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Evidence based midwifery management of face presentation


Introduction

Face presentation is a rare, unanticipated event in which the fetal chin extends (instead of flexing down on its chest) as the fetal head descends during labour and birth. Since face presentation is rare, it may only happen a handful of times in a midwifery career of several decades. The aim of this module is to prepare midwives to recognise the characteristic signs of face presentation, and to understand when expectant management and intervention are appropriate for the wellbeing of the fetus and the mother.

Learning aims and objectives

On completion of this resource, midwives and student midwives will be better able to:

  • Recognise the signs of face presentation on vaginal examination
  • Differentiate between mentoanterior and mentoposterior presentations and understand the differences in management approaches that these presentations will require
  • Offer optimal care for women with diagnosed face presentation during labour and birth.

The module enables the midwife to recognise that when the chin is near the urethra the largest presenting diameter is no larger than for occiput presentation, so vaginal birth is not blocked and the fetus is likely to be born without any intervention. By initiating evidence-based discussions regarding face presentation management, the midwife should aim to encourage expectant management, thus reducing the use of caesarean section where possible.

Keywords and linking topics

Face presentation, mentum anterior, mentum posterior, ecchymosis, pubic arch, pelvic diameters, expectant management, caesarean surgery, water birth, evidence based midwifery

The Practising Midwife featured article

Judy Slome Cohain (2017). Midwifery management of face presentation. TPM 20(4), 8 – 11

Questions at the end of this resource will enable you to assess your knowledge and reflect on how you can incorporate it into your own practice. In the following questions, please select the answer that you believe to be correct. This will be marked and then you can move on to the next question. If you wish, at the end you can return for a further attempt at the questions.

Upon completion of the module, you will be able to download and save or print a certificate to include in your CPD/revalidation portfolio.