[Rockies5]

"Help!

Need suggestions for my sil...

She is due Aug 7th and at her appt with the midwife today she was told that baby is presenting 'face-first' with her head tilted back.

All midwife said to her was...."If you go into labor and baby hasn't moved...you'll be sent in for a c-section"

I looked at the 'spinning babies' website and it didn't show this position that I saw.

Any suggestions for positions or anything to get baby to move.

I know she can still move on her own at this point...but sil is pretty upset about it.

This is her 3rd baby...and she had her 1st two at home. She was planning on delivering at the Birth Center this time."

 

[Kidzaplenty]

A lot of hands and knees positions, rocking back and forth (pelvic tilts) should help. However, I am sure the baby will probably turn it's head the right way. If not, it is not impossible to deliver a baby like that vaginally.

Being that it is her third, the baby will probably right it self before birth.

 

[onlyboys]

This is a technical question, but how does a midwife determine that a baby is presenting face first? Ultrasound? Palpatation?

 

[Rockies5]

in this case it's palpatation, the head is hyperflexed as well.

it's face first, not face up

 

[Noelia430]

I would say lots of knee/chest positioning. Have someone use a Rebozo or towel/sheet and wrap it around her abdomen in this position and gentle jiggle to encourage the baby to move up a little to readjust. I hope this helps your friend!

 

[onlyboys]

I have seen pictures of a face-presenting birth. It *can* be done, but it sounds like her careproviders are not willing to attempt it.

I agree with the rebozo suggestion. I really hope baby moves and you get some better advice!

 

[pamamidwife]

According to every obstetrical and midwifery text, face presentation is no more dangerous to the mother/baby than the "normal" vertex / occiput presentation.

I don't know why she's being treated like this.

It's so sad.

Then again, it seems that any issue that arises is a "good cause" for cesarean.

It's really hard to diagnose a face presentation. I'd definitely want an u/s to confirm anything.

There were some incredible pics on the 'net awhile back of a face presentation -

Here's some info, including someone that says something different than other texts I have: http://www.gentlebirth.org/archives/facePres.html

and here, scroll down a bit for the 'face presentation' subset: http://www.gentlebirth.org/archives/...tml#Asynclitic

My preceptor attended a face presentation at home. Other than serious bruising to baby, everything was normal. I would imagine these babies should be seen by a chiropractor or someone familiar with craniosacral therapy soon after birth.

 

[maxmama]

We even do face presentations in our hospital. The kids do look like they've been through the wringer, though, and they end up with temporary Elvis lips.

 

[BelgianSheepDog]

IANAMW (

) but I remember reading about story JUST like this in Ina May's Guide To Childbirth--there are photos as well as a description of how the delivery was handled. Good luck!

 

[onlyboys]

So, in a case like this--face presentation--do you midwives & nurses recommend vitamin K shots/drops? Just curious.

:

 

[pamamidwife]

it's something I tell parents that they should re-evaluate, but I don't recommend it. It's just something that increases the risk of hemorrhagic disease of the newborn

 

[Midwife Kris]

Quote:

Originally Posted by pamamidwife it's something I tell parents that they should re-evaluate, but I don't recommend it. It's just something that increases the risk of hemorrhagic disease of the newborn

Vitamin K increases the risk? Do you have a cite for that because that is one I haven't read/heard. Thanks.

 

[BelgianSheepDog]

I read her as saying the presentation increases the risk, not the vitamin.

 

[wolfmom]

Don't let them con her! I was a face presentation AND 11 lbs, 2 oz, and my mother is not a big woman (5'3'' and about 120 lbs prepreg). She had a vaginal birth with me. The only thing she needs to be prepared for is the possibility of some more back labor if the babe is also posterior like I was.

