Deliveries with face presentation at Genesis Dnepr, Dnipro: management approach

Face presentation in labour is a situation in which the fetus’s chin (mentum) is directed toward the mother’s pelvis; this can affect the course of labour and the choice of delivery management.

This information is relevant for women in whom face presentation has been detected on examination or during labour.

It is advisable to discuss possible management options with your clinician in advance:

the criteria for attempting vaginal birth or indications for cesarean section;
the fetal monitoring plan;
and analgesia options — whether a plan can be agreed beforehand and under what conditions it might be changed.

The final decision is made individually based on the condition of the mother and baby and may be changed during labour in their best interests.

What is labor with a facial presentation

This is a situation in which the fetal chin is directed toward the mother's pelvis, and the shape of the head as it passes through the birth canal differs from the usual. This presentation requires careful assessment of the fetal position, maternal pelvic dimensions, and the progress of labor. Before speaking with the obstetrician and midwife, it is helpful to understand which factors will be decisive in choosing the management approach.

Altered head position that may impede the usual descent of the fetus
Different from the typical occiput (vertex) presentation — the chin presents first
Assessment of the mentum (chin) position as a key criterion for management
Discuss the birth plan in advance with your doctor and midwife, including options for monitoring and management
Be prepared to change the management during labor for the safety of both mother and baby

This information will help you prepare to discuss delivery management options. The final decision is made individually and may change during the course of delivery.

Who this approach to delivery may be suitable for

This format explains in which situations labor and delivery with a face presentation are considered. It may not be suitable for everyone — the decision depends on examinations and the course of the pregnancy. It is helpful to discuss conditions, management options, and possible changes to the plan with your healthcare provider in advance.

Wanting to discuss the possible birth scenarios in advance and understand management options
Planning for a partner or support person to be present during labor
Needing to discuss pain relief options and consult an anesthesiologist ahead of time
Wishing to remain active and change positions during labor when there are no contraindications
Having a pregnancy without serious complications, which is assessed during examinations
Taking previous birth experience into account when planning management of the current delivery
Needing a clear and calm delivery plan with the option to revise it

This approach is discussed individually and is not a final decision until after examinations. During labor the plan may change in the interests of the safety of the mother and baby.

When this arrangement may be restricted or changed

Not every planned approach is possible with a face presentation; sometimes restrictions or a change of tactics are required. Decisions are made based on examinations and continuous monitoring of the mother’s and baby’s condition. The plan is discussed in advance but may change during labor for safety.

- Obstetric complications that prevent safe descent of the fetus through the birth canal
- Signs of fetal distress on monitoring that require immediate assessment and action
- A sudden deterioration in the mother’s condition requiring urgent surgical intervention
- Indications for a cesarean section that make vaginal attempts unsafe
- Contraindications to a specific type of analgesia identified during the anesthesiology assessment before delivery
- Infectious or logistical constraints that may prevent partner-assisted births in the delivery room
- Suboptimal pelvic dimensions or fetal position during labor progression, assessed as labor progresses

Such limitations are a normal part of obstetric practice aimed at safety. The doctor and midwife will explain the need for changes and propose a further plan of action.

Who and how decisions are made about the mode of delivery

This explains who decides what kind of delivery will take place and how a management plan is formed in cases of facial presentation. The decision is a collaborative process between you and the medical team, not the fulfillment of a single wish. The physician and obstetrician assess the mother's condition, ultrasound results, test findings, and the fetus's progress. If necessary, an anesthesiologist and neonatologist are brought into the discussion.

The wishes of the patient and partner are taken into account when planning labor management
Assessment of the pregnant woman by the physician and obstetrician based on examination, ultrasound, and tests
Monitoring of the fetus's and mother's condition during labor influences management decisions
Prior consultation with an anesthesiologist when planning possible pain-relief or anesthesia methods
Involvement of a neonatologist when there is increased risk or a need for urgent neonatal care
Joint discussion of the plan, considering clinical indications and the patient's preferences
The decision to perform urgent surgical intervention is made by the team in the interest of safety

The final decision is made jointly and relies on medical data and your preferences. The plan may change during labor — staff will explain the reasons and propose the next safe step.

