What is Face Presentation?

In the standard birth presentation (the vertex presentation), the crown of the baby’s head exits the mother’s pelvic inlet with the chin tucked into the chest. In the face presentation, the baby’s head bends backwards and the face is the first part to present at the opening of the birth canal. Face presentation inhibits the baby’s descent through the birth canal, potentially resulting in a number of serious birth injuries. Facial and skull trauma, prolonged labor, fetal compromise, birth asphyxia, abnormal fetal heart rate patterns, cerebral palsy, and even death are possible complications of a mismanaged face presentation birth.

Whether your child’s permanent injuries or cerebral palsy resulted from a face presentation birth or from another labor and delivery injury, a skilled Michigan Cerebral Palsy lawyer from our team can help you find financial, emotional, and medical support. To begin your free legal evaluation, contact our Michigan cerebral palsy lawyers in any one of the following ways:

What Causes Face Presentation?

Factors causing face presentation are similar to those that may lead to any fetal malpresentation. Conditions that increase the likelihood of a baby in face presentation include:

  • Multiple gestations: Women carrying more than one fetus at a time risk having a baby in the face presentation.
  • Grand multiparity (a woman who has given birth five or more times)
  • Fetal malformations: Babies with conditions like neck masses or fluid buildup in the skull (hydrocephalus) are often born in the face presentation.
  • Prematurity and low birth weight
  • Too much amniotic fluid (polyhydramnios)
  • Cephalopelvic disproportion (CPD): Size incompatibilities between the mother’s pelvis and the baby can lead to face presentation.
  • Macrosomia: A baby larger than its gestational average may lead to space issues in the womb and assume the face presentation.
  • Multiple nuchal cords: If the umbilical cord wraps around the baby’s neck more than once, it can often bend the head into the face presentation.
  • Contracted maternal pelvis: Abnormally small maternal pelvises can interfere with normal delivery and contort the baby into face presentation.
  • Previous C-section

What Complications Are Associated with Face Presentation?

  • Prolonged labor
  • Facial trauma
  • Facial edema (fluid buildup in the face, often the result of trauma)
  • Skull molding: Abnormal head shape is a result of pressures on the baby’s head during delivery.
  • Respiratory distress and difficulty in ventilation: Upper airway trauma and edema can limit the baby’s ability to move air in and out of the lungs.
  • Spinal cord injury
  • Abnormal fetal heart rate patterns
  • Tenfold increase in fetal compromise
  • Decreased APGAR score (a post-delivery test measures how well the baby withstood the birthing process and how the baby is doing after delivery)
  • Increased fetal death numbers

Diagnosing Babies in the Face Presentation

Face presentation is diagnosed during the first or second stage of labor when a physician can begin to detect the baby’s facial features. From this point, physicians can diagnose the baby by using ultrasound readings. It is important that a physician pay close attention to the facial features of the baby in order to not mistake the delivery for a breech presentation birth.

Managing the Face Presentation During Pregnancy, Labor and Delivery

Since trauma and bruising are almost always a result of face presentation births, a physician must always extend informed consent and delivery options to the parents when a face presentation is detected. Physicians and patients should be prepared for a C-section delivery.

According to one study, severely poor fetal heart rate abnormalities occur in 53% of face presentation deliveries and only 14% of babies had the normal heart readings. For this reason, it is crucial that babies in face presentation be monitored closely during labor.

Face Presentation and Medical Malpractice

Michigan Lawyers Handling Cases Related to Birth Injury, Face Presentation, and Medical Malpractice

The complications related to face presentation are complex, so it is crucial that experienced physicians monitor the baby closely.

The following scenarios reflect medical malpractice and negligence:

  • Physician fails to quickly order and perform an emergency C-section if there are signs of fetal distress, labor is not progressing, or the baby fails to rotate into the safe “MA” position (where the chin is facing the front of the mother).
  • Physician fails to check for pelvic adequacy once face presentation is diagnosed.
  • The baby isn’t properly or immediately hooked up to a ventilator if necessary.
  • The physician fails to extend informed consent to the mother of a baby in face presentation (she isn’t given the option of C-section).
  • The physician fails to explain and obtain consent if forceps or vacuum extractors are used.

If you gave birth to your child in the face presentation and he or she was later diagnosed with permanent injuries like cerebral palsy, hypoxic ischemic encephalopathy (HIE), or intellectual disabilities, call our experienced lawyers today at (888) 592-1857 or fill out our online contact form. The lawyers at Michigan Cerebral Palsy Attorneys will evaluate your case for free to determine if your newborn suffered injuries due to the negligence of a medical professional.

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 Sources:

  • Julian S & Galerneau F. Face and brow presentations in labor. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2012.
  • Gardberg M, Leonova Y, Laakkonen E. Malpresentations–impact on mode of delivery. Acta Obstet Gynecol Scand 2011; 90:540.Ducarme G, Ceccaldi PF, Chesnoy V, et al.
  • [Face presentation: retrospective study of 32 cases at term]. Gynecol Obstet Fertil 2006; 34:393.
  • Bhal PS, Davies NJ, Chung T. A population study of face and brow presentation. J Obstet Gynaecol 1998; 18:231.
  • Williams Obstetrics, 23rd Ed, Cunningham, FG, Leveno, KJ, Bloom, JC, et al (Eds), McGraw-Hill, 2010.
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