Management of labor with brow (frontal) presentation at the Genesis Dnepr Clinic, Dnipro.

Labor with a brow presentation is a situation in which the fetal presenting part is the brow (brow presentation). This may be relevant if that fetal position is identified on examination late in pregnancy or at the onset of labor. It is important to discuss management options, the criteria for choosing the mode of delivery, and monitoring considerations with your doctor and obstetrician in advance, including pain relief. The final decision is made based on the condition of the mother and fetus, and the plan may change during labor in the interests of both their safety.

What this type of presentation means

Labor with a forehead (frontal) presentation is a situation in which the presenting part during delivery is the baby's forehead. It differs from a normal cephalic presentation in the orientation and shape of the presenting part, and can sometimes alter the course of labor. Before discussing options with your doctor and obstetrician it is important to understand which parameters will be assessed and what delivery options are possible. Decisions are made on an individual basis and may change during the course of labor.

Altered orientation of the baby's head as it passes through the birth canal
Prolongation of the second stage (pushing phase) may occur in some cases
Need for careful monitoring of the mother and fetus
Discuss possible delivery scenarios in advance with your doctor and obstetrician
Limitations for vaginal delivery depend on the size and position of the baby's head
The birth plan may be adjusted in the interests of the safety of the mother and baby

The final decision is based on the current condition of the mother and baby; be prepared to discuss changes during labor.

Who may be suitable candidates for delivery with a brow presentation

Delivery with a brow presentation may be appropriate in certain situations, but the choice of delivery method is always individualized. At a consultation, baseline data, possible scenarios and the criteria for attempting a vaginal birth are discussed. It is important to talk in advance about partner presence and pain relief so the team knows your preferences.

A desire to discuss possible delivery scenarios and criteria for choosing a method in advance
Having a partner or close person whose participation is organized and medically approved
The need to discuss pain relief options and to consult an anesthesiologist if necessary
A need to understand who will manage the labor and make operative decisions and how they will do so
Pregnancy progressing without serious complications and there being potential to attempt a vaginal birth
A desire to remain active and choose comfortable positions during labor
Previous birth experience that should be taken into account when planning the current delivery
An expectation of a calmer, clearer, and mutually agreed delivery plan discussed in advance

The final decision is made based on the condition of the mother and fetus; the plan may change during labor in the interest of safety.

When this type of delivery may be unsuitable or require restrictions

Brow (frontal) presentation deliveries can be considered as an option, but in certain situations the delivery plan may be changed. Decisions are based on the current condition of the mother and fetus, monitoring results, and the team's clinical assessment. The team may propose a different approach in the interests of safety, and this is a normal part of labor management.

Obstetric complications requiring urgent intervention or expedited delivery
Signs of fetal distress on fetal heart monitoring
Failure of labor to progress when progression is expected
Indications for operative delivery (cesarean section) in the interests of safety
Contraindications to the chosen method of analgesia/anesthesia, to be discussed with the physician and midwife
Infectious or organizational restrictions affecting the partner's presence in the delivery room
Maternal conditions in which immediate measures take priority over the initial plan

Such a change of plan is a normal medical response to a changing situation; the team will always explain the reasons and the next steps.

Who decides on the mode of delivery

The decision on the mode of delivery is made jointly by the patient and the medical team, taking into account your preferences and the clinical picture. In brow presentation the choice relies particularly on examination findings and the progress of labor. The obstetric team is involved, and an anesthesiologist and neonatologist are consulted if necessary. The plan is individualized and can be adjusted during labor in the interest of safety.

The patient expresses preferences, fears, and questions in advance
Assessment by the physician and obstetrician of the pregnancy, test results, and ultrasound findings
Monitoring of the fetal condition and assessment of labor progress over time
Involvement of an anesthesiologist when discussing pain relief options
Involvement of a neonatologist if there is a risk of complications or an operative intervention is planned
Joint weighing of potential risks and benefits before the final decision
The team’s readiness to change the plan if medical indications arise

The decision is made together, taking into account your wishes and objective medical data. If the plan changes, the team will explain the reasons and propose the next safe step.

