Kneeling in awe of the unfolding birth before me, I quickly realize that I am in unfamiliar territory. I see swollen tissue that perhaps is a urethra emerging or that ambiguous vaginal tissue that presents before the vertex. Another contraction and clearly, it’s the baby’s lips. Soon the eyes emerge and in between, barely perceptible is his nose. The mother asks, “what is that?” And I can emphatically tell her it’s her baby’s face presenting first.
Face presentation happens in approximately 1 out of every 600-800 births, often this can be a longer labor and/or a longer second stage, if there is progression.
This was a quick labor, seven hours in total. I joined this birthing family in transition, barely having time to listen to the fetal heart rate before she felt like pushing. As she was standing and swaying her hips she said, “I hope you’re not going to make me stop moving.” This child was in a hurry.
Typically, during labor, a baby’s head becomes flexed, chin to chest, with the crown presenting first as it is the least significant diameter. By comparison, the fetal face presents a larger cephalic diameter that needs to negotiate the pelvis. Here is where pelvic shape can play a significant role in the passage of a baby.
Factors that could influence a baby’s presentation include genetic disorders, multiple nuchal cords, pelvic shape, multiparity, or black race. Or there may be no identifiable reason.
Babies who make this journey will have significant swelling and bruising of the face and molding of their heads as seen in this photo. During their journey out, their heart rate might show signs of stress, with slowing heard during contractions and pushing. This child’s heart rate was strong throughout.
The stars were in alignment for this baby, fast labor, ample pelvis, and a 10-minute second stage. I am in awe of women and their journey’s through labor and honored to have been in attendance at this particular birth.