Glossary

Term · Getting Ready for Birth

crowning

Also: head crowning, crowned

The point in birth when the baby's head is visible at the vaginal opening and does not slip back between pushes. The birth is close.

In plain words

Crowning is the stage in pushing when the top of the baby's head shows at the vaginal opening. It stays visible between contractions. Before crowning, the head moves down and back. At crowning, the tissue around the vaginal opening stretches the most. Many mothers feel a burning or stretching sensation at this point. The speed of the head's delivery matters for the . A slower delivery, with support for the tissue, is linked to fewer serious tears. A partner or may guide the head through a contraction. Crowning is a sign that birth is close. It is not the end of the . The shoulders and body still need to be born.

The deeper version

Crowning describes the head at its widest diameter across the vulvar ring, when the and bulbocavernosus muscle are maximally stretched. Rate of stretch, angle of head delivery, and perineal support are the main modifiable factors in perineal trauma. Aasheim and colleagues (Cochrane Database of Systematic Reviews, 2017) found that hands-on perineal techniques, including warm compresses and guided delivery of the head, were associated with fewer third- and fourth-degree tears, with low-certainty evidence on other outcomes. ACOG Practice Bulletin 198 (2018) on obstetric lacerations recognizes that the rate of head descent and the use of both shape perineal injury, and it notes that the evidence for routine manual techniques is mixed. Controversy remains over whether maternal pushing style at crowning, rather than the clinician's technique, has the larger effect.

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Sources

  • Aasheim V, Nilsen ABV, Lukasse M, Reinar LM — Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews, 2017
  • American College of Obstetricians and Gynecologists — Practice Bulletin 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery, 2018

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