What to discuss with your doctor in advance

These questions will help you prepare for a conversation about labor with a brow presentation and make sure you don't miss the main points. Take the list to your appointment and write down answers and clarifications as you go. The discussion will help build a clear plan that can be adjusted if necessary during labor.

What approach to delivery do you recommend and why?
Is partner support allowed, who can be present, and under what conditions?
What pain relief/analgesia options are available, and is an anesthesiologist consultation needed?
How do previous deliveries, cesarean section, or prior complications affect the current plan?
Are there any chronic conditions that should be taken into account when planning delivery?
Which recent ultrasounds and tests should I bring or discuss at the appointment?
What is the plan if the mother's or fetus’s condition changes during labor?
What should I pack for the hospital and which documents should I prepare in advance?
When is it best to go to the clinic/hospital when labor begins or if the waters break/there is leaking?
What are the postpartum accommodation conditions and the expected discharge time?

Write down the answers and clarify any unclear points before labor. Remember that the plan may change in the interest of your and your baby’s safety.

How preparation for this type of delivery proceeds

Preparation for delivery in the case of a brow presentation is a step-by-step discussion and assessment of the mother’s and fetus’s condition, not an attempt to “order” a specific outcome. At the appointment the obstetrician and midwife review the examination data, go over the plan and possible actions if the situation changes. If necessary, an anesthesiologist and neonatologist are involved, and the partner’s role is agreed upon.

Consultation with the obstetrician and midwife to assess the current status of the pregnancy
Review of the antenatal record and discussion of the most recent ultrasounds and test results
Discussion of the birth plan, possible alternatives, and criteria for changing the scenario
Consultation with an anesthesiologist if you plan to discuss pain-relief options
Preparing the partner: rules for presence and their role during labor
Checking documents and organizational matters upon admission to the maternity hospital
Packing for the maternity hospital according to a short list that will be provided at the consultation
An agreed plan of action in case of deterioration or signs of preterm labor

Preparation helps you and the team be ready for different scenarios, but the final decision is made according to the situation during labor. The team will explain any changes in detail if the plan needs to be adjusted.

How labor progresses with a brow presentation

Labor with a brow presentation usually follows the familiar sequence but requires increased attention to the position of the fetal head and its dynamics. The process is adapted to your individual circumstances, and the plan may change as needed for safety. Below are the typical stages you will encounter in the delivery room.

Admission to the clinic and initial registration; measurement of vital signs
Examination by the physician and midwife to assess cervical dilation and the baby’s position
Monitoring contractions and assessing their regularity and strength
Fetal cardiomonitoring to check the baby’s condition during labor
Discussion of pain relief and consultation with an anesthesiologist if necessary
Management of labor by the obstetrician and midwife with regular assessments of progress
The second stage (pushing) with support and guidance on positions and breathing
Birth of the baby with careful monitoring of the passage of the head and shoulders
Initial examination of the newborn and provision of any necessary neonatal care
The first hours after birth: monitoring the mother, assistance with breastfeeding, and care

The team will explain each step and the reasons for any possible changes to the plan so you understand what will happen next.

Pain relief during labor in this format

The issue of pain relief is discussed in advance and upon admission to the maternity hospital, especially in cases of brow presentation. At the consultation, available options, benefits, and possible limitations for your situation are reviewed. If necessary, an anesthesiologist’s consultation is arranged to choose the best method taking into account the mother’s health and the progress of labor.

Discussion of pain relief at the prenatal consultation and upon admission to the clinic
Anesthesiologist consultation to assess options and contraindications
Regional and systemic methods may be offered in the clinic (as indicated)
The choice of method depends on the condition of the mother, the fetus, and the dynamics of labor
The decision can be adjusted during labor if the situation changes
The presence of contraindications may make some methods unsuitable in a particular case
Monitoring of the mother’s and fetus’s condition continues after pain relief is provided

Discuss your expectations and concerns in advance — the team will explain available options and risks.

Remember that a fully predictable reaction to pain relief is not possible, so the main priority is the safety of the mother and baby.