What to discuss with your doctor in advance

Before delivery with a face presentation, it’s important to discuss key issues with your doctor and obstetrician ahead of time to understand possible scenarios and the criteria for decision-making. Below are short questions to help you prepare for the consultation and clarify the plan of action. Remember, the final decision may change during labor in the interest of the mother’s and baby’s safety.

What mode of delivery do you consider possible in my case, given the ultrasound findings?
Can we plan for a birth with my partner present, and what are the requirements for that?
What pain relief options are appropriate and is an anesthesiologist consultation needed?
How should my previous deliveries, cesarean section, or complications be taken into account when choosing a management approach?
Which chronic medical conditions are important to consider when planning delivery?
Which ultrasound results and laboratory tests should I have when admitted to the maternity hospital?
What is the plan of action if the fetal position changes or signs of fetal distress appear?
When is it best to go to the clinic when contractions start or other symptoms occur?
What documents and personal items should I bring to the hospital?
What postpartum accommodations and care are provided for the mother and baby?

Write down the answers and discuss them at your appointment — this will help you and the medical team more quickly agree on a clear and safe plan.

Preparation for childbirth with face presentation

Preparation is a series of assessments and agreements between you and the medical team, not a mere formality. The goal is to clarify possible scenarios, necessary examinations, and the roles of those involved in advance. Preparation makes decision‑making easier but does not guarantee that the plan will remain unchanged.

Consultation with an obstetrician and a midwife to assess fetal position and the course of the pregnancy
Review of the maternity record and existing test results before planning delivery management
Additional tests appropriate to the gestational age, if necessary
Discussion of the birth plan: criteria for attempting vaginal delivery and alternatives
Consultation with an anesthesiologist when planning pain relief and assessing contraindications
Preparation of the birth partner: role during labor, access rules, and possible restrictions
Instruction on signs of labor onset and recommendations on when to go to the clinic/hospital
Checking the list of items, documents, and arrangements for the post-delivery stay

Such preparation helps you and the team have a clear guide and respond more quickly. During labor, the plan may change as needed for the safety of the mother and baby.

How labor typically proceeds in cases of face presentation

Labor with a face presentation follows stages similar to normal labor but with closer monitoring and readiness to change tactics. The entire process is focused on the safety of the mother and baby: the team assesses progress and makes decisions as labor unfolds. Below is a typical scenario that may be adjusted depending on the clinical situation.

Admission to the clinic at the onset of contractions or according to a prearranged plan
Examination by an obstetrician and midwife to assess the condition and choose a management strategy
Observation of contractions: frequency, strength, and intervals
Monitoring the fetal condition with periodic assessment of the heart rate
Discussion of pain relief and consultation with an anesthesiologist if necessary
Management of labor by the doctor and midwife, with support and recommendations on maternal positions
Pushing stage when the mother is ready and labor dynamics are favorable
Birth of the baby with controlled delivery of the head and body, providing assistance if necessary
Initial examination of the newborn and assessment of adaptation, involving a neonatologist if needed
The first hours after birth: observation of mother and baby, assistance with feeding and care

This scenario provides a general idea of how labor may proceed; the specific plan is discussed in advance and may change in the interest of safety.

The medical team will always explain the reasons for any changes and propose further steps.

Pain relief during labor in this format

Pain relief in cases of face presentation is discussed in advance, especially if you are considering an epidural or other methods. At the consultation, the anesthesiologist will explain the available options, assess their safety and any possible contraindications. The pain relief plan is made taking into account the mother’s condition and the progress of labor and may be adjusted during delivery.

Discussing pain relief in advance when planning labor management
Consultation with an anesthesiologist to assess methods and contraindications
Assessment of the suitability of epidural anesthesia and other available options
Choosing a method taking into account the mother’s condition, test results, and the course of labor
The possibility to change the decision and method of pain relief during labor
Limitations on methods in the presence of contraindications or an acute clinical situation
Coordinating the pain relief plan with the obstetric team before admission to the maternity hospital

The anesthesiologist and obstetrician will explain the risks and expected effects of each method and help you make an informed decision.

