types of presentation in delivery

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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.

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.

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.

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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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Delivery, face and brow presentation.

Julija Makajeva ; Mohsina Ashraf .

Affiliations

Last Update: January 9, 2023 .

• Continuing Education Activity

Face and brow presentation is a malpresentation during labor when the presenting part is either the face or, in the case of brow presentation, it is the area between the orbital ridge and the anterior fontanelle. This activity reviews the evaluation and management of these two presentations and explains the role of the interprofessional team in managing delivery safely for both the mother and the baby.

• Describe the mechanism of labor in the face and brow presentation.
• Summarize potential maternal and fetal complications during the face and brow presentations.
• Review different management approaches for the face and brow presentation.
• Outline some interprofessional strategies that will improve patient outcomes in delivery cases with face and brow presentation issues.
• Introduction

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 presentation in term labor is the vertex, where the fetal neck is flexed to the chin, minimizing the head circumference.

Face presentation – an abnormal form of cephalic presentation where the presenting part is mentum. This typically occurs because of hyperextension of the neck and the occiput touching the fetal back. Incidence of face presentation is rare, accounting for approximately 1 in 600 of all presentations. [1] [2] [3]

In brow presentation, the neck is not extended as much as in face presentation, and the leading part is the area between the anterior fontanelle and the orbital ridges. Brow presentation is considered the rarest of all malpresentation with a prevalence of 1 in 500 to 1 in 4000 deliveries. [3]

Both face and brow presentations occur due to extension of the fetal neck instead of flexion; therefore, conditions that would lead to hyperextension or prevent flexion of the fetal neck can all contribute to face or brow presentation. These risk factors may be related to either the mother or the fetus. Maternal risk factors are preterm delivery, contracted maternal pelvis, platypelloid pelvis, multiparity, previous cesarean section, black race. Fetal risk factors include anencephaly, multiple loops of cord around the neck, masses of the neck, macrosomia, polyhydramnios. [2] [4] [5]

These malpresentations are usually diagnosed during the second stage of labor when performing a digital examination. It is possible to palpate orbital ridges, nose, malar eminences, mentum, mouth, gums, and chin in face presentation. Based on the position of the chin, face presentation can be further divided into mentum anterior, posterior, or transverse. In brow presentation, anterior fontanelle and face can be palpated except for the mouth and the chin. Brow presentation can then be further described based on the position of the anterior fontanelle as frontal anterior, posterior, or transverse.

Diagnosing the exact presentation can be challenging, and face presentation may be misdiagnosed as frank breech. To avoid any confusion, a bedside ultrasound scan can be performed. [6]  The ultrasound imaging can show a reduced angle between the occiput and the spine or, the chin is separated from the chest. However, ultrasound does not provide much predicting value in the outcome of the labor. [7]

• Anatomy and Physiology

Before discussing the mechanism of labor in the face or brow presentation, it is crucial to highlight some anatomical landmarks and their measurements. 

Planes and Diameters of the Pelvis

The three most important planes in the female pelvis are the pelvic inlet, mid pelvis, and pelvic outlet. 

Four diameters can describe the pelvic inlet: anteroposterior, transverse, and two obliques. Furthermore, based on the different landmarks on the pelvic inlet, there are three different anteroposterior diameters, named conjugates: true conjugate, obstetrical conjugate, and diagonal conjugate. Only the latter can be measured directly during the obstetric examination. The shortest of these three diameters is obstetrical conjugate, which measures approximately 10.5 cm and is a distance between the sacral promontory and 1 cm below the upper border of the symphysis pubis. This measurement is clinically significant as the fetal head must pass through this diameter during the engagement phase. The transverse diameter measures about 13.5cm and is the widest distance between the innominate line on both sides. 

The shortest distance in the mid pelvis is the interspinous diameter and usually is only about 10 cm. 

Fetal Skull Diameters

There are six distinguished longitudinal fetal skull diameters:

• Suboccipito-bregmatic: from the center of anterior fontanelle (bregma) to the occipital protuberance, measuring 9.5 cm. This is the presenting diameter in vertex presentation. 
• Suboccipito-frontal: from the anterior part of bregma to the occipital protuberance, measuring 10 cm 
• Occipito-frontal: from the root of the nose to the most prominent part of the occiput, measuring 11.5cm
• Submento-bregmatic: from the center of the bregma to the angle of the mandible, measuring 9.5 cm. This is the presenting diameter in face presentation where the neck is hyperextended. 
• Submento-vertical: from the midpoint between fontanelles and the angle of the mandible, measuring 11.5cm 
• Occipito-mental: from the midpoint between fontanelles and the tip of the chin, measuring 13.5 cm. It is the presenting diameter in brow presentation. 

Cardinal Movements of Normal Labor

• Neck flexion
• Internal rotation
• Extension (delivers head)
• External rotation (Restitution)
• Expulsion (delivery of anterior and posterior shoulders)

Some of the key movements are not possible in the face or brow presentations.  

Based on the information provided above, it is obvious that labor will be arrested in brow presentation unless it spontaneously changes to face or vertex, as the occipito-mental diameter of the fetal head is significantly wider than the smallest diameter of the female pelvis. Face presentation can, however, be delivered vaginally, and further mechanisms of face delivery will be explained in later sections.

• Indications

As mentioned previously, spontaneous vaginal delivery can be successful in face presentation. However, the main indication for vaginal delivery in such circumstances would be a maternal choice. It is crucial to have a thorough conversation with a mother, explaining the risks and benefits of vaginal delivery with face presentation and a cesarean section. Informed consent and creating a rapport with the mother is an essential aspect of safe and successful labor.

• Contraindications

Vaginal delivery of face presentation is contraindicated if the mentum is lying posteriorly or is in a transverse position. In such a scenario, the fetal brow is pressing against the maternal symphysis pubis, and the short fetal neck, which is already maximally extended, cannot span the surface of the maternal sacrum. In this position, the diameter of the head is larger than the maternal pelvis, and it cannot descend through the birth canal. Therefore the cesarean section is recommended as the safest mode of delivery for mentum posterior face presentations. 

Attempts to manually convert face presentation to vertex, manual or forceps rotation of the persistent posterior chin to anterior are contraindicated as they can be dangerous.

Persistent brow presentation itself is a contraindication for vaginal delivery unless the fetus is significantly small or the maternal pelvis is large.

Continuous electronic fetal heart rate monitoring is recommended for face and brow presentations, as heart rate abnormalities are common in these scenarios. One study found that only 14% of the cases with face presentation had no abnormal traces on the cardiotocograph. [8] It is advised to use external transducer devices to prevent damage to the eyes. When internal monitoring is inevitable, it is suggested to place monitoring devices on bony parts carefully. 

People who are usually involved in the delivery of face/ brow presentation are:

• Experienced midwife, preferably looking after laboring woman 1:1
• Senior obstetrician 
• Neonatal team - in case of need for resuscitation 
• Anesthetic team - to provide necessary pain control (e.g., epidural)
• Theatre team  - in case of failure to progress and an emergency cesarean section will be required.
• Preparation

No specific preparation is required for face or brow presentation. However, it is essential to discuss the labor options with the mother and birthing partner and inform members of the neonatal, anesthetic, and theatre co-ordinating teams.

• Technique or Treatment

Mechanism of Labor in Face Presentation

During contractions, the pressure exerted by the fundus of the uterus on the fetus and pressure of amniotic fluid initiate descent. During this descent, the fetal neck extends instead of flexing. The internal rotation determines the outcome of delivery, if the fetal chin rotates posteriorly, vaginal delivery would not be possible, and cesarean section is permitted. The approach towards mentum-posterior delivery should be individualized, as the cases are rare. Expectant management is acceptable in multiparous women with small fetuses, as a spontaneous mentum-anterior rotation can occur. However, there should be a low threshold for cesarean section in primigravida women or women with large fetuses.

When the fetal chin is rotated towards maternal symphysis pubis as described as mentum-anterior; in these cases further descend through the vaginal canal continues with approximately 73% cases deliver spontaneously. [9] Fetal mentum presses on the maternal symphysis pubis, and the head is delivered by flexion. The occiput is pointing towards the maternal back, and external rotation happens. Shoulders are delivered in the same manner as in vertex delivery.

Mechanism of Labor in Brow Presentation

As this presentation is considered unstable, it is usually converted into a face or an occiput presentation. Due to the cephalic diameter being wider than the maternal pelvis, the fetal head cannot engage; thus, brow delivery cannot take place. Unless the fetus is small or the pelvis is very wide, the prognosis for vaginal delivery is poor. With persistent brow presentation, a cesarean section is required for safe delivery.

• Complications

As the cesarean section is becoming a more accessible mode of delivery in malpresentations, the incidence of maternal and fetal morbidity and mortality during face presentation has dropped significantly. [10]

However, there are still some complications associated with the nature of labor in face presentation. Due to the fetal head position, it is more challenging for the head to engage in the birth canal and descend, resulting in prolonged labor.

Prolonged labor itself can provoke foetal distress and arrhythmias. If the labor arrests or signs of fetal distress appear on CTG, the recommended next step in management is an emergency cesarean section, which in itself carries a myriad of operative and post-operative complications.

Finally, due to the nature of the fetal position and prolonged duration of labor in face presentation, neonates develop significant edema of the skull and face. Swelling of the fetal airway may also be present, resulting in respiratory distress after birth and possible intubation.

• Clinical Significance

During vertex presentation, the fetal head flexes, bringing the chin to the chest, forming the smallest possible fetal head diameter, measuring approximately 9.5cm. With face and brow presentation, the neck hyperextends, resulting in greater cephalic diameters. As a result, the fetal head will engage later, and labor will progress more slowly. Failure to progress in labor is also more common in both presentations compared to vertex presentation.

Furthermore, when the fetal chin is in a posterior position, this prevents further flexion of the fetal neck, as browns are pressing on the symphysis pubis. As a result, descend through the birth canal is impossible. Such presentation is considered undeliverable vaginally and requires an emergency cesarean section.

Manual attempts to change face presentation to vertex, manual or forceps rotation to mentum anterior are considered dangerous and are discouraged.

• Enhancing Healthcare Team Outcomes

A multidisciplinary team of healthcare experts supports the woman and her child during labor and the perinatal period. For a face or brow presentation to be appropriately diagnosed, an experienced midwife and obstetrician must be involved in the vaginal examination and labor monitoring. As fetal anomalies, such as anencephaly or goiter, can contribute to face presentation, sonographers experienced in antenatal scanning should also be involved in the care. It is advised to inform the anesthetic and neonatal teams in advance of the possible need for emergency cesarean section and resuscitation of the neonate. [11] [12]

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Disclosure: Julija Makajeva declares no relevant financial relationships with ineligible companies.

Disclosure: Mohsina Ashraf declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Makajeva J, Ashraf M. Delivery, Face and Brow Presentation. [Updated 2023 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Sonographic diagnosis of fetal head deflexion and the risk of cesarean delivery. [Am J Obstet Gynecol MFM. 2020] Sonographic diagnosis of fetal head deflexion and the risk of cesarean delivery. Bellussi F, Livi A, Cataneo I, Salsi G, Lenzi J, Pilu G. Am J Obstet Gynecol MFM. 2020 Nov; 2(4):100217. Epub 2020 Aug 18.
• Review Sonographic evaluation of the fetal head position and attitude during labor. [Am J Obstet Gynecol. 2024] Review Sonographic evaluation of the fetal head position and attitude during labor. Ghi T, Dall'Asta A. Am J Obstet Gynecol. 2024 Mar; 230(3S):S890-S900. Epub 2023 May 19.
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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 .