Monitoring and safety during labor

During labor with a brow (forehead) presentation, the team pays increased attention to monitoring to detect changes in the condition of the mother and fetus in a timely manner. Monitoring is a routine part of labor management and does not necessarily indicate a problem. The physician and midwife regularly assess parameters, and additional specialists are called in as needed.

Monitoring the mother's vital signs: blood pressure, pulse, temperature, and bleeding status
Assessment of the fetal heartbeat with a stethoscope and, if necessary, CTG (cardiotocography)
Monitoring the strength and regularity of contractions and the pace of cervical dilation
Regular examinations by the obstetrician and midwife to assess labor progress
Support and monitoring during pain relief/analgesia, with involvement of an anesthesiologist if needed
The team's readiness to change management promptly if the condition of the mother or fetus worsens
Availability of a neonatologist and the necessary equipment to assist the newborn immediately after birth
Open communication with the patient about monitoring results and the proposed steps

Monitoring helps the team make prompt decisions in the interest of the mother’s and baby’s safety. If the plan is changed, the team will explain the reasons and the subsequent actions.

If labor progresses differently than planned

The birth plan is a guideline that the team is prepared to adjust depending on the situation; such flexibility ensures the safety of the mother and baby. In the case of a brow presentation, changes may be needed because of the pace of labor or fetal monitoring results. The team will explain the reasons and propose the next step based on the current condition.

Rapid assessment of the situation by the obstetrician and midwife to make a decision
Revision of the birth plan with an explanation of the reasons and possible options
Partner presence may be temporarily limited for medical or organizational reasons
Transition from spontaneous labor to augmentation if progress stalls
Decision to perform operative delivery (cesarean section) if necessary
Epidural anesthesia may be withheld if contraindicated or in an emergency
Changing from an upright birthing position to another position that is safer at that moment

Changing the plan is not a mistake but a standard medical tactic when circumstances change.

The team will explain the reasons and subsequent steps in detail.

Possible risks and limitations

Any mode of delivery, including delivery in a frontal (forehead) presentation, has limitations that are taken into account during planning. Risks depend on the condition of the mother, the fetus and the progression of labor, so the decision is always individualized. It is important to understand that some measures may become necessary during the process, and this is normal medical practice.

Risks depend on the condition of the mother, the fetus, and the course of the pregnancy
May require stimulation/augmentation of labor or operative (surgical/assisted) delivery
Some analgesia/anesthesia methods may be unsuitable in specific situations
The doctor and midwife will explain in advance the situations in which the plan may be changed
Partner attendance may be limited for infection-control or organizational reasons
Do not base the choice of delivery format solely on someone else’s birth experience
The safety of the mother and baby takes priority over a previously chosen plan

Take these limitations into account when discussing the birth plan; the team will explain possible changes and the next steps in detail.

What happens immediately after childbirth

After the baby is born, quick routine actions are taken to assess the condition of the mother and baby and to facilitate early contact. In the clinic, the team provides an initial examination of the newborn and monitoring of the mother, as well as help with the first breastfeeding latch. The exact sequence may depend on the condition of both and on previously discussed plans.

First contact: initial breastfeeding latch and skin-to-skin contact when possible
Cardiotocography (CTG) during the end of labor and an initial examination by a neonatologist are always performed
Assessment of the newborn’s condition and provision of neonatal care if necessary
Monitoring the mother’s condition: bleeding, blood pressure, pain control, and overall well‑being
Assistance with the first latch and feeding advice from medical staff
Performance of any necessary newborn procedures in the delivery unit (as indicated)
Transfer of the mother and baby to the ward with continued monitoring during the first hours

Each mother–baby pair is observed individually, and the team will explain all actions and the next steps. If additional measures are required, they will explain the reasons and the plan for further care in detail.

Role of the doctor and the birth team

Labor is managed by a team of specialists, not by a single person; their task is to jointly ensure safety and support. This is especially important in brow presentation, because careful assessment of the fetal position and the dynamics of labor is required. Each team member performs their role and informs you about the decisions made.