It still amazes me that my mom did that - I'm sure if she had me today she would be told she need a c-sec too! So sad!

peace and health,

 

[doctorjen]

I don't want to rain on any parades - and I'd certainly not think a face presentation = automatic cesearean, but the 2 face presentations I'm aware of in my hospital in the last 2 years ended up cesareans after very long labors and failure to descend. The baby must present mentum anterior to fit in most cases, and if the babe does not rotate it presents a much larger diameter similar to a true brow presentation with the head extended. I didn't attend either of the women with a face presentation I mentioned, but the doc who did is pretty patient, and both mothers were multips, and the nurses who were there told me about trying a lot of different positions and one woman got to complete and pushed a long time first, while the other stalled out at 8 cms for many hours prior to cesarean.
When I was a student, though, I saw a 16 year old first time mom deliver a face presentation vaginally while flat on her back on a delivery table (I trained in a very archaic system) and she had no problems whatsoever. It was even a pretty good size baby. Baby had a lot of facial swelling but was otherwise fine. Also, interestingly, the swelling delayed the pedi from realizing that the baby had Down syndrome - but this was likely unrelated to the face presentation (unless maybe the relatively decreased muscle tone of a trisomy 21 baby makes them more likely to present awkwardly.)

 

[Charmie981]

I agree with Pam that it would be pretty hard to determine a face presentation from palpation. A de-flexed head, maybe, but a FACE presentation? Unless she felt lips or a nose during a vaginal exam, I wouldn't think the MW could know it was a face for sure at this point in pregnancy.

I too have heard stories of vaginal births with face presentations, but I've never actually seen one.

 

[pamamidwife]

Quote:

Originally Posted by BelgianSheepDog I read her as saying the presentation increases the risk, not the vitamin.

yeah, any malpresentation that causes significant bruising increases the risk of HDN.

Thanks, BSD, for clarifying for me.

 

[pamamidwife]

Quote:

Originally Posted by doctorjen I don't want to rain on any parades - and I'd certainly not think a face presentation = automatic cesearean, but the 2 face presentations I'm aware of in my hospital in the last 2 years ended up cesareans after very long labors and failure to descend. The baby must present mentum anterior to fit in most cases, and if the babe does not rotate it presents a much larger diameter similar to a true brow presentation with the head extended. I didn't attend either of the women with a face presentation I mentioned, but the doc who did is pretty patient, and both mothers were multips, and the nurses who were there told me about trying a lot of different positions and one woman got to complete and pushed a long time first, while the other stalled out at 8 cms for many hours prior to cesarean. When I was a student, though, I saw a 16 year old first time mom deliver a face presentation vaginally while flat on her back on a delivery table (I trained in a very archaic system) and she had no problems whatsoever. It was even a pretty good size baby. Baby had a lot of facial swelling but was otherwise fine. Also, interestingly, the swelling delayed the pedi from realizing that the baby had Down syndrome - but this was likely unrelated to the face presentation (unless maybe the relatively decreased muscle tone of a trisomy 21 baby makes them more likely to present awkwardly.)

I guess, then, Jen, it would depend upon the ability of the mom to handle what could be a more painful labor and also the position of the baby? Like, if baby was posterior, then you'd have an issue of the mentum getting hung up wrong?

So, it would be favorable in a mentum anterior position? Or would it be favorable then in the mentum posterior (what would be a occiput anterior in an occiput vertex) position? Does this make sense?

 

[MamaTaraX]

While looking for pictures of a face presentation, I found this gorgeous posterior one

Reading about thi smakes me want to get our my 2nd son's birth pictures. He was posterior throughout my labor until right before he was born. My water broke, he flipped, and crowned. His face was really bruised up, you could tell obviously that he'd been ramming into stuff on his way out. I wonder if he was more than just posterior some of that time? Hmm... Though I'm pretty sure if I got them out I'd see hair coming out before his sweet little face.

Namaste, Tara

 

[pamamidwife]

oh wait! seeing that picture totally made it DING in my brain!

so, if baby was anterior, then the diameter would be too large, right? but if baby is posterior, then the diameter is smaller.

am I just needing some sleep?