Face Presentation

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.

IMG_1271The 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.

Reflections of a Fledgling Midwife

This summer as a midwifery fellow with Shar and Carol has been remarkable. I feel so privileged to have become part of the family that is MCNYC, to have shared in the excitement and joy of expecting families and to have been present as they welcomed their new babes.

I have been immersed in the “birth world” for 5 years now, as a labor and delivery nurse and midwifery student, but this summer gave me a new degree of respect and appreciation for the birthing process and the strength and power of women. It also showed me that there is another, more humane and family-oriented way to care for women and their pregnancies at a time when I was disheartened by the many limitations of hospital-based practices.


Shar and Carol support and nurture the families they care for in a way that I had never before seen from a provider. They gave me that same degree of support as a fledgling midwife—generously teaching me the ins and outs of running a business, the skills of careful palpation, basics of herbal remedies, and how to hold space for laboring women in a place that is theirs rather than ours. I will be forever grateful to them for this experience.I am also so thankful to the families who opened their homes to me and let me be part of their experiences. I learned so much from each of them.

And here is what I will remember most: a four-year-old girl waking up in the middle of the night to find her mother moaning deeply in the pool in their living room, and then, sleepy-eyed, pulling up her little chair to the edge of the pool and resting her head in her arms, watching her mother, turning to me now and again, smiling in wonder at her mother’s strength. 


Solomon’s Birth Story

Solomon’s Birth Story:

The short version of my son’s birth story goes something like this: Before he was born, I knew that labor was so intense that I wouldn’t be able to make a sentence through it. So when I couldn’t talk anymore, that would be THE sign that I was in labor, the time to call for assistance, marinate in laborland and whatnot.  After he was born, I was pretty stunned to realize that I had become a parent without any of that.

Let’s just say that Solomon’s birth simply wasn’t what I was expecting.

Since my brother and I were born early, at 36 weeks, I went into pregnancy nervous that I would deliver around then. I got our apartment pretty much ready by 35 weeks, but I really wanted to birth at home and couldn’t do that until 37 weeks. As much as I knew that my labor would be mine rather than my mom’s, her experience was the closest benchmark I’d got. I had no idea to what extent my labor would be all my own.

Once I got past the 37-week mark and into homebirthing territory, I was relieved. I was doubly-relieved when I finished up enough at work to transition day-to-day responsibilities to my interim at 39+4. I was grateful that my company helped me keep some projects active so that I didn’t need to start my leave before becoming a parent.

Of course, my oft-stated perspective was that “while the average for a first-time parent was 40+5, no one is average.” Other loudmouth opinions in that sphere also included: “Guys, this is a uterine condition, not a liver condition. Stop telling me that I can’t have a drink” and “Look, in America we’ve got this trope that childbirth is the most painful thing ever. But it’s all a cultural expectation. In the Netherlands, only 35% of women experience pain in childbirth.”

At 40+3 my husband and I had our last regularly scheduled midwifery appointment and started talking about how to bring on labor just in case the child didn’t emerge in the coming week. For the first time, I started considering what would happen if the delivery went in the other direction –if the baby was too big for my loins or emerged too late for a homebirth. I made an appointment for an ultrasound at 41 weeks. And then, that evening after yoga, I had increased discharge and some leakage. I was excited. I thought “It’s finally starting!” We made an appointment for the next morning to confirm that my water had broken.

The morning of 40+4 we checked my pH and were disappointed to learn that my water had not actually broken. Shar mentioned that everyone’s labor pattern is different. For example, that it was possible to start with contractions five minutes apart. And we went about our days. My husband and I worked from home. I went to acupuncture for the fifth time that week. My dad was in town visiting for the day and so we met up for a beer. Around 5pm at the brewery I felt uncomfortable and needed to walk around. I excused myself and went to the bathroom. My dad was the family member who “just wanted to know” when labor was starting. But was this labor starting? I had no idea. I didn’t want to get anyone unnecessarily excited. And I certainly didn’t want anyone “just checking in” after two days in labor. Dad knew that the plan was to share the news once the baby was out. In hindsight, that was definitely a contraction.