Complete predictability of the pain experience cannot be guaranteed, but the team aims to provide the safest and most comfortable care possible.

How safety and monitoring are ensured during labor in this setting

Monitoring is a routine, planned part of labor management, especially in cases of face presentation. The team monitors both the mother and the baby and is ready to promptly adjust management if the situation changes.

Importantly, actions are aimed at timely decision-making in the interests of safety.

Examination and regular monitoring by the physician and midwife of the mother’s overall condition
Fetal heart monitoring by auscultation and, if needed, CTG (cardiotocography)
Assessment of labor progress: contraction frequency, cervical dilation, and fetal descent
Monitoring key maternal parameters: blood pressure, bleeding, and general well‑being
Rapid readiness of the team to change tactics or perform operative intervention if indicated
Involvement of a neonatologist for initial assessment and assistance to the newborn as needed
Informing the patient and partner about the monitoring process and the reasons for any possible changes in the plan

This monitoring helps detect changes in time and make safe decisions. You will be kept informed of the situation and the next steps will be explained.

What happens if labor doesn't go according to plan

A birth plan is a guideline that may change if the progress of labour or the condition of the mother and baby require it. In births with a face presentation, the team is prepared in advance for several alternative scenarios and promptly adjusts tactics. It is important that any changes are made for safety and are explained.

Revision of the birth plan in the interests of the mother’s and baby’s safety
Suspension of partner-supported labour if urgent intervention is needed or infection-control restrictions apply
Transition from natural/expectant management to stimulation of contractions or to cesarean section when indicated
Inability to provide epidural analgesia in an emergency or if contraindications are identified
Changing from an upright/vertical position to a more controlled position if labour dynamics worsen
Adjusting the plan with minimal intervention if signs of risk to the baby appear
Immediate involvement of a neonatologist or other specialist team if urgent care is required

Such changes do not mean “failure”; they are a normal part of safe labour management. Your doctor and midwife will tell you the reasons for any adjustments and propose the next steps.

Possible risks and limitations when choosing a mode of delivery

Any mode of delivery has limitations, and this is especially important to remember in cases of face presentation. Risks depend on the condition of the mother, the baby, and the course of the pregnancy, so decisions are made based on clinical data. Discuss in advance with your doctor under what circumstances the plan might change.

Limitations of the chosen mode depend on the condition of the mother, the fetus, and the course of the pregnancy
The possibility of converting to a cesarean section if rapid intervention is required
The need for additional observation or enhanced monitoring during labor
Restrictions on pain-relief methods if contraindications are identified
Organizational or infection-control restrictions on having a birth partner in the delivery room
Do not base your choice of management solely on other people’s birth experiences
Prioritizing safety may require changing the plan for the sake of the mother and baby

Discuss these issues with your doctor before labor — this will help you understand possible scenarios and prepare in advance. During labor the team will explain the reasons for any changes and propose next steps.

What happens immediately after delivery

Immediately after birth, the teams focus on safety and the mother's first contact with the baby. In deliveries with a face presentation, standard measures are carried out carefully and, if necessary, promptly. The clinic always performs CTG to assess the condition and a newborn is given an initial examination by a neonatologist.

First skin-to-skin contact if the mother and baby are stable
Mandatory CTG (cardiotocography) to assess fetal heart activity after delivery
Initial examination of the newborn by a neonatologist and assessment of adaptation
Examination of the mother by a physician and obstetrician, monitoring of blood pressure and bleeding
Delivery of the placenta and, if necessary, its assessment and measures to control bleeding
Treatment and suturing of the birth canal if tears or an episiotomy are present
Assistance with the first latch and breastfeeding support, if possible
Transfer to the ward and observation during the first hours after delivery

Specific actions depend on the condition of you and your baby; the team will explain each step. If additional help is needed, you and your baby will be provided with the necessary monitoring and support.

