Legally Reviewed by:

Jonathan Rosenfeld

March 2, 2023

Over $400 Million worth of case results

Awarded The Best Lawyer in 2024 by U.S. News

Nationally Recognized in Legal Community

When a child is delivered vaginally, the child exits the birthing canal head first with their chin against their chest. Alternatively, breech babies are born with a face presentation that slows the labor process down. This is also known as cephalic presentation.

There are serious dangers associated when face presentation occurs that could prolong the labor and cause trauma and swelling to the face and skull.

Developing Fetus Alternate Presentation

Face presentation births are known to cause abnormal fetal heart rate patterns, breathing-related complications including HIE (hypoxic-ischemic encephalopathy, a serious form of brain damage that is the result of insufficiently oxygenated blood.

In rare cases, the baby may die from a face presentation delivery. Here, medical malpractice can cause birth injury. The doctor often should have performed a manual rotation or a cesarean delivery to avoid serious complications.

Medical Malpractice Lawyers Filing Cerebral Palsy Cases for Birth Injury

Rosenfeld Injury Lawyers help families whose children suffered birth injuries in the labor and delivery stages.

Contact our law firm today to learn more about your legal rights in a medical malpractice case. You may be entitled to financial compensation if the doctor failed to take action with an increased risk of cerebral palsy.

Breech Presentation Is A Rare But Serious Birth Injury

According to information supplied by the National Institutes of Health (NIH) [1], face presentation deliveries occur in one out of every 600 childbirths.

The US National Library of Medicine [2] states that cephalopelvic disproportion (CPD), anencephaly, fetal macrosomia (with the baby’s abnormally large for its gestational age), and prematurity are constant obstetric factors that predispose the child to a face presentation during delivery.

The NIH states that the “majority of perinatal losses reported in face presentations have resulted in traumatic operative vaginal deliveries, specifically version and extraction of admitted forceps rotations. Recent experience at this institution of a limited series of face presentations demonstrate that, with careful intrapartum surveillance, delivery can be accomplished with no increase in risk to either [the] mother or fetus.”

How Medical Professionals Examine the Baby’s Head

The medical team in the delivery room can confirm the position of the baby as an abnormal presentation by using ultrasound equipment.

In some cases, immediate medical intervention is required including performing a cesarean section to prevent any ventilation issue. The doctor should usually not try to use a vacuum extractor.

In other cases, the child is intubated as soon as they are born to ensure they receive adequate oxygen and prevent the development of serious neurological disorders including hydrocephalus (fluid buildup in the brain) and cerebral palsy.

Many of the common conditions associated with face presentation labor and delivery involve:

  • Lack of oxygen to the child’s brain (birth asphyxia);
  • HIE (hypoxic-ischemic encephalopathy) where the basal ganglia are damaged;
  • Neonatal encephalopathy;
  • LBP (Periventricular leukomalacia);
  • Permanent brain damage;
  • Umbilical cord complications;
  • Birth asphyxia;
  • Microcephaly;
  • Seizure disorders;
  • Low muscle tone;
  • Muscle disorders;
  • Cerebral palsy.

The Causes of Face Presentation

There are numerous causes for a baby to be born with a face and brow presentation that could compromise their health and well-being. Some of these causes involve:

  • Fetal malformations during the pregnancy;
  • Grand multiparity when the mother has previously given birth to five or more babies;
  • Multiple births when the mother is pregnant with more than one child including twins, triplets, and quadruplets;
  • Too much amniotic fluid in the womb (polyhydramnios);
  • Low birth weight caused by prematurity or not;
  • CPD (cephalopelvic disproportion) when the baby’s head or body is not the same size as the opening in the mother’s pelvis;
  • Previous cesarean sections;
  • Carrying the child past the due date
  • Macrosomia,when the baby is exceptionally oversized, are abnormally large caused by genetics are stimulated growth brought on by the mother’s excessive insulin and blood glucose levels;
  • Small maternal pelvis that has compromised contractions and other associated birth complications;
  • Multiple nuchal cords when the fetal umbilical cord is wrapped around the child’s neck.

