Head Engagement in Pregnancy: What Is It?

Medically Reviewed by Traci C. Johnson, MD on March 19, 2023
3 min read

The last few weeks of your pregnancy bring lots of excitement. You’re about to meet your new baby. You may also be anxious, especially if you’ve never given birth before. You’ve probably heard details from your doctor about the baby’s positioning, including the term head engagement. It’s one of the most important steps before delivering your baby. 

During pregnancy, some babies spend most of their time head-up, with their feet near the bottom of the womb. In the last four weeks of pregnancy, babies tend to rotate. Most turn until they’re upside down, with their heads near your pelvis. This is the beginning of head engagement. It readies them, and you, for a head-first delivery. 

If you’re a first-time parent, your baby will likely begin to turn as soon as 36 weeks. If you’ve given birth before, your current baby may not engage until just hours before labor

Once your baby is upside down, they begin to drop into your pelvis. Doctors measure head engagement to determine how far into your pelvis your baby has settled. 

It’s measured on a scale of -5 to 3 “stations.” When your baby is at a -5 station, they haven’t settled into your pelvis at all. If they’re at 0 station, they’re fully engaged. Once you’ve gone into labor and the baby is crowning, they’re at +3 station.

Head engagement matters for two reasons. 

First, if your baby hasn’t rotated and begun head engagement, there’s a possibility that they’ll come into the birth canal right-side-up, or breech. This can make labor and delivery more complicated for you and your baby. Your doctor will pay attention to whether your baby has started to engage to make sure that everything is going smoothly and to make plans if it looks like you’ll experience a breech labor. 

Second, engagement should happen before the labor process. While engagement doesn’t mean that you’re about to go into labor, you’re unlikely to go into labor until your baby has engaged. 

Your doctor will check your baby’s engagement. Most use ultrasounds or physical exams to determine how far your baby has dropped into your pelvis. 

In the physical exam, doctors check your stomach, pelvis, and abdomen to feel for your baby’s head compared to your pelvic bone. In general, if they feel the curve of your baby’s head above your pelvis, then your baby hasn’t finished dropping yet. If they don’t feel the curve above your pelvis, then your baby is likely engaged. 

You can also pay attention to signs that give you a good idea if your baby has started the rotation down: 

  • An increased need to go to the bathroom, since your baby is lower and pressing on your bladder 
  • Less heartburn, because your baby isn’t pressing on your stomach as much 
  • Less pressure on your lungs, because your baby is lower in your abdomen 
  • A lower “baby bump,” sitting nearer your pelvis instead of your ribs

There’s no one way to make sure your baby engages. But gentle activity and stretches may help encourage your baby to drop and help relax your pelvis before labor begins. Ask your doctor about whether any of the following activities might help you:

  • Yoga stretches to loosen the pelvis
  • Using a birthing ball
  • Prenatal massages
  • Visiting a prenatal chiropractor
  • Generally moving your body with walking and low-impact exercise