Other presentations

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. If they do not, a cesarean delivery is usually recommended.

In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

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14.1 Four Methods of Delivery

Learning objectives.

• Differentiate among the four methods of speech delivery.
• Understand when to use each of the four methods of speech delivery.

Maryland GovPics – House of Ruth Luncheon – CC BY 2.0.

The easiest approach to speech delivery is not always the best. Substantial work goes into the careful preparation of an interesting and ethical message, so it is understandable that students may have the impulse to avoid “messing it up” by simply reading it word for word. But students who do this miss out on one of the major reasons for studying public speaking: to learn ways to “connect” with one’s audience and to increase one’s confidence in doing so. You already know how to read, and you already know how to talk. But public speaking is neither reading nor talking.

Speaking in public has more formality than talking. During a speech, you should present yourself professionally. This doesn’t mean you must wear a suit or “dress up” (unless your instructor asks you to), but it does mean making yourself presentable by being well groomed and wearing clean, appropriate clothes. It also means being prepared to use language correctly and appropriately for the audience and the topic, to make eye contact with your audience, and to look like you know your topic very well.

While speaking has more formality than talking, it has less formality than reading. Speaking allows for meaningful pauses, eye contact, small changes in word order, and vocal emphasis. Reading is a more or less exact replication of words on paper without the use of any nonverbal interpretation. Speaking, as you will realize if you think about excellent speakers you have seen and heard, provides a more animated message.

The next sections introduce four methods of delivery that can help you balance between too much and too little formality when giving a public speech.

Impromptu Speaking

Impromptu speaking is the presentation of a short message without advance preparation. Impromptu speeches often occur when someone is asked to “say a few words” or give a toast on a special occasion. You have probably done impromptu speaking many times in informal, conversational settings. Self-introductions in group settings are examples of impromptu speaking: “Hi, my name is Steve, and I’m a volunteer with the Homes for the Brave program.” Another example of impromptu speaking occurs when you answer a question such as, “What did you think of the documentary?”

The advantage of this kind of speaking is that it’s spontaneous and responsive in an animated group context. The disadvantage is that the speaker is given little or no time to contemplate the central theme of his or her message. As a result, the message may be disorganized and difficult for listeners to follow.

Here is a step-by-step guide that may be useful if you are called upon to give an impromptu speech in public.

• Take a moment to collect your thoughts and plan the main point you want to make.
• Thank the person for inviting you to speak.
• Deliver your message, making your main point as briefly as you can while still covering it adequately and at a pace your listeners can follow.
• Thank the person again for the opportunity to speak.
• Stop talking.

As you can see, impromptu speeches are generally most successful when they are brief and focus on a single point.

Extemporaneous Speaking

Extemporaneous speaking is the presentation of a carefully planned and rehearsed speech, spoken in a conversational manner using brief notes. By using notes rather than a full manuscript, the extemporaneous speaker can establish and maintain eye contact with the audience and assess how well they are understanding the speech as it progresses. The opportunity to assess is also an opportunity to restate more clearly any idea or concept that the audience seems to have trouble grasping.

For instance, suppose you are speaking about workplace safety and you use the term “sleep deprivation.” If you notice your audience’s eyes glazing over, this might not be a result of their own sleep deprivation, but rather an indication of their uncertainty about what you mean. If this happens, you can add a short explanation; for example, “sleep deprivation is sleep loss serious enough to threaten one’s cognition, hand-to-eye coordination, judgment, and emotional health.” You might also (or instead) provide a concrete example to illustrate the idea. Then you can resume your message, having clarified an important concept.

Speaking extemporaneously has some advantages. It promotes the likelihood that you, the speaker, will be perceived as knowledgeable and credible. In addition, your audience is likely to pay better attention to the message because it is engaging both verbally and nonverbally. The disadvantage of extemporaneous speaking is that it requires a great deal of preparation for both the verbal and the nonverbal components of the speech. Adequate preparation cannot be achieved the day before you’re scheduled to speak.

Because extemporaneous speaking is the style used in the great majority of public speaking situations, most of the information in this chapter is targeted to this kind of speaking.

Speaking from a Manuscript

Manuscript speaking is the word-for-word iteration of a written message. In a manuscript speech, the speaker maintains his or her attention on the printed page except when using visual aids.

The advantage to reading from a manuscript is the exact repetition of original words. As we mentioned at the beginning of this chapter, in some circumstances this can be extremely important. For example, reading a statement about your organization’s legal responsibilities to customers may require that the original words be exact. In reading one word at a time, in order, the only errors would typically be mispronunciation of a word or stumbling over complex sentence structure.

However, there are costs involved in manuscript speaking. First, it’s typically an uninteresting way to present. Unless the speaker has rehearsed the reading as a complete performance animated with vocal expression and gestures (as poets do in a poetry slam and actors do in a reader’s theater), the presentation tends to be dull. Keeping one’s eyes glued to the script precludes eye contact with the audience. For this kind of “straight” manuscript speech to hold audience attention, the audience must be already interested in the message before the delivery begins.

It is worth noting that professional speakers, actors, news reporters, and politicians often read from an autocue device, such as a TelePrompTer, especially when appearing on television, where eye contact with the camera is crucial. With practice, a speaker can achieve a conversational tone and give the impression of speaking extemporaneously while using an autocue device. However, success in this medium depends on two factors: (1) the speaker is already an accomplished public speaker who has learned to use a conversational tone while delivering a prepared script, and (2) the speech is written in a style that sounds conversational.

Speaking from Memory

Memorized speaking is the rote recitation of a written message that the speaker has committed to memory. Actors, of course, recite from memory whenever they perform from a script in a stage play, television program, or movie scene. When it comes to speeches, memorization can be useful when the message needs to be exact and the speaker doesn’t want to be confined by notes.

The advantage to memorization is that it enables the speaker to maintain eye contact with the audience throughout the speech. Being free of notes means that you can move freely around the stage and use your hands to make gestures. If your speech uses visual aids, this freedom is even more of an advantage. However, there are some real and potential costs. First, unless you also plan and memorize every vocal cue (the subtle but meaningful variations in speech delivery, which can include the use of pitch, tone, volume, and pace), gesture, and facial expression, your presentation will be flat and uninteresting, and even the most fascinating topic will suffer. You might end up speaking in a monotone or a sing-song repetitive delivery pattern. You might also present your speech in a rapid “machine-gun” style that fails to emphasize the most important points. Second, if you lose your place and start trying to ad lib, the contrast in your style of delivery will alert your audience that something is wrong. More frighteningly, if you go completely blank during the presentation, it will be extremely difficult to find your place and keep going.

Key Takeaways

• There are four main kinds of speech delivery: impromptu, extemporaneous, manuscript, and memorized.
• Impromptu speaking involves delivering a message on the spur of the moment, as when someone is asked to “say a few words.”
• Extemporaneous speaking consists of delivering a speech in a conversational fashion using notes. This is the style most speeches call for.
• Manuscript speaking consists of reading a fully scripted speech. It is useful when a message needs to be delivered in precise words.
• Memorized speaking consists of reciting a scripted speech from memory. Memorization allows the speaker to be free of notes.
• Find a short newspaper story. Read it out loud to a classroom partner. Then, using only one notecard, tell the classroom partner in your own words what the story said. Listen to your partner’s observations about the differences in your delivery.
• In a group of four or five students, ask each student to give a one-minute impromptu speech answering the question, “What is the most important personal quality for academic success?”
• Watch the evening news. Observe the differences between news anchors using a TelePrompTer and interviewees who are using no notes of any kind. What differences do you observe?

Stand up, Speak out Copyright © 2016 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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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.

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

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Face and Brow Presentation

• Author: Teresa Marino, MD; Chief Editor: Carl V Smith, MD  more...
• Sections Face and Brow Presentation
• Mechanism of Labor
• Labor Management

At the onset of labor, assessment of the fetal presentation with respect to the maternal birth canal is critical to the route of delivery. At term, the vast majority of fetuses present in the vertex presentation, where the fetal head is flexed so that the chin is in contact with the fetal thorax. The fetal spine typically lies along the longitudinal axis of the uterus. Nonvertex presentations (including breech, transverse lie, face, brow, and compound presentations) occur in less than 4% of fetuses at term. Malpresentation of the vertex presentation occurs if there is deflexion or extension of the fetal head leading to brow or face presentation, respectively.

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 internal examination through the cervix. The occiput of a vertex is usually hard and has a smooth contour, while the face and brow tend to be more irregular and soft. Like the occiput, the mentum can present in any position relative to the maternal pelvis. For example, if the mentum presents in the left anterior quadrant of the maternal pelvis, it is designated as left mentum anterior (LMA).

In a brow presentation, the fetal head is midway between full flexion (vertex) and hyperextension (face) along a longitudinal axis. The presenting portion of the fetal head is between the orbital ridge and the anterior fontanel. The face and chin are not included. The frontal bones are the point of designation and can present (as with the occiput during a vertex delivery) in any position relative to the maternal pelvis. When the sagittal suture is transverse to the pelvic axis and the anterior fontanel is on the right maternal side, the fetus would be in the right frontotransverse position (RFT).

Face presentation occurs in 1 of every 600-800 live births, averaging about 0.2% of live births. Causative factors associated with a face presentation are similar to those leading to general malpresentation and those that prevent head flexion or favor extension. Possible etiology includes multiple gestations, grand multiparity, fetal malformations, prematurity, and cephalopelvic disproportion. At least one etiological factor may be identified in up to 90% of cases with face presentation.

Fetal anomalies such as hydrocephalus, anencephaly, and neck masses are common risk factors and may account for as many as 60% of cases of face presentation. For example, anencephaly is found in more than 30% of cases of face presentation. Fetal thyromegaly and neck masses also lead to extension of the fetal head.

A contracted pelvis or cephalopelvic disproportion, from either a small pelvis or a large fetus, occurs in 10-40% of cases. Multiparity or a large abdomen can cause decreased uterine tone, leading to natural extension of the fetal head.

Face presentation is diagnosed late in the first or second stage of labor by examination of a dilated cervix. On digital examination, the distinctive facial features of the nose, mouth, and chin, the malar bones, and particularly the orbital ridges can be palpated. This presentation can be confused with a breech presentation because the mouth may be confused with the anus and the malar bones or orbital ridges may be confused with the ischial tuberosities. The facial presentation has a triangular configuration of the mouth to the orbital ridges compared to the breech presentation of the anus and fetal genitalia. During Leopold maneuvers, diagnosis is very unlikely. Diagnosis can be confirmed by ultrasound evaluation, which reveals a hyperextended fetal neck. [ 1 , 2 ]

Brow presentation is the least common of all fetal presentations and the incidence varies from 1 in 500 deliveries to 1 in 1400 deliveries. Brow presentation may be encountered early in labor but is usually a transitional state and converts to a vertex presentation after the fetal neck flexes. Occasionally, further extension may occur resulting in a face presentation.

The causes of a persistent brow presentation are generally similar to those causing a face presentation and include cephalopelvic disproportion or pelvic contracture, increasing parity and prematurity. These are implicated in more than 60% of cases of persistent brow presentation. Premature rupture of membranes may precede brow presentation in as many as 27% of cases.