Obstetrician‑gynecologist — assesses risks and makes key clinical decisions
Midwife — supports the process, helps with positioning and coping with contractions
Anesthesiologist — advises on pain relief and ensures its safety when needed
Neonatologist — performs the newborn’s initial examination and provides neonatal care
Surgical/operating team — prepares for and performs operative delivery when indicated
The doctor and midwife regularly monitor labor progress and the fetus’s condition
The team explains what is happening to the patient and discusses possible changes to the plan
Coordination among specialists ensures a rapid response if the situation changes

The team works to ensure you understand the steps and feel supported; final decisions prioritize the safety of the mother and baby.

How this format is convenient for the patient

In a brow presentation, a prearranged birth plan makes the process clearer and more predictable for the mother. These conditions allow discussion of possible courses of action and reduce some of the uncertainty before labor. The convenience lies in clear agreements with the team and the possibility of prompt management if the situation changes.

A clear plan with predefined criteria for changing the approach
The opportunity to discuss and agree on your preferences in advance
Less uncertainty thanks to regular assessments of progress and explanations from the team
The option to choose and arrange for the presence of a specific doctor
Opportunity for your partner to participate, subject to organizational and medical requirements
Access to discussed pain-relief options and consultation with an anesthesiologist
Continuous monitoring of mother and fetus with prompt response to changes
The team's readiness for different scenarios and prompt coordination of actions

These conveniences help you feel more informed and calmer, but the final decision always depends on the condition of the mother and baby at the time of delivery.

What happens during a pre-delivery consultation

A pre-delivery consultation is a structured appointment where the doctor and midwife assess your situation and discuss a possible plan for delivery. At the appointment they take your medical history, review the maternity record, and look over the results of recent examinations. You state your wishes and questions, and the team explains possible limitations and available options. Sometimes several visits are required to clarify the plan and monitor progress.

Medical history taking: previous deliveries, chronic conditions, and current complaints
Review of the maternity record and discussion of recent examination notes
Review of ultrasound and laboratory test results (if available)
Stating your preferences regarding the birth format and partner presence
Explanation of possible limitations and criteria for changing the plan
Discussion of pain relief options and referral to an anesthesiologist if needed
Recommendations on when to go to the clinic once labor activity begins
Answers to your questions and agreement on the next step or follow-up

The consultation helps form a clear and flexible plan; the final decision may be refined as labor approaches or during the process.

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 delivery

This is a short checklist of what is useful to prepare before arriving at the maternity hospital. In brow presentation it is especially important to have all documentation and up-to-date tests for a quick assessment of the situation. On admission the team will check your documents and maternity record and discuss the plan. If anything is unclear, clarify it at your prenatal consultation in advance.

Documents: passport, identification and medical documents
Maternity record with notes on prenatal care
Results of recent pregnancy tests and ultrasounds
A list of regularly taken medications — discuss with your doctor and obstetrician/midwife in advance
Items for the mother: a short list of comfortable essentials needed in the first hours
Items for the baby: prepared as a basic set
Items for the partner and confirmation/arrangement of their presence if needed
Contact phone numbers for your doctor and a plan outlining which signs mean you should go to the clinic

If you need clarifications about the list or arrival timing, discuss them at your next consultation — the team will advise.

Maternity ward conditions

The maternity ward is organized to ensure safe management of labor and a calm recovery afterward. In cases of labor with a brow (frontal) presentation the team pays increased attention to monitoring and is prepared to make rapid decisions. Equipment, specialists, and rules for partner presence are agreed in advance depending on the clinical situation.

Delivery rooms with necessary monitoring and equipment for observing the mother and fetus
Recovery rooms with the option for mother-and-baby rooming-in (room-in)
Constant availability of a neonatologist for initial examination and care of the newborn
Anesthesiologist involvement in planning analgesia and for emergency indications
Possibility of partner-supported births provided medical and organizational requirements are met
Coordination of accompanying staff (midwife/nurse) and allocation of responsibilities in the delivery room
Readiness of the surgical team and equipment for operative delivery if necessary

If you have preferences or questions about your stay, discuss them in advance at a consultation — the team will explain available options and any limitations.