Our doulas had counseled us to “distract yourselves for as long as possible if you think labor is starting. Only engage with it when you can’t ignore it.” So that we would save up our energy for when we needed it. When we got home, we made mac’n’cheese and set to watching Shakespeare in Love. I started feeling crampy every 5-10 minutes for a bit –so we started timing. These started coming every 5 minutes and lasted about a minute. I thought “Wow, I’m so suggestible. This is exactly what Shar said could happen.”

Halfway into the movie, the contractions were still coming and I was distracted. We figured it probably WAS labor. This was 9pm. We went upstairs and called Shar. We talked through a contraction. I found that doing the cat-cow yoga posture on hands and knees helped, so would drop to the floor and shift around. I wasn’t comfortable, but I could think and talk clearly. We made a plan to call back when my water had broken. We called our doula Yael and made the plan to call back when the contractions got longer and stronger or when I was uncomfortable enough to want assistance. I felt like taking a bath. I thought I might be more comfortable there. The bath was great, but my contractions shortened to 30 seconds long and did not intensify. It seemed like labor was stalling.

In childbirth education class, we had learned that the one sign of labor that EVERYONE goes through is a pattern of quickening contractions of lengthening duration and increasing intensity. We were watching for this and we were disconcerted that I had short waves where I felt crampy and then didn’t. We thought, “Oh man. This could take days.”

My husband and I weren’t sure what role would be helpful for him to play, and we WERE sure that it would be helpful later if he could be more well-rested than I was, so he went to sleep.

I skimmed the copy of the birth plan that I’d printed out a month prior. There were a set of mantras that I had intended to use. A story from Ina May’s Guide to Childbirth kept coming back to me –that of a woman who was confident that she was going to open huge and did. But somehow, “I’m going to get huge” wasn’t working for me in the moment.

I talked to my primate self, affirmed that my body knew what to do, and a song came to me from a religious service that I had been to years earlier: “I release and I let go.” So I sang and hummed that refrain throughout the night.

When I felt crampy, I sat on the toilet and leaked a few drops of blood and mucous. When it passed, I tried to rest, but I just couldn’t get comfortable, so I headed back to the toilet. (Props to my husband who had installed a heated seat a few months earlier!) For hours, I kept crossing the threshold from the bedroom to the bathroom, waiting for my water to break. I was monitoring my ability to think straight. Around 1:00am a friend on the West Coast texted. I wanted to write back, “labor sucks,” but stopped myself. I mean, what would be the point in complaining? I was way too compos mentis to be seriously in labor.

Around 2:30, my husband woke up from some sound I had made. My cramps had shifted and I was starting to grunt. After checking in with me, he dialed Shar. We didn’t think that my water had broken. She asked me “is that a contraction?” I responded, “I’m not sure.” I didn’t feel the crampiness of the contractions anymore. It felt different. I didn’t realize that I had made it through transition and was about to start pushing. Shar heard my grunting and said “why don’t I come over?” I was worried that I was unnecessarily bothering her and said, “are you sure?” Shar was just 25 minutes away. She hopped in the car.

We started running another bath because we figured that it had slowed things down earlier in the evening and wanted to do that again. If this was indeed pushing, it was worried that I might not be dilated and could inflame my cervix, which would make it harder to birth later. I’d heard something about that possibility on a freebirthing podcast that had come recommended by a birthing assistant.

On the phone with our doula Yael, she asked what I could feel inside me. I hadn’t thought to check, and didn’t want to introduce bacteria. When I put my fingers inside myself, I was scared to feel umbilical cord and thought that’s what it might be. Yael asked “what does it feel like?” About an inch in, it felt wrinkled, and then it felt smooth. She told me that was the baby’s head. Ahhh, this grunting was pushing. But I shouldn’t be able to make sentences if it was this close. Yael started getting dressed to come over. She told me later that at that point she considered it even odds that she’d find me 1cm dilated or already with a child, but she had never before heard someone make a sentence at that phase.