Diagnosis of a brow presentation can occasionally be made with abdominal palpation by Leopold maneuvers. A prominent occipital prominence is encountered along the fetal back, and the fetal chin is also palpable; however, the diagnosis of a brow presentation is usually confirmed by examination of a dilated cervix. The orbital ridge, eyes, nose, forehead, and anterior fontanelle are palpated. The mouth and chin are not palpable, thus excluding face presentation. Fetal ultrasound evaluation again notes a hyperextended neck.

As with face presentation, diagnosis is often made late in labor with half of cases occurring in the second stage of labor. The most common position is the mentum anterior, which occurs about twice as often as either transverse or posterior positions. A higher cesarean delivery rate occurs with a mentum transverse or posterior [ 3 ] position than with a mentum anterior position.

The mechanism of labor consists of the cardinal movements of engagement, descent, flexion, internal rotation, and the accessory movements of extension and external rotation. Intuitively, the cardinal movements of labor for a face presentation are not completely identical to those of a vertex presentation.

While descending into the pelvis, the natural contractile forces combined with the maternal pelvic architecture allow the fetal head to either flex or extend. In the vertex presentation, the vertex is flexed such that the chin rests on the fetal chest, allowing the suboccipitobregmatic diameter of approximately 9.5 cm to be the widest diameter through the maternal pelvis. This is the smallest of the diameters to negotiate the maternal pelvis. Following engagement in the face presentation, descent is made. The widest diameter of the fetal head negotiating the pelvis is the trachelobregmatic or submentobregmatic diameter, which is 10.2 cm (0.7 cm larger than the suboccipitobregmatic diameter). Because of this increased diameter, engagement does not occur until the face is at +2 station.

Fetuses with face presentation may initially begin labor in the brow position. Using x-ray pelvimetry in a series of 7 patients, Borrell and Ferstrom demonstrated that internal rotation occurs between the ischial spines and the ischial tuberosities, making the chin the presenting part, lower than in the vertex presentation. [ 4 , 5 ] Following internal rotation, the mentum is below the maternal symphysis, and delivery occurs by flexion of the fetal neck. As the face descends onto the perineum, the anterior fetal chin passes under the symphysis and flexion of the head occurs, making delivery possible with maternal expulsive forces.

The above mechanisms of labor in the term infant can occur only if the mentum is anterior and at term, only the mentum anterior face presentation is likely to deliver vaginally. If the mentum is posterior or transverse, the fetal neck is too short to span the length of the maternal sacrum and is already at the point of maximal extension. The head cannot deliver as it cannot extend any further through the symphysis and cesarean delivery is the safest route of delivery.

Fortunately, the mentum is anterior in over 60% of cases of face presentation, transverse in 10-12% of cases, and posterior only 20-25% of the time. Fetuses with the mentum transverse position usually rotate to the mentum anterior position, and 25-33% of fetuses with mentum posterior position rotate to a mentum anterior position. When the mentum is posterior, the neck, head and shoulders must enter the pelvis simultaneously, resulting in a diameter too large for the maternal pelvis to accommodate unless in the very preterm or small infant.

Three labor courses are possible when the fetal head engages in a brow presentation. The brow may convert to a vertex presentation, to a face presentation, or remain as a persistent brow presentation. More than 50% of brow presentations will convert to vertex or face presentation and labor courses are managed accordingly when spontaneous conversion occurs.

In the brow presentation, the occipitomental diameter, which is the largest diameter of the fetal head, is the presenting portion. Descent and internal rotation occur only with an adequate pelvis and if the face can fit under the pubic arch. While the head descends, it becomes wedged into the hollow of the sacrum. Downward pressure from uterine contractions and maternal expulsive forces may cause the mentum to extend anteriorly and low to present at the perineum as a mentum anterior face presentation.

If internal rotation does not occur, the occipitomental diameter, which measures 1.5 cm wider than the suboccipitobregmatic diameter and is thus the largest diameter of the fetal head, presents at the pelvic inlet. The head may engage but can descend only with significant molding. This molding and subsequent caput succedaneum over the forehead can become so extensive that identification of the brow by palpation is impossible late in labor. This may result in a missed diagnosis in a patient who presents later in active labor.

If the mentum is anterior and the forces of labor are directed toward the fetal occiput, flexing the head and pivoting the face under the pubic arch, there is conversion to a vertex occiput posterior position. If the occiput lies against the sacrum and the forces of labor are directed against the fetal mentum, the neck may extend further, leading to a face presentation.

The persistent brow presentation with subsequent delivery only occurs in cases of a large pelvis and/or a small infant. Women with gynecoid pelvis or multiparity may be given the option to labor; however, dysfunctional labor and cephalopelvic disproportion are more likely if this presentation persists.

Labor management of face and brow presentation requires close observation of labor progression because cephalopelvic disproportion, dysfunctional labor, and prolonged labor are much more common. As mentioned above, the trachelobregmatic or submentobregmatic diameters are larger than the suboccipitobregmatic diameter. Duration of labor with a face presentation is generally the same as duration of labor with a vertex presentation, although a prolonged labor may occur. As long as maternal or fetal compromise is not evident, labor with a face presentation may continue. [ 6 ] A persistent mentum posterior presentation is an indication for delivery by cesarean section.

Continuous electronic fetal heart rate monitoring is considered mandatory by many authors because of the increased incidence of abnormal fetal heart rate patterns and/or nonreassuring fetal heart rate patterns. [ 7 ] An internal fetal scalp electrode may be used, but very careful application of the electrode must be ensured. The mentum is the recommended site of application. Facial edema is common and can obscure the fetal facial anatomy and improper placement can lead to facial and ophthalmic injuries. Oxytocin can be used to augment labor using the same precautions as in a vertex presentation and the same criteria of assessment of uterine activity, adequacy of the pelvis, and reassuring fetal heart tracing.

Fetuses with face presentation can be delivered vaginally with overall success rates of 60-70%, while more than 20% of fetuses with face presentation require cesarean delivery. Cesarean delivery is performed for the usual obstetrical indications, including arrest of labor and nonreassuring fetal heart rate pattern.

Attempts to manually convert the face to vertex (Thom maneuver) or to rotate a posterior position to a more favorable anterior mentum position are rarely successful and are associated with high fetal morbidity and mortality and maternal morbidity, including cord prolapse, uterine rupture, and fetal cervical spine injury with neurological impairment. Given the availability and safety of cesarean delivery, internal rotation maneuvers are no longer justified unless cesarean section cannot be readily performed.

Internal podalic version and breech extraction are also no longer recommended in the modern management of the face presentation. [ 8 ]

Operative delivery with forceps must be approached with caution. Since engagement occurs when the face is at +2 position, forceps should only be applied to the face that has caused the perineum to bulge. Increased complications to both mother and fetus can occur [ 9 ] and operative delivery must be approached with caution or reserved when cesarean section is not readily available. Forceps may be used if the mentum is anterior. Although the landmarks are different, the application of any forceps is made as if the fetus were presenting directly in the occiput anterior position. The mouth substitutes for the posterior fontanelle, and the mentum substitutes for the occiput. Traction should be downward to maintain extension until the mentum passes under the symphysis, and then gradually elevated to allow the head to deliver by flexion. During delivery, hyperextension of the fetal head should be avoided.

As previously mentioned, the persistent brow presentation has a poor prognosis for vaginal delivery unless the fetus is small, premature, or the maternal pelvis is large. Expectant management is reasonable if labor is progressing well and the fetal well-being is assessed, as there can be spontaneous conversion to face or vertex presentation. The earlier in labor that brow presentation is diagnosed, the higher the likelihood of conversion. Minimal intervention during labor is recommended and some feel the use of oxytocin in the brow presentation is contraindicated.

The use of operative vaginal delivery or manual conversion of a brow to a more favorable presentation is contraindicated as the risks of perinatal morbidity and mortality are unacceptably high. Prolonged, dysfunctional, and arrest of labor are common, necessitating cesarean section delivery.

The incidence of perinatal morbidity and mortality and maternal morbidity has decreased due to the increased incidence of cesarean section delivery for malpresentation, including face and brow presentation.

Neonates delivered in the face presentation exhibit significant facial and skull edema, which usually resolves within 24-48 hours. Trauma during labor may cause tracheal and laryngeal edema immediately after delivery, which can result in neonatal respiratory distress. In addition, fetal anomalies or tumors, such as fetal goiters that may have contributed to fetal malpresentation, may make intubation difficult. Physicians with expertise in neonatal resuscitation should be present at delivery in the event that intubation is required. When a fetal anomaly has been previously diagnosed by ultrasonographic evaluation, the appropriate pediatric specialists should be consulted and informed at time of labor.

Bellussi F, Ghi T, Youssef A, et al. The use of intrapartum ultrasound to diagnose malpositions and cephalic malpresentations. Am J Obstet Gynecol . 2017 Dec. 217 (6):633-41. [QxMD MEDLINE Link] .

[Guideline] Ghi T, Eggebø T, Lees C, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol . 2018 Jul. 52 (1):128-39. [QxMD MEDLINE Link] . [Full Text] .

Shaffer BL, Cheng YW, Vargas JE, Laros RK Jr, Caughey AB. Face presentation: predictors and delivery route. Am J Obstet Gynecol . 2006 May. 194(5):e10-2. [QxMD MEDLINE Link] .

Borell U, Fernstrom I. The mechanism of labour. Radiol Clin North Am . 1967 Apr. 5(1):73-85. [QxMD MEDLINE Link] .

Borell U, Fernstrom I. The mechanism of labour in face and brow presentation: a radiographic study. Acta Obstet Gynecol Scand . 1960. 39:626-44.

Gardberg M, Leonova Y, Laakkonen E. Malpresentations--impact on mode of delivery. Acta Obstet Gynecol Scand . 2011 May. 90(5):540-2. [QxMD MEDLINE Link] .

Collaris RJ, Oei SG. External cephalic version: a safe procedure? A systematic review of version-related risks. Acta Obstet Gynecol Scand . 2004 Jun. 83(6):511-8. [QxMD MEDLINE Link] .

Verspyck E, Bisson V, Gromez A, Resch B, Diguet A, Marpeau L. Prophylactic attempt at manual rotation in brow presentation at full dilatation. Acta Obstet Gynecol Scand . 2012 Nov. 91(11):1342-5. [QxMD MEDLINE Link] .

Johnson JH, Figueroa R, Garry D. Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. Obstet Gynecol . 2004 Mar. 103(3):513-8. [QxMD MEDLINE Link] .

Benedetti TJ, Lowensohn RI, Truscott AM. Face presentation at term. Obstet Gynecol . 1980 Feb. 55(2):199-202. [QxMD MEDLINE Link] .

BROWNE AD, CARNEY D. OBSTETRICS IN GENERAL PRACTICE. MANAGEMENT OF MALPRESENTATIONS IN OBSTETRICS. Br Med J . 1964 May 16. 1(5393):1295-8. [QxMD MEDLINE Link] .

Campbell JM. Face presentation. Aust N Z J Obstet Gynaecol . 1965 Nov. 5(4):231-4. [QxMD MEDLINE Link] .

Contributor Information and Disclosures

Teresa Marino, MD Assistant Professor, Attending Physician, Division of Maternal-Fetal Medicine, Tufts Medical Center Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape.

Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists , American Institute of Ultrasound in Medicine , Association of Professors of Gynecology and Obstetrics , Central Association of Obstetricians and Gynecologists , Society for Maternal-Fetal Medicine , Council of University Chairs of Obstetrics and Gynecology , Nebraska Medical Association Disclosure: Nothing to disclose.

Chitra M Iyer, MD, Perinatologist, Obstetrix Medical Group, Fort Worth, Texas.

Chitra M Iyer, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists , Society of Maternal-Fetal Medicine .

Disclosure: Nothing to disclose.

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Your baby in the birth canal

During labor and delivery, your baby must pass through your pelvic bones to reach the vaginal opening. The goal is to find the easiest way out. Certain body positions give the baby a smaller shape, which makes it easier for your baby to get through this tight passage.

The best position for the baby to pass through the pelvis is with the head down and the body facing toward the mother's back. This position is called occiput anterior.

Information

Certain terms are used to describe your baby's position and movement through the birth canal.

FETAL STATION

Fetal station refers to where the presenting part is in your pelvis.

• The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
• Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
• 0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
• If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.

In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.

This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between their head and tailbone.

Your baby will most often settle into a position in the pelvis before labor begins.

• If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
• If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.

FETAL ATTITUDE

The fetal attitude describes the position of the parts of your baby's body.

The normal fetal attitude is commonly called the fetal position.

• The head is tucked down to the chest.
• The arms and legs are drawn in towards the center of the chest.

Abnormal fetal attitudes include a head that is tilted back, so the brow or the face presents first. Other body parts may be positioned behind the back. When this happens, the presenting part will be larger as it passes through the pelvis. This makes delivery more difficult.

DELIVERY PRESENTATION

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.

• This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
• There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).

If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.

Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:

• A complete breech is when the buttocks present first and both the hips and knees are flexed.
• A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
• Other breech positions occur when either the feet or knees present first.

The shoulder, arm, or trunk may present first if the fetus is in a transverse lie. This type of presentation occurs less than 1% of the time. Transverse lie is more common when you deliver before your due date, or have twins or triplets.

CARDINAL MOVEMENTS OF LABOR

As your baby passes through the birth canal, the baby's head will change positions. These changes are needed for your baby to fit and move through your pelvis. These movements of your baby's head are called cardinal movements of labor.

• This is when the widest part of your baby's head has entered the pelvis.
• Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).
• This is when your baby's head moves down (descends) further through your pelvis.
• Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.
• During descent, the baby's head is flexed down so that the chin touches the chest.
• With the chin tucked, it is easier for the baby's head to pass through the pelvis.

Internal Rotation

• As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
• Usually, the baby will be face down toward your spine.
• Sometimes, the baby will rotate so it faces up toward the pubic bone.
• As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.
• As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
• At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.

External Rotation

• As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.
• After the head is delivered, the top shoulder is delivered under the pubic bone.
• After the shoulder, the rest of the body is usually delivered without a problem.

Alternative Names

Shoulder presentation; Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude; Fetal descent; Fetal station; Cardinal movements; Labor-birth canal; Delivery-birth canal

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Kilpatrick SJ, Garrison E, Fairbrother E. Normal labor and delivery. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 11.

Review Date 11/10/2022

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

• Childbirth Problems

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Complete Guide for Effective Presentations, with Examples

July 9, 2018 - Dom Barnard

During a presentation you aim to look confident, enthusiastic and natural. You’ll need more than good words and content to achieve this – your delivery plays a significant part. In this article, we discuss various techniques that can be used to deliver an effective presentation.

Effective presentations

Think about if you were in the audience, what would:

• Get you to focus and listen
• Make you understand
• Activate your imagination
• Persuade you

Providing the audience with interesting information is not enough to achieve these aims – you need to ensure that the way you present is stimulating and engaging. If it’s not, you’ll lose the audience’s interest and they’ll stop listening.

Tips for an Effective Presentation

Professional public speakers spend hours creating and practicing presentations. These are the delivery techniques they consider:

Keep it simple

You shouldn’t overwhelm your audience with information – ensure that you’re clear, concise and that you get to the point so they can understand your message.

Have a maximum of  three main points  and state them at the beginning, before you explain them in more depth, and then state them at the end so the audience will at least remember these points.

If some of your content doesn’t contribute to your key message then cut it out. Also avoid using too many statistics and technical terminology.

Connect with your audience

One of the greatest difficulties when delivering a presentation is connecting with the audience. If you don’t  connect with them  it will seem as though you’re talking to an empty room.

Trying to make contact with the audience makes them feel like they’re part of the presentation which encourages them to listen and it shows that you want to speak to them.

Eye contact and smile

Avoiding eye contact is uncomfortable because it make you look insecure. When you  maintain eye contact  the audience feels like you’re speaking to them personally. If this is something you struggle with, try looking at people’s foreheads as it gives the impression of making eye contact.

Try to cover all sections of the audience and don’t move on to the next person too quickly as you will look nervous.

Smiling also helps with rapport and it reduces your nerves because you’ll feel less like you’re talking to group of faceless people. Make sure you don’t turn the lights down too much before your presentation so you can all clearly see each other.

Body language

Be aware of your body language and use it to connect:

• Keep your arms uncrossed so your  body language is more open .
• Match your facial expressions with what you’re saying.
• Avoid fidgeting and displaying nervous habits, such as, rocking on your feet.
• You may need to glance at the computer slide or a visual aid but make sure you predominantly face the audience.
• Emphasise points by using hand gestures but use them sparingly – too little and they’ll awkwardly sit at your side, too much and you’ll be distracting and look nervous.
• Vary your gestures so you don’t look robotic.
• Maintain a straight posture.
• Be aware of  cultural differences .

Move around

Avoid standing behind the lectern or computer because you need to reduce the distance and barriers between yourself and the audience.  Use movement  to increase the audience’s interest and make it easier to follow your presentation.

A common technique for incorporating movement into your presentation is to:

• Start your introduction by standing in the centre of the stage.
• For your first point you stand on the left side of the stage.
• You discuss your second point from the centre again.
• You stand on the right side of the stage for your third point.
• The conclusion occurs in the centre.

Watch 3 examples of good and bad movement while presenting

Example: Movement while presenting

Your movement at the front of the class and amongst the listeners can help with engagement. Think about which of these three speakers maintains the attention of their audience for longer, and what they are doing differently to each other.

Speak with the audience

You can conduct polls using your audience or ask questions to make them think and feel invested in your presentation. There are three different types of questions:

Direct questions require an answer: “What would you do in this situation?” These are mentally stimulating for the audience. You can pass a microphone around and let the audience come to your desired solution.

Rhetorical questions  do not require answers, they are often used to emphasises an idea or point: “Is the Pope catholic?

Loaded questions contain an unjustified assumption made to prompt the audience into providing a particular answer which you can then correct to support your point: You may ask “Why does your wonderful company have such a low incidence of mental health problems?” The audience will generally answer that they’re happy.

After receiving the answers you could then say “Actually it’s because people are still unwilling and too embarrassed to seek help for mental health issues at work etc.”

Be specific with your language

Make the audience feel as though you are speaking to each member individually by using “you” and “your.”

For example: asking “Do you want to lose weight without feeling hungry?” would be more effective than asking “Does anyone here want to lost weight without feeling hungry?” when delivering your presentation. You can also increase solidarity by using “we”, “us” etc – it makes the audience think “we’re in this together”.

Be flexible

Be prepared to adapt to the situation at the time, for example, if the audience seems bored you can omit details and go through the material faster, if they are confused then you will need to come up with more examples on the spot for clarification. This doesn’t mean that you weren’t prepared because you can’t predict everything.

Vocal variety

How you say something is just as is important as the content of your speech – arguably, more so.

For example, if an individual presented on a topic very enthusiastically the audience would probably enjoy this compared to someone who covered more points but mumbled into their notes.

• Adapt your voice  depending on what are you’re saying – if you want to highlight something then raise your voice or lower it for intensity. Communicate emotion by using your voice.
• Avoid speaking in monotone as you will look uninterested and the audience will lose interest.
• Take time to pronounce every word carefully.
• Raise your pitch when asking questions and lower it when you want to sound severe.
• Sound enthusiastic – the more you sound like you care about the topic, the more the audience will listen. Smiling and pace can help with this.
• Speak loudly and clearly – think about projecting your voice to the back of the room.
• Speak at a  pace that’s easy to follow . If you’re too fast or too slow it will be difficult for the audience to understand what you’re saying and it’s also frustrating. Subtly fasten the pace to show enthusiasm and slow down for emphasis, thoughtfulness or caution.

Prior to the presentation, ensure that you  prepare your vocal chords :

• You could read aloud a book that requires vocal variety, such as, a children’s book.
• Avoid dairy and eating or drinking anything too sugary beforehand as mucus can build-up leading to frequent throat clearing.
• Don’t drink anything too cold before you present as this can constrict your throat which affects vocal quality.
• Some people suggest a warm cup of tea beforehand to relax the throat.

Practice Presentation Skills

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Pause to breathe

When you’re anxious your breathing will become quick and shallow which will affect the control you have on your voice. This can consequently make you feel more nervous. You want to breathe steadily and deeply so before you start speaking take some deep breaths or implement controlled breathing.

Controlled breathing is a common technique that helps slow down your breathing to normal thus reducing your anxiety. If you think this may be useful practice with these steps:

• Sit down in an upright position as it easier for your lungs to fill with air
• Breathe in through your nose and into your abdomen for four seconds
• Hold this breathe for two seconds
• Breathe out through your nose for six seconds
• Wait a few seconds before inhaling and repeating the cycle

It takes practice to master this technique but once you get used to it you may want to implement it directly before your presentation.

Completely filling your lungs during a pause will ensure you reach a greater vocal range.

During the presentation delivery, if you notice that you’re speaking too quickly then pause and breathe. This won’t look strange – it will appear as though you’re giving thought to what you’re saying. You can also strategically plan some of your pauses, such as after questions and at the end of sections, because this will give you a chance to calm down and it will also give the audience an opportunity to think and reflect.

Pausing will also help you  avoid filler words , such as, “um” as well which can make you sound unsure.

• 10 Effective Ways to use Pauses in your Speech

Strong opening

The first five minutes are  vital to engage the audience  and get them listening to you. You could start with a story to highlight why your topic is significant.

For example, if the topic is on the benefits of pets on physical and psychological health, you could present a story or a study about an individual whose quality of life significantly improved after being given a dog. The audience is more likely to respond better to this and remember this story than a list of facts.

Example: Which presentation intro keeps you engaged?

Watch 5 different presentation introductions, from both virtual and in-person events. Notice how it can only take a few seconds to decide if you want to keep listening or switch off. For the good introductions, what about them keeps you engaged?

More experienced and confident public speakers use humour in their presentations. The audience will be incredibly engaged if you make them laugh but caution must be exercised when using humour because a joke can be misinterpreted and even offend the audience.

Only use jokes if you’re confident with this technique, it has been successful in the past and it’s suitable for the situation.

Stories and anecdotes

Use stories whenever you can and judge whether you can tell a story about yourself because the audience are even more interested in seeing the human side of you.

Consider telling a story about a mistake you made, for example, perhaps you froze up during an important presentation when you were 25, or maybe life wasn’t going well for you in the past – if relevant to your presentation’s aim. People will relate to this as we have all experienced mistakes and failures. The more the audience relates to you, the more likely they will remain engaged.

These stories can also be  told in a humorous way  if it makes you feel more comfortable and because you’re disclosing a personal story there is less chance of misinterpretation compared to telling a joke.