Role of the physician and the delivery team

Labor is managed by a team in which each specialist has their own task, but decisions are made jointly. The physician and the obstetrician assess the situation, monitor its progress, and involve specialists as needed. The team also explains to the patient what is happening and the reasons for the decisions made.

Obstetrician-gynecologist — assesses risks, chooses the approach, and makes clinical decisions
Obstetrician/midwife — supports the labor, assists with positions and direct management
Anesthesiologist — evaluates the possibility of analgesia and administers it when indicated
Neonatologist — performs the initial examination and provides care to the newborn if necessary
Operating room/surgical team — ready for urgent intervention if the delivery plan changes
Nursing staff — monitors parameters and provides continuous care
The team continuously informs the patient about the course of labor and the reasons for decisions made

The team’s work is focused on the safety of the mother and the baby. In cases of facial presentation, the team is especially attentive to labor dynamics and promptly revises the plan when necessary.

Why this delivery format is convenient

This format helps make the birth plan clearer and more predictable in cases of face presentation. It provides an opportunity to discuss management options, the team's role, and expectations in advance. At the same time, the final decision always depends on the condition of the mother and baby and may change during labor.

A clear birth management plan agreed with the obstetrician and midwife
The opportunity to discuss personal preferences and constraints in advance
Reduced uncertainty when making clinical decisions
The ability to choose and arrange for a specific physician to be present
An organizationally and medically facilitated possibility for the partner to be present
Availability of agreed pain-relief options after consultation with the anesthesiologist
Continuous monitoring of mother and baby with the team's rapid readiness to change tactics

These advantages help expectant parents feel more confident when preparing for childbirth. If necessary, staff will explain the reasons for any changes and propose a safe plan going forward.

How a pre-delivery consultation works

A consultation is a structured discussion of your situation and possible delivery scenarios.

At the appointment, medical history, documents, and test results are reviewed, after which safe options and limitations are discussed together. Sometimes a follow-up visit or additional consultations are required to clarify the plan.

History-taking: previous births, chronic conditions, and current complaints
Review and analysis of the maternity record and results of recent examinations
Examination and assessment of the fetal position by the physician and midwife
Discussion of your preferences regarding the format of delivery and partner presence
Explanation of possible limitations and the criteria according to which the plan may change
Help in choosing a safe delivery format and agreeing on a tentative plan of action
Information about signs of labor onset and recommendations on when to go to the clinic
Answers to questions and, if necessary, referral for consultations with an anesthesiologist or neonatologist

The consultation helps provide a clear guide, but it does not always resolve all questions at the first visit. The team will record agreements and, if necessary, schedule further monitoring or examinations.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparation for admission for labor

Preparing for admission helps you orient more quickly in the delivery room, especially if the fetus has a facial presentation. Gather key documents and test results so the team can quickly assess the situation. Discuss the list with your doctor in advance — the plan may be adjusted during labor.

Documents: passport, identification code, and emergency contact details
Maternity record with notes on pregnancy care and important physician remarks
Results of recent tests and ultrasound scans that affect the delivery plan
Items for the mother: basic personal belongings and things needed during the first hours
Items for the baby: essentials for the first night and for registration procedures
Items for the partner: documents and a minimal set for staying in the delivery room
Regular medications — bring them with you and discuss their use with the doctor beforehand
Doctor’s contact information and a copy of the agreed preliminary birth plan for quick briefing

This basic set simplifies admission and allows the team to act more quickly. If you have any questions, confirm the list at your doctor’s appointment.

Conditions of the maternity department at Genesis Dnepr

When delivery occurs with a face presentation, not only the management tactics but also the organization of the process in the maternity ward are important. Our delivery rooms and recovery wards are designed for effective team work and monitoring of mother and baby. Below is a brief description of how care is organized and which services are available in the delivery suite.

Delivery rooms equipped for planned and emergency labor management
Recovery rooms with the option for mother and baby to stay together (rooming-in)
A neonatologist available at all times for initial examination and newborn care
An on-call anesthesiologist for consultation and administration of analgesia/anesthesia as indicated
Operating room readiness for surgical delivery if necessary
Possibility of partner-accompanied births, subject to medical and organizational conditions
Individual support by an obstetrician and a midwife during labor
Monitoring and care during the first hours after birth, with checks on the condition of both mother and baby

These provisions are intended to ensure safe and clear support during childbirth.

