
“Leopold maneuvers a wonderful way to determine quickly how the fetus is lying in a person’s uterus,” explains Kecia Gaither, OB/GYN, doctor of maternal-fetal medicine, and director of perinatal services at NYC Health and Hospitals/Lincoln. “And, in experienced hands, they can give an estimate of fetal weight.” They’re also low-cost, non-invasive, and don’t require the use of expensive equipment such as an ultrasound. Plus they tell your provider how ready your baby is for birth so they can better prepare for your labor.
Ideal Position
At the beginning of your pregnancy, your fetus will move around your womb freely, but towards the end, they should get into a position that’s optimal for vaginal delivery. Before birth, your baby should be head-down, facing your back, with their chin tucked to their chest so that their head is ready to enter the pelvis. This is called the cephalic presentation and it is the ideal position for childbirth. Most babies will settle into this position between the 32nd and 36th week of pregnancy. This position makes labor less complicated. Around 96% of babies will be born in the cephalic position.
Cephalic Posterior Position
This position is also known as an occiput position or it’s sometimes nicknamed “sunny-side-up.” It means that your baby is positioned head down, but they’re facing out instead of towards your spine. This position could increase your chances of a painful and prolonged delivery.
Breech Position
A breech position means that your baby’s bottom is facing downwards. There are three different breech positions:
Frank breech: The baby’s legs are up, with feet near the headFootling breech: One or both legs are lowered in the cervixComplete breech: The baby’s bottom is first and its knees are bent
Any of these positions can make for a riskier delivery, so you are at risk of a C-section delivery if the baby doesn’t change position before labor.
Transverse Lie
Your baby might also be in a transverse lie position at the end of the third trimester, which means they are lying sideways across your uterus instead of vertically. If they don’t change position, it could make for dangerous labor, so a C-section will be required.
Fetal Weight Estimate
Leopold’s maneuvers can also be used to estimate how big your baby is. Fetal weight estimates help your healthcare provider plan for birth, too. In general, a baby who is estimated to be 10 pounds or more might require a C-section birth because your baby could get caught in the birth canal.
Risks and Contraindications
There are no known risks for using Leopold’s maneuvers, as long as they are being performed by qualified medical professionals. However, they are as accurate at determining the position or estimated weight of your baby before the 36th week of your pregnancy. So, your medical provider will not likely use them before your 36-week checkup. For your own comfort, your provider will likely ask you to pee before they do the procedure, because a full bladder can make it difficult to really determine your baby’s position with accuracy. Your provider might also not use these maneuvers if you were in an accident. “If blunt force trauma has occurred during pregnancy, it may be best to use an ultrasound to avoid any further bruising that could be worsened by palpating,” explains Shutz. Leopold’s maneuvers are typically very accurate, but it is possible that your healthcare provider will still perform an ultrasound prior to your delivery to confirm your baby’s position, particularly if they are concerned that your baby has moved or is in a transverse or breech position.
A Word From Verywell
Leopold’s maneuvers are usually performed after 36 weeks by your healthcare provider to determine your baby’s position and estimate their birth weight. This will help you and your provider be better prepared for your labor and determine if it might be safer to perform a c-section. The maneuvers should not hurt and they are very accurate, though your provider might still perform an ultrasound to confirm any findings. They are also more complicated to perform on patients who have polyhydramnios, which is when you have too much amniotic fluid surrounding your baby, as well as people with fibroids.