Anecdotes are especially valuable for your introduction and between different sections of the presentation because they engage the audience. Ensure that you plan the stories thoroughly beforehand and that they are not too long.

Focus on the audience’s needs

Even though your aim is to persuade the audience, they must also get something helpful from the presentation. Provide the audience with value by giving them useful information, tactics, tips etc. They’re more likely to warm to you and trust you if you’re sharing valuable information with them.

You could also highlight their pain point. For example, you might ask “Have you found it difficult to stick to a healthy diet?” The audience will now want to remain engaged because they want to know the solution and the opportunities that you’re offering.

Use visual aids

Visual aids are items of a visual manner, such as graphs, photographs, video clips etc used in addition to spoken information. Visual aids are chosen depending on their purpose, for example, you may want to:

• Summarise information.
• Reduce the amount of spoken words, for example, you may show a graph of your results rather than reading them out.
• Clarify and show examples.
• Create more of an impact. You must consider what type of impact you want to make beforehand – do you want the audience to be sad, happy, angry etc?
• Emphasise what you’re saying.
• Make a point memorable.
• Enhance your credibility.
• Engage the audience and maintain their interest.
• Make something easier for the audience to understand.

Some general tips for  using visual aids :

• Think about how can a visual aid can support your message. What do you want the audience to do?
• Ensure that your visual aid follows what you’re saying or this will confuse the audience.
• Avoid cluttering the image as it may look messy and unclear.
• Visual aids must be clear, concise and of a high quality.
• Keep the style consistent, such as, the same font, colours, positions etc
• Use graphs and charts to present data.
• The audience should not be trying to read and listen at the same time – use visual aids to highlight your points.
• One message per visual aid, for example, on a slide there should only be one key point.
• Use visual aids in moderation – they are additions meant to emphasise and support main points.
• Ensure that your presentation still works without your visual aids in case of technical problems.

10-20-30 slideshow rule

Slideshows are widely used for presentations because it’s easy to create attractive and professional presentations using them. Guy Kawasaki, an entrepreneur and author, suggests that slideshows should  follow a 10-20-30 rule :

• There should be a maximum of 10 slides – people rarely remember more than one concept afterwards so there’s no point overwhelming them with unnecessary information.
• The presentation should last no longer than 20 minutes as this will leave time for questions and discussion.
• The font size should be a minimum of 30pt because the audience reads faster than you talk so less information on the slides means that there is less chance of the audience being distracted.

If you want to give the audience more information you can provide them with partially completed handouts or give them the handouts after you’ve delivered the presentation.

Keep a drink nearby

Have something to drink when you’re on stage, preferably water at room temperature. This will help maintain your vocal quality and having a sip is a subtle way of introducing pauses.

Practice, practice, practice

If you are very familiar with the content of your presentation, your audience will perceive you as confident and you’ll be more persuasive.

• Don’t just read the presentation through – practice everything,  including your transitions  and using your visual aids.
• Stand up and speak it aloud, in an engaging manner, as though you were presenting to an audience.
• Ensure that you practice your body language and gesturing.
• Use VR to  practice in a realistic environment .
• Practice in front of others and get their feedback.
• Freely improvise so you’ll sound more natural on the day. Don’t learn your presentation verbatim because you will sound uninterested and if you lose focus then you may forget everything.
• Create cards to use as cues – one card should be used for one key idea. Write down brief notes or key words and ensure that the cards are physically connected so the order cannot be lost. Visual prompts can also be used as cues.

This video shows how you can practice presentations in virtual reality. See our  VR training courses .

Two courses where you can practice your presentations in interactive exercises:

• Essential Public Speaking
• How to Present over Video

Try these different presentation delivery methods to see which ones you prefer and which need to be improved. The most important factor is to feel comfortable during the presentation as the delivery is likely to be better.

Remember that the audience are generally on your side – they want you to do well so present with confidence.

pregnancy health center / pregnancy a-z list / what are the different fetal positions article

What Are the Different Fetal Positions?

• Medical Author: Karthik Kumar, MBBS
• Medical Reviewer: Pallavi Suyog Uttekar, MD

5 Types of Fetal Positions and Presentations

• Comments **COMMENTSTAGLIST**
• More **OTHERTAGLIST**

The relationship between your baby's backbone and your backbone when your baby is in-utero is called the fetal position. Your baby can be in a variety of fetal positions, some make birth easier than others.

• Longitudinal position: The fetus’ and mother’s backbones are parallel to each other in this position.
• Transverse position: In this posture, the fetus’ backbone is at a right angle to the mother's backbone.
• Oblique position: The inclination angle of the fetus backbone is more than 0 and less than 90 degrees of the mother's backbone in this position.

Most people, however, confuse fetal position with the fetal presentation.

• Fetal position refers to whether the fetus is facing backward (facing the woman's back when she lies down) or forward (facing the woman's abdomen when she lies down).
• Fetal presentation is the body part of the baby that leads the way out of the birth canal.

The fetal position and presentation of your baby may influence the difficulty of your delivery. The baby may drop down into the pelvis before the due date. Here are some of the different positions and presentations your baby can get into while you are preparing for childbirth .

During pregnancy and when preparing for childbirth , there are exercises moms can do when the baby is active to get it in the optimal fetal position, which is known as baby spinning. Starting at the 35th week of pregnancy, talk to your doctor about maternal positioning.

Occiput anterior (OA) or vertex presentation

This is the optimal fetal positioning for childbirth . The baby enters the pelvis with their head down and chin tucked to the chest, facing the mother's back. The head points to the birth canal in this position.

There are two more presentations in OA:

• The baby will remain in the OA position, but the face, rather than the head, will be pointing toward the birth canal.
• This occurs when the chin is not tucked against the chest and instead points outward.
• During a vaginal examination, the doctor can detect this position by feeling the baby's bony jaws and mouth.
• In brow presentation, the baby will be in the OA position with their forehead pointing toward the birth canal. The doctor can feel the anterior fontanelle and the orbits of the forehead during the vaginal examination.
• One arm lies along with the head, pointing toward the birth canal.
• The arms may slide back during the delivery process, but if they do not, extra care must be taken to safely remove the baby.

Occiput posterior (OP)

• The baby enters the pelvis with its head down but facing the mother's front or abdomen.
• In general, approximately 10 to 34 percent of babies remain in the OP position during the first stage of labor before shifting to the optimal (OA) position.
• However, some babies remain in this position, which can make labor difficult and necessitate an emergency Cesarean delivery.
• This fetal position can cause labor to be prolonged, resulting in instrumental interventions, severe perineal tears, or Cesarean delivery.

The cephalic presentation or head-first positions are referred to as OA and OP.

Occiput transverse (OT)

• In the womb, the baby is lying sideways, and if they do not turn to the optimal position in time for birth, a Cesarean delivery is required.
• During a vaginal examination, the doctor may feel the shoulder, arm, elbow, or hand protruding into the vagina.
• This baby position increases the risk of umbilical cord prolapse, which occurs when the umbilical cord protrudes before the baby.
• Cord prolapse can occur in about one percent of babies in the transverse position, which is a medical emergency that necessitates an immediate Cesarean delivery.
• In some cases, assisted delivery is performed by manually rotating the baby or using forceps or a vacuum to position the baby in the ideal position.

Umbilical cord presentation

• During this time, the umbilical cord is the first to emerge from the birth canal.
• The condition of the uterine membrane, however, distinguishes umbilical cord presentation from prolapse.
• A cord presentation occurs when the umbilical cord enters the birth canal before the water breaks, whereas a cord prolapse occurs after the water breaks, necessitating an emergency Cesarean delivery.

Breech position

The infant is positioned with its buttocks directed toward the birth canal, resulting in the following types of breech positions:

• The buttocks are pointing toward the birth canal, with the legs folded at the knees and the feet close to the buttocks.
• In a vaginal delivery, this position increases the risk of an umbilical cord loop. Furthermore, the cord may pass through the cervix before the head, injuring the baby.
• The buttocks are pointing toward the birth canal with the legs straight up and the feet reaching the head.
• This can result in an umbilical cord loop, which can injure the baby during vaginal birth.
• The baby's buttocks are pointing down, and one of their feet is pointing toward the birthing canal.
• This can result in an umbilical cord prolapse, which can cut off the fetus' blood supply and oxygen supply.

A clinical examination of the abdomen, a vaginal examination, or an ultrasound examination is used to determine the position and presentation of the fetus during pregnancy.

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7.2 Methods of Presentation Delivery

Jordan Smith; Melissa Ashman; eCampusOntario; Brian Dunphy; Andrew Stracuzzi; and Linda Macdonald

The Importance of Delivery

Delivery is what you are probably most concerned about when it comes to giving presentations. This section is designed to help you give the best delivery possible and eliminate some of the nervousness you might be feeling. To do that, you should first dismiss the myth that presenting is just reading and talking at the same time. Presentations have more formality than talking. During a presentation, such as an oral report, you should project professionalism. This means meeting the expectations of your situation and audience. Start by being well groomed and wearing clean, appropriate clothes for the situation. Professionalism in speaking also means being prepared to use language correctly and appropriately for the audience and the topic, making eye contact with your audience, projecting confidence, and knowing your topic very well.

Methods of Presentation Delivery

There are four methods of delivery that can help you balance between too much and too little formality and memorization when giving a presentation.

Impromptu Speaking

Impromptu speaking is the presentation of a short message without advance preparation. You have probably done impromptu speaking many times in informal, conversational settings. Self-introductions in group settings are examples of impromptu speaking: “Hi, my name is Jocelyn, and I’m an account manager.” Another example of impromptu presenting occurs when you answer a question such as, “What did you think of the report?” Your response has not been pre-planned, and you are constructing your arguments and points as you speak.

The advantage of this kind of speaking is that it is spontaneous and responsive in a group context. The disadvantage is that the speaker is given little or no time to think of the central theme of their message. As a result, the message may be disorganized and difficult for listeners to follow.

This step-by-step guide may be useful if you are called upon to give an impromptu presentation in public:

• Take a moment to collect your thoughts and plan the main point you want to make. You might write a few keywords on a notepad if you have one near.
• Thank the person for inviting you to speak. Avoid making comments about being unprepared, called upon at the last moment, on the spot, or feeling uneasy.
• Deliver your message, making your main point as briefly as you can while still covering it adequately and at a pace your listeners can follow.
• If you can use a structure, using numbers if possible: “Two main reasons . . .” or “Three parts of our plan. . .” or “Two side effects of this drug. . .” Timeline structures are also effective, such as “past, present, and future” or “East Coast, Midwest, and West Coast”.
• Thank the person again for the opportunity to speak.
• Stop talking (it is easy to “ramble on” when you do not have something prepared). If in front of an audience, do not keep talking as you move back to your seat.

Impromptu presentations are generally most successful when they are brief and focus on a single point.

For additional advice on impromptu speaking, watch the following 4-minute video from Toastmasters: Impromptu Speaking :

(Direct link to Toastmasters Impromptu Speaking )

Manuscript Presentations

Manuscript presentations  are the word-for-word iteration of a written message . The advantage of reading from a manuscript is the exact repetition of original words. In some circumstances, this exact wording can be extremely important. For example, reading a statement about your organization’s legal responsibilities to customers may require that the original words be exact. Acceptable uses of a manuscript include

• Highly formal occasions (e.g. a commencement speech)
• Particularly emotional speeches (e.g. a wedding speech, a eulogy)
• Situations in which word-for-word reading is required (e.g. a speech written by someone else; a corporate statement; a political speech)
• Within a larger speech, the reading of a passage from another work (e.g. a poem; a book excerpt).

