Understanding Baby’s Position: A Case Study on the High Head

When we support our clients through pregnancy and in preparing for birth, one essential consideration is the baby’s position in the body. How the baby is aligned and engaged within the pelvis can significantly affect both the comfort of pregnancy and the progress of labor.

Today, I share a case study of a client whose baby’s head at 39 weeks remained high above the pelvic inlet – what’s often referred to as a high or mobile head. This case study explores what happens when a baby’s head remains high late in pregnancy – and how mindful pelvic assessment and targeted myofascial release can create meaningful change in preparing both the body and the baby for birth.

The Case: When Baby’s Head Stays High

The client, pregnant with her second child, came in at 39 weeks with persistent sacral pain. Her tissues were notably soft and flexible, likely reflecting a connective tissue variation with a higher proportion of Type III collagen.

On palpation of baby’s position, it was clear that the bottom of the baby’s head was sitting roughly 1–2 inches above the top of the pubic bone, meaning the baby had not yet engaged into the pelvis. While this often goes unnoticed by providers, for professionals skilled in perinatal bodywork, it’s a valuable clinical clue.

Palpation to determine the baby’s position – including the relation of the baby’s head to the pubic bone – is a highly useful tool within our scope. When we identify that the head is still high and mobile, it signals the need to explore possible myofascial and ligamentous restrictions that might be preventing engagement.

Understanding the “High or Mobile Head”

A high head means the baby’s head is easily moved from side to side and has not yet descended into the pelvic inlet. For the birthing parent, this often presents as pressure or discomfort higher up in the rib cage or upper abdomen because baby’s body remains elevated under the diaphragm.

It’s also common to find tailbone pain, sacral tension, or hypertonic pelvic floor muscles especially when both sides are tight. Think of the pelvic floor as a “stoplight” for birth. When bilateral tension is present, it can act as a signal to the baby saying, not yet – don’t come down.

Areas commonly contributing to a high head include:

• Posterior (back) rib tension
• Bilateral gluteal or sacral ligament tightness
• Hypertonic or restricted pelvic floor muscles
• Round ligament or psoas tension

Each of these creates subtle resistance in the pelvic space that may inhibit the baby’s descent.

Treatment and Outcome

During this client’s session, I addressed the patterns of tension found in the glutes, sacrum, ribs, and pelvic floor. As we released these restrictions, I could feel the baby’s position change as the baby’s head started to settle lower – just beginning to engage into the pelvis.

A few days later, the client went into labor naturally and delivered smoothly. While we can’t know with certainty what triggered the onset, the improved engagement likely allowed the uterus to work more efficiently, reducing the effort needed to bring baby through the pelvis.

When baby begins labor already engaged, the process often unfolds with greater ease and efficiency – less effort for both uterus and the baby.

Advancing Birth Preparation Skills

For any therapist, bodyworker, or birth professional, learning to palpate and interpret baby’s position provides critical insight into prenatal care. These hands-on skills allow you to:

• Identify when the baby’s head is high or not aligned midline
• Recognize tissue tension patterns contributing to restricted space
• Facilitate releases that support better engagement and comfort

Understanding the baby’s position and where the head, buttocks, and uterine fundus sit in relation to one another can reveal much about the body’s alignment and readiness for birth. When these structures aren’t vertically stacked, gentle treatment of the uterine ligaments and surrounding fascia can help restore balance and optimize space for the baby’s descent. In both the Holistic Treatment of the Pregnant Body and Pregnancy Pain and Beyond courses,  you learn how to palpate the baby’s position in the body. 

Awareness of fetal position – combined with skilled touch and anatomical understanding – empowers us to help clients approach birth with greater alignment, comfort, and confidence. Subtle shifts often yield profound outcomes.

Here’s to helping every baby find their perfect path into the world.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com