I was in the bath on my hands and knees and realized that I was pushing. I breathed gently and slowly. I burned a bit, and all of a sudden my child’s head was outside me. My husband was sitting on a stool in the bathroom, trying to figure out how to climb through the glass partition and into the tub. Before he could move, I squatted, caught our child and sat down against the far end of the tub – holding a slippery little one to my stomach. The next moments were very quiet. We held our breath, frozen in fear, looking at the purple, blood-stained baby. My husband took a picture to send to Shar. Then Solomon hollered as if to say “This is new. Where am I!?” My husband and I locked eyes in relief and disbelief.

We recognized the sound of buzzer the second time Shar rang. My husband went to let her in. Yael arrived a few minutes later. I had no idea what to do next and I was spent. Shar helped birth the placenta. We moved my son to my husband’s chest. Yael helped me out of the bath. And we all repaired to the bed for some actual repair. The shots of lidocaine before stitching up some minor tears were the most painful part!

After reflecting on the experience, I can piece together a fragmented explanation of how in the world this happened. For the last seven years, I’ve done a kind of yoga that’s focused on directing your perineum –so when I told myself to open, I guess I knew how. And my grandmother birthed my mom unattended at home. And I’m a wuss about pain, but totally stubborn when it comes to sticking out intensity. I tend to navigate the world by stubbornly trying things until my troubleshooting succeeds. I’m reluctant to ask for help before I know that I need it. All in all, I trust my body. I believe that if there had been a complication, labor would have slowed down and my body would have signaled that it needed help. My inner monkey knew how to do this after all. And although this birth was an outlier in so many ways, in the end Solomon was born at 40+5. For that to be the average, someone’s gotta deliver then. And this time around, that someone was me.Birth

Audrey’s Birth Story

I think my homebirth story requires some background. I went through midwives in a hospital with our firstborn and had high hopes of having a lovely natural birth, but of course that didn’t happen. Having gone through the hospital experience once, I realized how incredibly difficult it is to get a natural unmedicated birth in a hospital environment. When we decided to have a second child, I knew I wanted it to be different. I wanted an unmedicated birth and to progress at my own pace. As eager as I was for a homebirth, our path to having a second child wasn’t that easy. Continue reading “Audrey’s Birth Story”

Bérénice & Zélie – Birth story

I was 2 weeks late. I had been having cramps on and off for two weeks. I was told it was the cervix softening, that the labor was gonna be easier. I could be a few centimeters open already…

Yet the labor would not start.

After the 41week, we did a little every day to push it along; massages, acupuncture, walking, eating spicy, sex… nothing was working.

Continue reading “Bérénice & Zélie – Birth story”

Becca’s Birth Story


Our Birth Story.

I’m a doula. From the moment we found out we were pregnant, I had a lot of ideas of what I wanted our labor and birth to look like. I didn’t want to focus too much on the expected due date and I didn’t want to have too many “plans” for laboring. Carol and Shar were perfect guides on this journey and gateway to a new chapter of life. Continue reading “Becca’s Birth Story”

A Letter to Finley

Finley Parker Eisenstein
Born Feb 8, 2019 7:38am
7lbs 10oz, 21in

Finley’s Birth Story as remembered by Mommy and Daddy

Dear Finley,

Your brother woke Mommy up at 12:30am the morning you were born. She got up and sang him back to sleep quickly, but Mommy realized she had a headache. So, Mommy put peppermint oil on behind her ears and made herself a cup of coffee. She then decided to go take a bath rather than get back in bed. She lit a “Calm” candle from H&M and played a lot of Wailin’ Jenny’s while she was in the bath. Actually, it wasn’t a bath. Mommy sat on the floor of the bathtub and “watered” herself with the shower hose. It felt amazing and made her headache go away. Continue reading “A Letter to Finley”