Manuscript presentations, however, have a significant disadvantage: Your connection with the audience may be affected. Eye contact, so important for establishing credibility and relationship, may be limited by reading, your use of gestures will be limited if you are holding a manuscript, and a handheld manuscript itself might appear as a barrier between you and the audience. In addition, it is difficult to change language or content in response to unpredictable audience reactions. Reading a manuscript is not as easy as one might think. Keeping your place in a manuscript is difficult and most of us will sound monotone.

• Write the speech in a conversational style, and
• Practice your speech so that it flows naturally.

Preparation will make the presentation more engaging and enhance your credibility:

• Select and edit material so that it fits within your time limit;
• Select material that will be meaningful for your particular audience;
• Know the material well so that you can look up at your audience and back at the manuscript without losing your place; and
• Identify keywords for emphasis.

An essential part of preparation is preparing your manuscript. The following suggestions are adapted from the University of Hawai’i Maui Community College Speech Department:

• Use a full 8.5 x 11inch sheet of paper, not notecards.
• Use only one side of the page.
• Include page numbers.
• Use double or triple line spacing.
• Use a minimum of 16 pt. font size.
• Avoid overly long or complex sentences.
• Use bold or highlight the first word of each sentence, as illustrated by the University of Hawai’i.

• Add notations—“slow down,” “pause,” “look up,” underline keywords, etc. as reminders about delivery.
• Highlight words that should be emphasized.
• Add notes about pronunciation.
• Include notations about time, indicating where you should be at each minute marker.

To deliver the speech effectively, make sure you are comfortable with the manuscript delivery style. To engage your audience,

• Practice your presentation.
• Try to avoid reading in a monotone. Just as contrast is important for document design, contrast is important in speaking. Vary your volume, pace, tone, and gestures.
• Make sure that you can be clearly understood. Speak loud enough that the back of the room can hear you, pronounce each word clearly, and try not to read too fast.
• Maintain good eye contact with your audience. Look down to read and up to speak.
• Match gestures to the content of the speech, and avoid distracting hand or foot movements.
• If there is no podium, hold the manuscript at waist height.

Memorized Speaking

Memorized speakin g is the recitation of a written message that the speaker has committed to memory. Actors , of course, recite from memory whenever they perform from a script in a stage play, television program, or movie scene. When it comes to speeches, memorization can be useful when the message needs to be exact and the speaker does not want to be confined by notes.

The advantage to memorization is that it enables the speaker to maintain eye contact with the audience throughout the speech. Being free of notes means that you can move freely around the stage and use your hands to make gestures. If your speech uses visual aids, this freedom is even more of an advantage. However, there are some real and potential costs.

First, unless you also plan and memorize every vocal cue (the subtle but meaningful variations in speech delivery, which can include the use of pitch, tone, volume, and pace), gesture, and facial expression, your presentation will be flat and uninteresting, and even the most fascinating topic will suffer and you will not effectively engage your audience. (Manuscript speaking often suffers the same fate.) Second, if you lose your place and start trying to ad lib, the contrast in your style of delivery will alert your audience that something is wrong. More frighteningly, if you go completely blank during the presentation, it will be extremely difficult to find your place and keep going. Memorizing a presentation takes a great deal of time and effort to achieve a natural flow and conversational tone.

Extemporaneous Presentations

The extemporaneous speaking style benefits from the flexibility and naturalness that comes with impromptu speaking as well as the benefits of well-developed content and organization that comes with manuscript or memorized speaking. This presentation delivery style maximizes all of the benefits of the various presentation styles while minimizing their challenges.

Extemporaneous presentations are carefully planned and rehearsed presentations, delivered in a conversational manner using brief notes or a slide deck . By using notes rather than a full manuscript, the extemporaneous presenter can establish and maintain eye contact with the audience and assess how well they are understanding the presentation as it progresses.

To avoid over-reliance on notes or slides, you should have a strong command of your subject matter.  Then select an organizational pattern that works well for your topic. Your notes or slide deck should reflect this organizational pattern. In preparation, create an outline of your speech.

Watch some of the following 10-minute videos of a champion speaker presenting an extemporaneous speech at the 2017 International Extemporaneous Speaking National Champion. :

(Direct link to 2017 International Extemporaneous Speaking National Champion video)

Presenting extemporaneously has some advantages. It promotes the likelihood that you, the speaker, will be perceived as knowledgeable and credible since you know the speech well  enough that you do not need to read it. In addition, your audience is likely to pay better attention to the message because it is engaging both verbally and non-verbally. It also allows flexibility; you are working from the strong foundation of an outline, but if you need to delete, add, or rephrase something at the last minute or to adapt to your audience, you can do so.

Adequate preparation cannot be achieved the day before you are scheduled to present, so be aware that if you want to present a credibly delivered speech, you will need to practice many times. Extemporaneous presenting is the style used in the great majority of business presentation situations.

7.2 Methods of Presentation Delivery Copyright © 2022 by Jordan Smith; Melissa Ashman; eCampusOntario; Brian Dunphy; Andrew Stracuzzi; and Linda Macdonald is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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The 8 Types of Presentation Styles: Which Category Do You Fall Into?

Updated: December 16, 2020

Published: September 24, 2018

Types of Presentations

• Visual Style
• Freeform Style
• Instructor Style
• Coach Style
• Storytelling Style
• Connector Style
• Lessig Style
• Takahashi Style

Everyone on the internet has an opinion on how to give the “perfect” presentation.

One group champions visual aids, another thinks visual aids are a threat to society as we know it. One expert preaches the benefits of speaking loudly, while another believes the softer you speak the more your audience pays attention. And don’t even try to find coordinating opinions on whether you should start your presentation with a story, quote, statistic, or question.

But what if there wasn’t just one “right” way to give a presentation? What if there were several? Below, I’ve outlined eight types of presentation styles. They’re used by famous speakers like Steve Jobs and Al Gore -- and none of them are wrong.

Check out each one and decide which will be most effective for you.

Types of Presentation Styles

1. visual style.

What it is: If you’re a firm believer slides simply exist to complement your talking points, this style is for you. With this speaking style, you might need to work a little harder to get your audience engaged, but the dividends can be huge for strong public speakers, visionaries, and storytellers.

When to use it: This style is helpful when speaking to a large audience with broad interests. It’s also great for when you need to throw together slides quickly.

Visual style presenter: Steve Jobs

2. Freeform Style

What it is: This impromptu style of presenting doesn’t require slides. Instead, the speaker relies on strong stories to illustrate each point. This style works best for those who have a short presentation time and are extremely familiar with their talking points.

When to use it: Elevator pitches, networking events, and impromptu meetings are all scenarios in which to use a freeform style of speaking. You’ll appear less rehearsed and more conversational than if you were to pause in the middle of a happy hour to pull up your presentation on a tablet.

Freeform style presenter: Sir Ken Robinson

3. Instructor Style

What it is: This presentation style allows you to deliver complex messages using figures of speech, metaphors, and lots of content -- just like your teachers and professors of old. Your decks should be built in logical order to aid your presentation, and you should use high-impact visuals to support your ideas and keep the audience engaged.

When to use it: If you’re not a comfortable presenter or are unfamiliar with your subject matter (i.e., your product was recently updated and you’re not familiar with the finer points), try instructor-style presenting.

Instructor style presenter: Al Gore

4. Coach Style

What it is: Energetic and charismatic speakers gravitate towards this style of presenting. It allows them to connect and engage with their audience using role play and listener interaction.

When to use it: Use this presentation style when you’re speaking at a conference or presenting to an audience who needs to be put at ease. For example, this style would work well if you were speaking to a group of executives who need to be sold on the idea of what your company does rather than the details of how you do it.

Coach style presenter: Linda Edgecombe

5. Storytelling Style

What it is: In this style, the speaker relies on anecdotes and examples to connect with their audience. Stories bring your learning points to life, and the TED’s Commandments never let you down: Let your emotions out and tell your story in an honest way.

When to use it: Avoid this style if you’re in the discovery phase of the sales process. You want to keep the conversation about your prospect instead of circling every point or question back to you or a similar client. This style is great for conference speaking, networking events, and sales presentations where you have adequate time to tell your stories without taking minutes away from questions.

Storytelling style presenter: Jill Bolte Taylor

6. Connector Style

What it is: In this style, presenters connect with their audience by showing how they’re similar to their listeners. Connectors usually enjoy freeform Q&A and use gestures when they speak. They also highly encourage audience reaction and feedback to what they’re saying.

When to use it: Use this style of presenting early in the sales process as you’re learning about your prospect’s pain points, challenges, and goals. This type of speaking sets your listener at ease, elicits feedback on how you’re doing in real time, and is more of a dialogue than a one-sided presentation

Connector style presenter: Connie Dieken

7. Lessig Style

What it is: The Lessig Style was created by Lawrence Lessig , a professor of law and leadership at Harvard Law School. This presentation style requires the presenter to pass through each slide within 15 seconds. When text is used in a slide, it’s typically synchronized with the presenter’s spoken words.

When to use it: This method of presentation is great for large crowds -- and it allows the speaker to use a balance of text and image to convey their message. The rapid pace and rhythm of the slide progression keeps audiences focused, engaged, and less likely to snooze.

Lessig style presenter: Lawrence Lessig

8. Takahashi Style

What it is: This method features large, bold text on minimal slides. It was devised by Masayoshi Takahashi , who found himself creating slides without access to a presentation design tool or PowerPoint. The main word is the focal point of the slide, and phrases, used sparingly, are short and concise.

When to use it: If you find yourself in Takahashi’s shoes -- without presentation design software -- this method is for you. This style works well for short presentations that pack a memorable punch.

Takahashi style presenter: Masayoshi Takahashi

Slides from one of Takahashi’s presentations:

Whether you’re speaking on a conference stage or giving a sales presentation , you can find a method that works best for you and your audience. With the right style, you’ll capture attention, engage listeners, and effectively share your message. You can even ask an AI presentation maker tool to create presentations for you in your preferred style

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12.2 Public Speaking 101: Organizing (Video) + Four Types of Presentation Delivery

(Mohawk College Student Success, 2022)

Four Types of Delivery

Different occasions call for different approaches to delivering a speech. Sometimes, you are expected to read word-for-word from a script with no variation. At other times, you may be allowed cue cards that function as signposts. In other situations still, you might be called upon with only moments to decide what it is you’re going to say! Consider these four different types of presentation:

12.2.1: Impromptu Speaking

• 12.2.2 Manuscript Presentation s

12.2.3 Extemporaneous Presentations

12.2.4 memorized speaking.

Impromptu speaking is the presentation of a short message without advance preparation. You have probably done impromptu speaking many times in informal, conversational settings. Self-introductions in group settings are examples of impromptu speaking: “Hi, my name is Steve, and I’m an account manager.” Another example of impromptu presenting occurs when you answer a question such as, “What did you think of the report?” Your response has not been pre-planned, and you are constructing your arguments and points as you speak. Even worse, you might find yourself going into a meeting and your boss says, “I want you to talk about the last stage of the project. . . “ and you had no warning.

The advantage of this kind of speaking is that it’s spontaneous and responsive in an animated group context. The disadvantage is that the speaker is given little or no time to contemplate the central theme of his or her message. As a result, the message may be disorganized and difficult for listeners to follow.