Brow Presentation

Brow presentation is often confused with face presentation. However, the baby’s neck does not extend as much. During this type of birth process, the neck extends backwards somewhat, and the chin remains on top.

The forehead enters the pelvis first during a vaginal delivery which can be impossible or extremely challenging because the diameter of the pelvis area and the child’s head in that angle might be misaligned to fit safely through the vaginal canal.

How Doctors Diagnose a Face Presentation

Doctors typically diagnose face presentation deliveries in the early stages of labor after performing a comprehensive examination of the mother’s dilated cervix.

An experienced medical professional can confuse a face presentation with the breech presentation that might not be confirmed until a comprehensive ultrasound test has been performed.

The doctor will classify the face presentation in one of three categories that include:

  • Mentum Anterior (MA)– Children are presented outside the vaginal birth canal with the chin up facing the front side of the mother.
  • Mentum Posterior (MP)– The child is born with their chin facing the mother’s back in a downward position toward the mother’s buttocks. This position provides an easy exit from the vaginal canal when the child’s head, neck, and shoulders enter the pelvis simultaneously.
  • Mentum Transverse (MT)– These children are born with their chin facing the side of the vaginal birth canal.

The Risk of Birth Complications

Delivering a baby with the face presentation can present serious, life-threatening risks. Because of that, doctors must provide full disclosure of all known delivery options and obtain an informed consent from the mother and family identifying how the patients were warned that their newborn was facing serious risks of injury if the mother did not undergo a cesarean section.

In serious cases, a C-section might be the only option to ensure a successful delivery and prevent injury and trauma that will likely occur if the family proceeds with the vaginal delivery.

If the doctor attempts to internally manipulate the baby’s position during delivery, serious problems could arise. Also, the medical staff must never use manual extractions and vacuum extractors to remove the infant through the vaginal canal from the uterine cavity. When doctors use forceps, the child usually suffers extreme traumatic injury.

Additionally, children delivered with a face presentation [3] are more likely to suffer from fetal heart rate abnormalities and respiratory distress.

Because of that, it is necessary that doctors closely monitor the child during labor by using a working external heart monitoring device in a timely manner. Attaching an internal device could cause severe injuries to the newborn if it is not placed properly.

If there is no other option than to use internal monitoring, the doctor must cautiously place electrodes over the child’s cheekbone, jaw or head to minimize the risk of traumatic injury.

Common Side Effects and Complications

  • Spinal column injury,
  • Fluid buildup (facial edema),
  • Physical trauma,
  • Delayed or prolonged labor,
  • Respiratory problems caused by trauma to the airway,
  • Skull molding where pressure creates an abnormal head shape,
  • Increased fetal compromise,
  • Abnormal heart rates,
  • Low Apgar score that would indicate that the newborn requires specialized care and assistance with their breathing.

Long Term Effects of Face Presentation

Face presentation can cause a number of long-term health effects for the baby. These types of birth injury could include:

  • Spinal cord injuries
  • Abnormal head shape
  • Intellectual disabilities
  • The baby’s brain can be damaged

The Appropriate Standard of Care When a Baby Presents Face First

The medical team must obtain an informed consent for the mother to provide any medical procedure including giving birth.

Informed consent relieves the medical team of complications that the mother agrees to continue with the delivery knowing her child will have a face presentation during the birthing process. The mother must be informed of the risk factors.

The doctor’s medical team must provide the mother with the option of undergoing a cesarean section instead of the vaginal birth to prevent serious complications including the development of cerebral palsy or other neurological condition.

Many mothers opt to undergo a C-section to avoid the child suffering injuries from extensive trauma or facial bruising that is common in face presentation births.

