During a typical, normal birth, the child exits the birthing canal head first with their chin against their chest. Alternatively, some children are born with a face presentation that slows the labor process down. There are serious dangers associated with a face presentation birth that could prolong the labor and cause trauma and swelling to the face and skull. 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 child can die from a face presentation delivery.
According to information supplied by the National Institutes of Health (NIH), face presentation deliveries occur in one out of every 600 childbirth. The US National Library of Medicine 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 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.”
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. In other cases, the child was 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 deliveries 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;
- 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 presentation that could compromise their health and well-being. Some of these causes involve:
- Fetal malformations;
- Grant 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;
- Excessive 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;
- 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 is often confused with face presentation. However, the child’s neck does not extend as much. During this type of childbirth, 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 to 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 Traverse (MT) – These children are born with their chin facing the side of the vaginal birth canal.
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 child 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 are more likely to suffer from fetal heart rate abnormalities. Because of that, it is necessary that doctors closely monitor the child during labor by using a working external heart monitoring device. 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 electrode over the child’s cheekbone, jaw or for 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 issues 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.
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 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. The doctor must thoroughly explain the complications, benefits, and risks associated with every delivery method and what to expect if medications including oxytocin, and assistive equipment including forceps and vacuum extractors are used.
There are numerous complications associated with undergoing a delivery involving face presentation. Because of that, the child must be continuously monitored, and the delivery handled by a competent obstetrician or medical team 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 there are indicators of the child is under fetal distress are not rotating into the correct position.
Most face presentation deliveries because 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. Many families facing years of ongoing care to 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.
Medical Malpractice and Face Presentation
Many cases handled by personal injury attorneys involving face 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 are properly 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 obtain 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 is 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.
Our legal team has 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. We treat every client with compassion and respect and will fight aggressively on your behalf to hold those responsible for injuring your child financially accountable.