Here is a step-by-step guide that may be useful if you are called upon to give an impromptu presentation in public:

• Take a moment to collect your thoughts and plan the main point you want to make.
• Thank the person for inviting you to speak. Avoid making comments about being unprepared, called upon at the last moment, on the spot, or feeling uneasy!
• Deliver your message, making your main point as briefly as you can and at a pace your listeners can follow.
• Use signposts to provide structure. For example, numbers: “Two main reasons . . .” or “Three parts of our plan. . .” or “Two side effects of this drug. . .” Timeline structures are also effective. For example, “Previously, …”; “Now, however,…”; “In looking ahead…”.
• Thank the person again for the opportunity to speak.
• Stop talking! (it is easy to “ramble on” when you don’t have something prepared). If in front of an audience, don’t keep talking as you move back to your seat.

Impromptu presentations:  the presentation of a short message without advance preparation . Impromptu presentations are generally most successful when they are brief and focus on a single point.

For additional advice on impromptu speaking, watch the following 4 minute video from Toastmasters: Impromptu Speaking

( Toastmasters International, 2013 )

12.2.2 Manuscript Presentations

Manuscript presentations are the word-for-word reading aloud of a written message . In a manuscript presentation, the speaker maintains their attention on the printed page except when using visual aids. The advantage of reading from a manuscript is that it is an exact representation of original words. In some circumstances this can be extremely important. For example, reading a statement about your organization’s legal responsibilities to customers may require that the original words be exact.

A manuscript presentation may be appropriate at a more formal affair (like a report to shareholders), when your presentation must be said exactly as written in order to convey the proper emotion or decorum the situation deserves.

However, there are costs involved in manuscript presentations. First, it’s typically an uninteresting way to present. Unless the presenter has rehearsed the reading as a complete performance animated with vocal expression and gestures, the presentation tends to be dull. Keeping one’s eyes glued to the script prevents eye contact with the audience. For this kind of “straight” manuscript presentation to hold audience attention, the audience must be already interested in the message and presenter before the delivery begins.

It is worth noting that professional speakers, actors, news reporters, and politicians often read from an autocue device, commonly called a teleprompter, especially when appearing on television, where eye contact with the camera is crucial. With practice, a presenter can achieve a conversational tone and give the impression of speaking extemporaneously and maintaining eye contact while using an autocue device. However, success in this medium depends on two factors: (1) the presenter is already an accomplished public speaker who has learned to use a conversational tone while delivering a prepared script, and (2) the presentation is written in a style that sounds conversational and in spoken rather than written, edited English.

Extemporaneous presentations  are carefully planned and rehearsed presentations, delivered in a conversational manner using brief notes . By using notes rather than a full manuscript, the extemporaneous presenter can establish and maintain eye contact with the audience and assess how well they are understanding the presentation as it progresses. Without all the words on the page to read, you have little choice but to look up and make eye contact with your audience.

Watch the following 10 minute video of a champion speaker presenting his extemporaneous speech: 2017 International Extemporaneous Speaking National Champion — Connor Rothschild Speech

( Rothschild, 2017 )

Presenting extemporaneously has some advantages. It promotes the likelihood that you, the speaker, will be perceived as knowledgeable and credible since you know the speech well  enough that you don’t need to read it. In addition, your audience is likely to pay better attention to the message because it is engaging both verbally and nonverbally. It also allows flexibility; you are working from the strong foundation of an outline, but if you need to delete, add, or rephrase something at the last minute or to adapt to your audience, you can do so.

The disadvantage of extemporaneous presentations is that it in some cases it does not allow for the verbal and the nonverbal preparation that are almost always required for a good speech.

Adequate preparation cannot be achieved the day before you’re scheduled to present, so be aware that if you want to present a credibly delivered speech, you will need to practice many times. Because extemporaneous presenting is the style used in the great majority of business presentation situations, most of the information in the subsequent sections of this chapter is targeted toward this kind of speaking.

Memorized speakin g is the recitation of a written message that the speaker has committed to memory. Actors , of course, recite from memory whenever they perform from a script in a stage play, television program, or movie scene. When it comes to speeches, memorization can be useful when the message needs to be exact and the speaker doesn’t want to be confined by notes.

The advantage to memorization is that it enables the speaker to maintain eye contact with the audience throughout the speech. Being free of notes means that you can move freely around the stage and use your hands to make gestures. If your speech uses visual aids, this freedom is even more of an advantage. However, there are some real and potential costs.

First, unless you also plan and memorize every vocal cue (the subtle but meaningful variations in speech delivery, which can include the use of pitch, tone, volume, and pace), gesture, and facial expression, your presentation will be flat and uninteresting, and even the most fascinating topic will suffer. Second, if you lose your place and start trying to ad lib, the contrast in your style of delivery will alert your audience that something is wrong. More frighteningly, if you go completely blank during the presentation, it will be extremely difficult to find your place and keep going. Obviously, memorizing a typical seven-minute presentation takes a great deal of time and effort, and if you aren’t used to memorizing, it is very difficult to pull off. Realistically, you probably will not have the time necessary to give a completely memorized speech. However, if you practice adequately, your approach will still feel like you are being extemporaneous.

Rothschild, C. (2017, June 27). 2017 International Extemporaneous Speaking National Champion: Connor Rothschild Speech [Video]. YouTube. https://youtu.be/lzoUu1fDmWE

Toastmasters International. (2013, July 3). Impromptu Speaking [Video]. YouTube. https://youtu.be/GefKPy5YYHI

12.2 Public Speaking 101: Organizing (Video) + Four Types of Presentation Delivery Copyright © 2022 by John Corr; Grant Coleman; Betti Sheldrick; and Scott Bunyan is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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Breech Births

In the last weeks of pregnancy, a baby usually moves so his or her head is positioned to come out of the vagina first during birth. This is called a vertex presentation. A breech presentation occurs when the baby’s buttocks, feet, or both are positioned to come out first during birth. This happens in 3–4% of full-term births.

What are the different types of breech birth presentations?

• Complete breech: Here, the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks.
• Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head.
• Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body.

What causes a breech presentation?

The causes of breech presentations are not fully understood. However, the data show that breech birth is more common when:

• You have been pregnant before
• In pregnancies of multiples
• When there is a history of premature delivery
• When the uterus has too much or too little amniotic fluid
• When there is an abnormally shaped uterus or a uterus with abnormal growths, such as fibroids
• The placenta covers all or part of the opening of the uterus placenta previa

How is a breech presentation diagnosed?

A few weeks prior to the due date, the health care provider will place her hands on the mother’s lower abdomen to locate the baby’s head, back, and buttocks. If it appears that the baby might be in a breech position, they can use ultrasound or pelvic exam to confirm the position. Special x-rays can also be used to determine the baby’s position and the size of the pelvis to determine if a vaginal delivery of a breech baby can be safely attempted.

Can a breech presentation mean something is wrong?

Even though most breech babies are born healthy, there is a slightly elevated risk for certain problems. Birth defects are slightly more common in breech babies and the defect might be the reason that the baby failed to move into the right position prior to delivery.

Can a breech presentation be changed?

It is preferable to try to turn a breech baby between the 32nd and 37th weeks of pregnancy . The methods of turning a baby will vary and the success rate for each method can also vary. It is best to discuss the options with the health care provider to see which method she recommends.

Medical Techniques

External Cephalic Version (EVC)  is a non-surgical technique to move the baby in the uterus. In this procedure, a medication is given to help relax the uterus. There might also be the use of an ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus.

Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the baby’s heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. ECV usually is done near a delivery room so if a problem occurs, a cesarean delivery can be performed quickly. The external version has a high success rate and can be considered if you have had a previous cesarean delivery.

ECV will not be tried if:

• You are carrying more than one fetus
• There are concerns about the health of the fetus
• You have certain abnormalities of the reproductive system
• The placenta is in the wrong place
• The placenta has come away from the wall of the uterus ( placental abruption )

Complications of EVC include:

• Prelabor rupture of membranes
• Changes in the fetus’s heart rate
• Placental abruption
• Preterm labor

Vaginal delivery versus cesarean for breech birth?

Most health care providers do not believe in attempting a vaginal delivery for a breech position. However, some will delay making a final decision until the woman is in labor. The following conditions are considered necessary in order to attempt a vaginal birth:

• The baby is full-term and in the frank breech presentation
• The baby does not show signs of distress while its heart rate is closely monitored.
• The process of labor is smooth and steady with the cervix widening as the baby descends.
• The health care provider estimates that the baby is not too big or the mother’s pelvis too narrow for the baby to pass safely through the birth canal.
• Anesthesia is available and a cesarean delivery possible on short notice

What are the risks and complications of a vaginal delivery?

In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to ease it through the birth canal. Sometimes forceps are used to guide the baby’s head out of the birth canal. Another potential problem is cord prolapse . In this situation the umbilical cord is squeezed as the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood. In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the course of labor. Cesarean delivery may be an option if signs develop that the baby may be in distress.

When is a cesarean delivery used with a breech presentation?

Most health care providers recommend a cesarean delivery for all babies in a breech position, especially babies that are premature. Since premature babies are small and more fragile, and because the head of a premature baby is relatively larger in proportion to its body, the baby is unlikely to stretch the cervix as much as a full-term baby. This means that there might be less room for the head to emerge.

Want to Know More?

• Creating Your Birth Plan
• Labor & Birth Terms to Know
• Cesarean Birth After Care

Compiled using information from the following sources:

• ACOG: If Your Baby is Breech
• William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 24.
• Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 21.

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From persuasive pitches that influence opinions to instructional demonstrations that teach skills, the different types of presentations serve a unique purpose, tailored to specific objectives and audiences.

Presentations that are tailored to its objectives and audiences are more engaging and memorable. They capture attention, maintain interest and leave a lasting impression. 

Don’t worry if you’re no designer —  Whether you need data-driven visuals, persuasive graphics or engaging design elements, Venngage can empower you to craft presentations that stand out and effectively convey your message.

Venngage’s intuitive drag-and-drop interface, extensive presentation template library and customizable design options make it a valuable tool for creating slides that align with your specific goals and target audience. 

Click to jump ahead:

8 Different types of presentations every presenter must know

How do i choose the right type of presentation for my topic or audience, types of presentation faq, 5 steps to create a presentation with venngage .

When it comes to presentations, versatility is the name of the game. Having a variety of presentation styles up your sleeve can make a world of difference in keeping your audience engaged. Here are 8 essential presentation types that every presenter should be well-acquainted with:

1. Informative presentation

Ever sat through a presentation that left you feeling enlightened? That’s the power of an informative presentation. 

This presentation style is all about sharing knowledge and shedding light on a particular topic. Whether you’re diving into the depths of quantum physics or explaining the intricacies of the latest social media trends, informative presentations aim to increase the audience’s understanding.

When delivering an informative presentation, simplify complex topics with clear visuals and relatable examples. Organize your content logically, starting with the basics and gradually delving deeper and always remember to keep jargon to a minimum and encourage questions for clarity.

Academic presentations and research presentations are great examples of informative presentations. An effective academic presentation involves having clear structure, credible evidence, engaging delivery and supporting visuals. Provide context to emphasize the topic’s significance, practice to perfect timing, and be ready to address anticipated questions. 