Continuous Monitoring Is Necessary

There are numerous complications associated with undergoing a delivery involving face presentation [4]. Because of that, the child must be continuously monitored, and the delivery handled by experienced physicians or medical teams with extensive experience in minimizing the potential risks involved in a complicated childbirth.

If any condition arrives that is out of the norm; the doctor must help the mother decide to undergo a cesarean section if indicators of the child being under fetal distress are not rotating into the correct position.

Most face presentation deliveries cause significant respiratory difficulties requiring immediate ventilation and sometimes intubation by placing a breathing tube to the child’s nostrils and down to their lungs.

Any failure to follow the acceptable standards of care could be identified as medical malpractice. This could result in a birth defect.

Babies could suffer brain injury, neurological disorders or develop cerebral palsy.

Many families facing years of ongoing care for a child born with a neurological condition like cerebral palsy caused by a face presentation birth will file a claim for compensation against the doctor or medical team responsible for providing a substandard level of care to the mother and child that caused birth injury.

Medical Malpractice and Face Presentation

Many birth injury cases handled by personal injury attorneys involving abnormal presentation injuries caused by medical mistakes are based on serious errors that include:

  • The doctor did not take immediate action to perform an emergency cesarean section even though there are obvious signs of fetal distress, non-progressing labor or when the child failed to rotate into the mentum anterior position.
  • The medical team never checked for pelvic adequacy after diagnosing the delivery involved a face presentation.
  • The medical team never hooked up the ventilator to the newborn immediately when required.
  • The doctor never provided adequate information to allow the baby’s mother to consent to a face presentation birth without giving the option of undergoing a cesarean section.
  • The doctor never explained the problem or obtained consent to use vacuum extractors or forceps to remove the baby from the vaginal canal.

Hiring a Birth Injury Attorney to Prosecute a CP Case

If your newborn has suffered a birth injury caused by the negligent actions of others, you are likely entitled to receive financial compensation to ensure you have adequate funding to provide care throughout your child’s lifetime.

Our legal team has represented victims of medical negligence who have suffered HIE (hypoxic-ischemic enthesopathy), developmental delays, cerebral palsy, seizure disorders, and PBL (periventricular leukomalacia), damage to the brains white matter that transmits messages to and from the brain and muscles.

Call Us for a Free Consultation

Our birth injury lawyers have years of experience in handling birth injury cases just like yours. Let us examine your case, identify every negligent party involved in your claim for compensation and discuss all available legal options to protect your rights in receiving the compensation you deserve.

Our lawyers have combined decades of experience helping families who have experienced fetal deaths and birth injuries. Call us at (888) 424-5757 for a free consultation or fill out a contact form. Once we form an attorney client relationship, we can go to work for you.

Resources: [1] NIH, [2] US National Library of Medicine, [3] NIH, [4] Medscape

Client Reviews

Jonathan Rosenfeld was professionally objective, timely, and knowledgeable. Also, his advice was extremely effective regarding my case. In addition, Jonathan was understanding and patient pertaining to any of my questions or concerns. I was very happy with the end result and I highly recommend Jonathan Rosenfeld.

- Michonne Proulx

Extremely impressed with this law firm. They took control of a bad motorcycle crash that left my uncle seriously injured. Without any guarantee of a financial recovery, they went out and hired accident investigators and engineers to help prove how the accident happened. I am grateful that they worked on a contingency fee basis as there was no way we could have paid for these services on our own.

- Ethan Armstrong

Jonathan helped my family heal and get compensation after our child was suffered a life threatening injury at daycare. He was sympathetic and in constant contact with us letting us know all he knew every step of the way. We were so blessed to find Jonathan!

- Giulia

This lawyer really helped me get compensation for my motorcycle accident case. I know there is no way that I could have gotten anywhere near the amount that Mr. Rosenfeld was able to get to settle my case. Thank you.

- Daniel Kaim

Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial.

- Lisa
Free Consultation (888) 424-5757