Face Presentation
Pictoral Midwifery, Comyns Berkely, 4th Edition. 1941
Face it. We have a lot to learn about fetal positioning. The old paradigm is fetal positions are random. The new paradigm is that babies match the space available.
Face and brow presentations occur when baby’s spine extended until the head is shifted back so baby’s face comes through the pelvis first.
Baby may settle in a face or brow presentation before labor or they may become a face or brow presentation, usually when a posterior baby has it’s chin pushed further up by the pelvic floor during descent.
A baby who is in a face-first or forehead-first position often started as an extended (chin up) occiput posterior or occiput transverse position. Coming down on to the pelvic floor with the forehead leading then “converted” this baby’s head to the face first position.
The baby’s face may be bruised for a couple days after the birth. The brow presentation may cause a redness but only occasionally will cause a bruise.
Mobility of the pelvis and the freedom of maternal movements often help bring the face-first baby down through the pelvis with good strong, uterine surges.
But not always. Sometimes the labor can’t move baby down. Cesareans are more common, but a portion of the higher surgical rate is because time is not given to the mother to begin or continue labor, or to be out of bed for this labor. Monitoring becomes important. Expect a bit of an unusual heart rate to contraction pattern seen in these labors.
What makes labor easier for a face-first baby and you?
Balance the body and the baby will thank you by curling into position to aim, not their face, but the crown of their head.
Flexion is physiological. So support physiology and the baby will change their position. We may need a little physics.
In Labor with a Face or Brow Presentation
Back baby up!
Forward-leaning Inversion with a jiggle of the buttocks right through 1-2 contractions often backs baby up so they can tuck their chin. Then they can aim into the pelvis with an easier position.
Shake the Apples in Forward-leaning Inversion with hands
A little effort can make labor a lot easier!
Only after baby’s crown is first, then do Side-lying Release in labor.
Before Labor with a face or brow presentation
Face presentation may reflect a psoas/pelvic floor imbalance with a collapse in the front body.
Free the piriformis, strengthen the buttocks, lengthen the hamstrings, squat for lengthening the pelvic floor, don’t worry about strengthening the pelvic floor right now. Alignment, walking, stabilizing and lengthening will tone the pelvic floor. Use it by breathing with your whole body.
Before labor, it’s safe to do Side-lying Release when baby’s face-first head isn’t in the pelvis yet.
Free the way
The psoas is the upper guide, the pelvic floor is the lower guide. release spasms and lengthen both.
Make room for the baby by releasing muscles that spasm, lengthen ligaments that are shortened, and support the abdominal muscles by attending to the muscles that interact with them, don’t go directly to the front first.
