The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Face Presentation

Although babies get terribly bruised during a face presentation, the diameters of the head are just as favorable as for a normal presentation *if* the baby is turned the right way, with the back POSTERIOR, but the chin (or mentum) ANTERIOR. Still, it seems so scary because of the way the neck is so bent backwards!

The diameters of the head in a face presentation are NOT "just as favorable as for a normal presentation". The physical dimensions of the PRESENTING part may be equal, but what follows the presenting part is what causes the problem! There are many more "dangers" to baby in this position, like facial edema, bruising, and "squishing/misshapen" and edema of the larynx leading to respiratory difficulty, and hyperextension injuries to the neck and spine (similar to whiplash and neck fractures!). Also, for mom a face presentation generally takes longer since the face dilates the cervix poorly (increased risk of C/S for FTP or CPD in a hospital setting), the mom generally experiences greater discomfort and may receive more extensive lacerations despite proper prevention. If you combine a face presentation with an anterior back so that the chin is actually mom's tailbone) "mentum posterior" vaginal delivery becomes almost IMPOSSIBLE and damage to mom and baby from a vaginal birth is almost "guaranteed" even in the hands of an experienced care provider! ........this isn't to say that a face presentation CAN'T get through if the baby is small relative to the mom's pelvis......just that it's not the IDEAL presentation! )

The following is said very tongue in cheek, but it may be that it actually *is* the ideal presentation. Oxorn-Foote reports that 90% of anterior face presentations delivery vaginally, and that beats heck out of all the other presentations, statistically. :-) (Of course, these statistics may be because many face presentations are not diagnosed until labor is very well established and directed towards a vaginal delivery, and because many face presentations seem to occur as labor progresses. I guess it's kind of like a variation on posterior asynclitism, turned 90 degrees. I wonder if face presentations are, in fact, more common in anthropoid pelves? I can't find this but would love to know.

Anyway, Oxorn-Foote really does paint a fairly rosy picture of face presentations, which was a tremendous shock to me, as they just seem too far from optimal. I was really surprised to learn that they do tend to deliver relatively easily. It was especially surprising to me that they would be easier to deliver than a brow presentation, which seems kind of in between. They say that face presentations occur in about 0.4% of births (not clear whether all or vaginal), only 30% are mentum posterior (back anterior), and most of these rotate to anterior (back posterior), of which 90% delivery vaginally. I haven't found anything that says that the prognosis for a face presentation is less favorable than for a vertex presentation.

NOTE - Some midwives say that a face presentation is caused by an OP baby where the occiput gets hung up on the sacral promontory so that the face pivots forward to make the chin the presenting part.  Just another good reason to encourage optimal fetal positioning and prevent occiput posterior presentations!