A face presentation birth is a rare fetal presentation during labor where the baby’s head is hyperextended, with the face as the presenting part. Normally, babies are born head-first in a vertex presentation, with the chin tucked. While face presentation introduces complexities, medical professionals manage these births to achieve the best outcomes for mother and baby.
Understanding Face Presentation
In a face presentation, the baby’s neck is completely extended, with the occiput (back of the head) touching the upper back, and the face emerging first. This differs from the more common vertex presentation where the chin is tucked, allowing the crown of the head to lead. It occurs in about 0.2% of live births (1 in 600 to 1 in 800).
Types of face presentation depend on the baby’s chin (mentum) position relative to the mother’s pelvis. Mento-anterior (chin towards mother’s front) is generally more favorable for vaginal birth. Mento-posterior (chin towards mother’s back) often leads to complications or necessitates a Cesarean section. Mento-transverse means the chin faces the side.
Several factors can contribute to a face presentation; often, the exact cause is unknown. Factors include conditions preventing fetal head flexion or encouraging extension, such as prematurity, macrosomia (larger baby size), or anencephaly, a severe birth defect. Other factors are cephalopelvic disproportion (small pelvic opening), polyhydramnios (excessive amniotic fluid), or multiple umbilical cord loops around the neck.
Risks and Potential Complications
While face presentation carries increased risks, many births proceed without severe complications, especially with proper medical management. However, the baby’s unique head positioning can lead to challenges for both mother and baby.
For the mother, risks include prolonged labor due to the head’s larger presenting diameter. This increases the need for a Cesarean section, especially for mento-posterior positions or if labor fails to progress adequately. There is also an increased likelihood of severe vaginal tears (e.g., third or fourth-degree lacerations) due to presenting facial features. Rare but serious complications like uterine rupture and postpartum hemorrhage may also have an increased risk, especially with prolonged labor or Cesarean delivery.
For the baby, specific concerns arise from labor pressure. Facial bruising and edema (swelling) are common but usually resolve quickly within 24 to 48 hours. Head molding, a temporary change in head shape, can be more pronounced but is typically benign and temporary. Severe neck hyperextension might temporarily compromise breathing at birth. Other potential issues include temporary facial nerve palsy, causing facial asymmetry, which usually resolves within weeks. Umbilical cord prolapse, a rare emergency where the cord falls before the baby, is also a consideration.
How Face Presentation is Managed
Face presentation is typically diagnosed during labor via vaginal examination, where the medical team can feel the baby’s facial features (mouth, nose, chin). An ultrasound can also confirm the diagnosis, revealing the hyperextended fetal neck. Early diagnosis helps in planning the management strategy.
Continuous monitoring of maternal and fetal well-being is important throughout labor, including fetal heart rate patterns and maternal contractions. Vaginal birth may be possible, especially if the baby is in a mento-anterior position, labor progresses well, and there are no signs of fetal distress. Even then, labor might be longer than usual.
Cesarean section is often the preferred delivery method, particularly for mento-posterior positions, prolonged labor, or fetal distress. It is often the safest option for mother and baby in complicated cases to prevent adverse outcomes. Instrumental delivery (forceps or vacuum extraction) is generally not recommended due to the high risk of severe facial or neck injury to the baby. Such interventions are typically avoided unless performed by highly experienced practitioners under specific, rare circumstances; vacuum extraction is specifically contraindicated.
Post-Birth Considerations
After a face presentation birth, specific considerations apply for the baby’s immediate care and the mother’s recovery. For the baby, temporary effects like facial bruising, swelling, or molding are common due to labor pressure. These effects are temporary and typically resolve within days to weeks without long-term issues. The baby is closely monitored for breathing difficulties or feeding challenges in the immediate postnatal period, though these are often minor. Most babies born with face presentation, especially with appropriate medical care, have good long-term outcomes.
For the mother, recovery varies by delivery mode. Vaginal birth may involve recovery from more extensive perineal tearing; a Cesarean section requires recovery from abdominal surgery. Emotional support during recovery is helpful, as this birth experience can be stressful. Follow-up appointments for mother and baby are important to ensure full recovery and address any lingering concerns.