Upon admission, the team will explain which options and limitations apply in your specific case.

When to seek urgent medical attention

Some symptoms require immediate attention and should not be postponed until a scheduled visit. During labor with a facial presentation it is especially important to report warning signs quickly. If something worries you, it is better to consult your doctor or go to the maternity hospital.

Vaginal bleeding, especially if it appears suddenly or is increasing
Your water has broken — seek care immediately, even if you do not have strong contractions
Regular contractions that are becoming more frequent and more intense
Severe, persistent abdominal or back pain that does not subside on its own
Noticeable decrease or absence of fetal movements compared with usual
High blood pressure, severe headache, or visual disturbances
Marked weakness, dizziness, fainting, or difficulty breathing that require evaluation
Fever above 38°C (100.4°F) or chills with fever
Any active/heavy bleeding, even if the amount seems small, requires medical attention
Any sudden change in how you feel that causes you significant concern

When in doubt, contacting your healthcare provider is the right step to assess the situation promptly and make decisions. Our team is always ready to help and explain the next steps.

Frequently Asked Questions

Question: Can the mode of delivery be decided in advance for face presentation?

Answer: You can discuss your preferred delivery plan in advance at a consultation, but the final decision depends on the examination, ultrasound and the progress of labor.

Question: Are such deliveries suitable for everyone?

Answer: No — suitability is assessed by the doctor based on the condition of the mother, the fetus and the course of pregnancy; the decision is made individually.

Question: Can the plan be changed during labor?

Answer: Yes — the plan is often revised as labor progresses in the interests of the safety of the mother and baby.

Question: Can the delivery format be discussed before labor starts and what is needed for that?

Answer: Yes — come to a consultation with your maternity record and the latest test results so the doctor can assess the possible options.

Question: Can I have my partner present during delivery?

Answer: Yes — partner-supported deliveries are possible if there are no organizational or infectious restrictions; details are discussed in advance.

Question: Is epidural anesthesia available for this type of delivery?

Answer: Epidural anesthesia may be an option, but its suitability is assessed by the anesthesiologist taking into account contraindications and the situation during labor.

Question: Who decides on pain relief?

Answer: The decision is made jointly by the patient, the anesthesiologist and the obstetrician, taking into account indications and the current condition.

Question: What happens if the chosen method of pain relief proves unsuitable during labor?

Answer: The pain relief plan can be adjusted; if there are contraindications or an emergency, other safe approaches will be used.

Question: When should I go to the clinic when contractions or other symptoms begin?

Answer: You should contact your doctor and go according to their recommendations if you have regular contractions, rupture of membranes (water breaking) or worrying symptoms.

Question: What should I bring to the maternity hospital?

Answer: Bring identification, your maternity record, test results, basic items for you and the baby, and any regular medications with a doctor’s note.

Question: Is a maternity record and test results required upon admission?

Answer: Yes — a maternity record and up-to-date tests help quickly assess the situation and adjust the labor management plan.

Question: Can I come in for delivery with tests already done?

Answer: Of course — bring all current tests and ultrasounds; this will speed up assessment and planning on admission.

Question: What happens if a cesarean section is needed?

Answer: If indicated, the team will promptly organize a cesarean section; you will be informed in advance about the reason and the next steps.

Question: How long do people usually stay in the clinic after delivery?

Answer: The length of stay depends on the condition of the mother and baby and is determined individually by the doctor.

Question: What is done immediately after the baby is born?

Answer: A neonatologist performs an initial examination, cardiotocography (CTG) is done if needed, first contact is arranged and observation is provided in the first hours.

Question: Can I meet the doctor beforehand or discuss an individualized plan?

Answer: Yes — you can schedule a consultation to discuss the plan, your wishes and any possible limitations.

Question: Can I get a second opinion if the proposed approach does not convince me?

Answer: Yes — you can request an additional consultation or a second opinion from another specialist to help make a decision.