2. Persuasive presentation

If you’ve ever been swayed by a passionate speaker armed with compelling arguments, you’ve experienced a persuasive presentation . 

This type of presentation is like a verbal tug-of-war, aiming to convince the audience to see things from a specific perspective. Expect to encounter solid evidence, logical reasoning and a dash of emotional appeal.

With persuasive presentations, it’s important to know your audience inside out and tailor your message to their interests and concerns. Craft a compelling narrative with a strong opening, a solid argument and a memorable closing. Additionally, use visuals strategically to enhance your points.

Examples of persuasive presentations include presentations for environmental conservations, policy change, social issues and more. Here are some engaging presentation templates you can use to get started with: 

3. Demonstration or how-to presentation

A Demonstration or How-To Presentation is a type of presentation where the speaker showcases a process, technique, or procedure step by step, providing the audience with clear instructions on how to replicate the demonstrated action. 

A demonstrative presentation is particularly useful when teaching practical skills or showing how something is done in a hands-on manner.

These presentations are commonly used in various settings, including educational workshops, training sessions, cooking classes, DIY tutorials, technology demonstrations and more. Designing creative slides for your how-to presentations can heighten engagement and foster better information retention. 

Speakers can also consider breaking down the process into manageable steps, using visual aids, props and sometimes even live demonstrations to illustrate each step. The key is to provide clear and concise instructions, engage the audience with interactive elements and address any questions that may arise during the presentation.

4. Training or instructional presentation

Training presentations are geared towards imparting practical skills, procedures or concepts — think of this as the more focused cousin of the demonstration presentation. 

Whether you’re teaching a group of new employees the ins and outs of a software or enlightening budding chefs on the art of soufflé-making, training presentations are all about turning novices into experts.

To maximize the impact of your training or instructional presentation, break down complex concepts into digestible segments. Consider using real-life examples to illustrate each point and create a connection. 

You can also create an interactive presentation by incorporating elements like quizzes or group activities to reinforce understanding.

5. Sales presentation

Sales presentations are one of the many types of business presentations and the bread and butter of businesses looking to woo potential clients or customers. With a sprinkle of charm and a dash of persuasion, these presentations showcase products, services or ideas with one end goal in mind: sealing the deal.

A successful sales presentation often has key characteristics such as a clear value proposition, strong storytelling, confidence and a compelling call to action. Hence, when presenting to your clients or stakeholders, focus on benefits rather than just features. 

Anticipate and address potential objections before they arise and use storytelling to showcase how your offering solves a specific problem for your audience. Utilizing visual aids is also a great way to make your points stand out and stay memorable.

A sales presentation can be used to promote service offerings, product launches or even consultancy proposals that outline the expertise and industry experience of a business. Here are some template examples you can use for your next sales presentation:

6. Pitch presentation

Pitch presentations are your ticket to garnering the interest and support of potential investors, partners or stakeholders. Think of your pitch deck as your chance to paint a vivid picture of your business idea or proposal and secure the resources you need to bring it to life. 

Business presentations aside, individuals can also create a portfolio presentation to showcase their skills, experience and achievements to potential clients, employers or investors. 

Craft a concise and compelling narrative. Clearly define the problem your idea solves and how it stands out in the market. Anticipate questions and practice your answers. Project confidence and passion for your idea.

7. Motivational or inspirational presentation

Feeling the need for a morale boost? That’s where motivational presentations step in. These talks are designed to uplift and inspire, often featuring personal anecdotes, heartwarming stories and a generous serving of encouragement.

Form a connection with your audience by sharing personal stories that resonate with your message. Use a storytelling style with relatable anecdotes and powerful metaphors to create an emotional connection. Keep the energy high and wrap up your inspirational presentations with a clear call to action.

Inspirational talks and leadership presentations aside, a motivational or inspirational presentation can also be a simple presentation aimed at boosting confidence, a motivational speech focused on embracing change and more.

8. Status or progress report presentation

Projects and businesses are like living organisms, constantly evolving and changing. Status or progress report presentations keep everyone in the loop by providing updates on achievements, challenges and future plans. It’s like a GPS for your team, ensuring everyone stays on track.

Be transparent about achievements, challenges and future plans. Utilize infographics, charts and diagrams to present your data visually and simplify information. By visually representing data, it becomes easier to identify trends, make predictions and strategize based on evidence.

Now that you’ve learned about the different types of presentation methods and how to use them, you’re on the right track to creating a good presentation that can boost your confidence and enhance your presentation skills . 

Selecting the most suitable presentation style is akin to choosing the right outfit for an occasion – it greatly influences how your message is perceived. Here’s a more detailed guide to help you make that crucial decision:

1. Define your objectives

Begin by clarifying your presentation’s goals. Are you aiming to educate, persuade, motivate, train or perhaps sell a concept? Your objectives will guide you to the most suitable presentation type. 

For instance, if you’re aiming to inform, an informative presentation would be a natural fit. On the other hand, a persuasive presentation suits the goal of swaying opinions.

2. Know your audience

Regardless if you’re giving an in-person or a virtual presentation — delve into the characteristics of your audience. Consider factors like their expertise level, familiarity with the topic, interests and expectations. 

If your audience consists of professionals in your field, a more technical presentation might be suitable. However, if your audience is diverse and includes newcomers, an approachable and engaging style might work better.

3. Analyze your content

Reflect on the content you intend to present. Is it data-heavy, rich in personal stories or focused on practical skills? Different presentation styles serve different content types. 

For data-driven content, an informative or instructional presentation might work best. For emotional stories, a motivational presentation could be a compelling choice.

4. Consider time constraints

Evaluate the time you have at your disposal. If your presentation needs to be concise due to time limitations, opt for a presentation style that allows you to convey your key points effectively within the available timeframe. A pitch presentation, for example, often requires delivering impactful information within a short span.

5. Leverage visuals

Visual aids are powerful tools in presentations. Consider whether your content would benefit from visual representation. If your PowerPoint presentations involve step-by-step instructions or demonstrations, a how-to presentation with clear visuals would be advantageous. Conversely, if your content is more conceptual, a motivational presentation could rely more on spoken words.

6. Align with the setting

Take the presentation environment into account. Are you presenting in a formal business setting, a casual workshop or a conference? Your setting can influence the level of formality and interactivity in your presentation. For instance, a demonstration presentation might be ideal for a hands-on workshop, while a persuasive presentation is great for conferences.

7. Gauge audience interaction

Determine the level of audience engagement you want. Interactive presentations work well for training sessions, workshops and small group settings, while informative or persuasive presentations might be more one-sided.

8. Flexibility

Stay open to adjusting your presentation style on the fly. Sometimes, unexpected factors might require a change of presentation style. Be prepared to adjust on the spot if audience engagement or reactions indicate that a different approach would be more effective.

Remember that there is no one-size-fits-all approach, and the best type of presentation may vary depending on the specific situation and your unique communication goals. By carefully considering these factors, you can choose the most effective presentation type to successfully engage and communicate with your audience.

To save time, use a presentation software or check out these presentation design and presentation background guides to create a presentation that stands out.    

What are some effective ways to begin and end a presentation?

Capture your audience’s attention from the start of your presentation by using a surprising statistic, a compelling story or a thought-provoking question related to your topic. 

To conclude your presentation , summarize your main points, reinforce your key message and leave a lasting impression with a powerful call to action or a memorable quote that resonates with your presentation’s theme.

How can I make my presentation more engaging and interactive?

To create an engaging and interactive presentation for your audience, incorporate visual elements such as images, graphs and videos to illustrate your points visually. Share relatable anecdotes or real-life examples to create a connection with your audience. 

You can also integrate interactive elements like live polls, open-ended questions or small group discussions to encourage participation and keep your audience actively engaged throughout your presentation.

Which types of presentations require special markings

Some presentation types require special markings such as how sales presentations require persuasive techniques like emphasizing benefits, addressing objections and using compelling visuals to showcase products or services. 

Demonstrations and how-to presentations on the other hand require clear markings for each step, ensuring the audience can follow along seamlessly. 

That aside, pitch presentations require highlighting unique selling points, market potential and the competitive edge of your idea, making it stand out to potential investors or partners.

Need some inspiration on how to make a presentation that will captivate an audience? Here are 120+ presentation ideas to help you get started. 

Creating a stunning and impactful presentation with Venngage is a breeze. Whether you’re crafting a business pitch, a training presentation or any other type of presentation, follow these five steps to create a professional presentation that stands out:

• Sign up and log in to Venngage to access the editor.
• Choose a presentation template that matches your topic or style.
• Customize content, colors, fonts, and background to personalize your presentation.
• Add images, icons, and charts to enhancevisual style and clarity.
• Save, export, and share your presentation as PDF or PNG files, or use Venngage’s Presentation Mode for online showcasing.

In the realm of presentations, understanding the different types of presentation formats is like having a versatile set of tools that empower you to craft compelling narratives for every occasion.

Remember, the key to a successful presentation lies not only in the content you deliver but also in the way you connect with your audience. Whether you’re informing, persuading or entertaining, tailoring your approach to the specific type of presentation you’re delivering can make all the difference.

Presentations are a powerful tool, and with practice and dedication (and a little help from Venngage), you’ll find yourself becoming a presentation pro in no time. Now, let’s get started and customize your next presentation!

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The ‘Orgasm Gap’ Isn’t Going Away for Straight Women

A new study suggests they still have fewer orgasms during sex than men do, even with age and experience.

By Catherine Pearson

Sex researchers and therapists have long known that women in heterosexual relationships tend to have fewer orgasms than men do. A large new study suggests that this “orgasm gap” persists — and does not improve with age.

The Numbers

The research, published recently in the journal Sexual Medicine, found that across all ages, men of all sexual orientations reported higher orgasm rates during sex — from 70 to 85 percent — compared with 46 to 58 percent for women. Lesbian and bisexual women between ages 35 and 49 reported higher orgasm rates than their heterosexual counterparts.

The analysis included data from eight Singles in America surveys, which are funded and conducted by Match.com annually in collaboration with The Kinsey Institute, the sexuality and relationships research program at Indiana University. The sample included more than 24,000 single Americans between the ages of 18 and 100.

Researchers were especially interested in the question of whether orgasm rates vary by age. Amanda Gesselman, a research scientist with the Kinsey Institute and lead author on the study, said she thought the team might find evidence that the orgasm gap narrows as women develop confidence and learn what they like (and, perhaps, their partners develop skills to help pleasure them).

However, while older gay and bisexual men and lesbian women did have higher orgasm rates, “we really didn’t see evidence of closing the orgasm gap overall,” she said, adding that she hopes future studies will explore the age-orgasm connection further.

“We really, as a society, sort of prioritize men’s pleasure and undervalue women’s sexual pleasure,” Dr. Gesselman said. “And I think that contributes to consistent disparities.”

The Limitations

Emily Nagoski, a sex educator and author of the book “Come Together” — who did not work on the new study — said a limitation of the study was that the survey asked: “When having sexual intercourse in general, what percentage of the time do you usually have an orgasm?” But it did not provide a more specific definition of what “sexual intercourse” means.

Research shows the majority of women require some form of clitoral stimulation in order to orgasm. So if straight women defined “sexual intercourse” as vaginal penetration alone, it makes sense that there was a significant gap in orgasm rates, she said.

A more revealing question might be, “What percentage of the sex you have do you like?” Dr. Nagoski said. “Orgasm is not the measure of a sexual encounter. Pleasure is the measure of a sexual encounter.”

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