When to seek urgent medical attention

In frontal presentation, as with any pregnancy, there are signs you should not wait for a scheduled appointment to address. If you notice one or more of the warning symptoms below, it’s best to contact the maternity ward (labor and delivery) promptly. A quick assessment allows appropriate measures to be taken and reduces risks.

Any amount of bloody discharge that is markedly different from your usual vaginal secretions
Your waters have broken or there is noticeable, continuous leaking of amniotic fluid
Regular contractions that are becoming more frequent and interfere with your normal activity or rest
Severe or unbearable pain in the lower abdomen or lower back
Decreased or absent fetal movements compared with the baby’s usual activity
High blood pressure, especially with dizziness or nausea
A severe headache that does not go away after rest and usual measures
Visual disturbances: blurring, flashing lights, or a sudden worsening of vision
Marked weakness, feeling faint, or fainting
Fever, elevated body temperature, or severe chills with sweating
Any sudden change in how you feel that causes serious concern

If you experience any of the above, contact the maternity ward or call emergency services immediately. Prompt action helps ensure timely assessment and a safe plan of care.

Frequently Asked Questions

Question: Can this type of delivery be planned in advance?
Answer: Often you can discuss and plan a preferred delivery format in advance, but the final decision depends on the clinical situation and may be clarified during labor.
Question: Is delivery in brow presentation suitable for everyone?
Answer: No — this depends on the mother's condition, the baby's size and position, and the progress of labor; assessment is made individually.
Question: Can the birth plan be changed during labor?
Answer: Yes — the plan can change for medical reasons; this is a normal part of safe labor management.
Question: Can we discuss the delivery format before labor starts?
Answer: Yes — discuss options at a prenatal/delivery consultation so the team knows your preferences and the criteria for decision-making.
Question: Can I have my partner present during birth?
Answer: Yes, if clinic medical and organizational requirements are met; there are situations when a partner’s presence may be restricted.
Question: How is pain relief discussed before delivery?
Answer: The available options, indications and contraindications are reviewed at consultation; if needed, you’ll be scheduled to see the anesthesiologist for detailed assessment.
Question: Is epidural anesthesia possible with a brow presentation?
Answer: The possibility of epidural anesthesia depends on the overall condition, contraindications and course of labor; the anesthesiologist makes the final decision together with the obstetric team.
Question: Who decides on pain relief?
Answer: Your stated preferences are taken into account, but the final choice and safety assessment are made by the doctor, midwife and anesthesiologist.
Question: What if the chosen method of pain relief is not suitable?
Answer: The plan will be adjusted on site: alternatives will be offered or a different approach will be used in the interests of maternal and fetal safety.
Question: When is it best to go to the hospital?
Answer: You should go when contractions are regular, membranes rupture (water breaks), there is bloody discharge, or if you feel a clear deterioration in condition; if in doubt, call the maternity ward.
Question: How do I know that regular contractions have started?
Answer: Regular contractions usually occur at a consistent frequency and increase in intensity over time; if contractions are frequent and prevent you from resting, have them evaluated.
Question: What should I take to the maternity hospital?
Answer: Bring identification, your maternity record, the results of recent tests, necessary personal items and any medications you take regularly (after discussing them with your doctor in advance).
Question: Are ID and the maternity record required at admission?
Answer: Yes — a passport and the maternity record with pregnancy management notes significantly speed up admission and assessment.
Question: Can I come with already completed tests and an ultrasound?
Answer: Yes — bring all current results; this helps the doctor assess the situation more quickly and adjust the plan.
Question: What happens if a cesarean section is needed?
Answer: If indicated, the team will explain the reason and prepare you for operative delivery; the priority is the safety of the mother and baby.
Question: Can I meet the doctor in advance or discuss the plan in person?
Answer: Yes — such consultations are held in advance to discuss wishes, limitations and plans for different scenarios.
Question: Can I get a second opinion if I’m not sure about the proposed management?
Answer: Yes — you can request an additional consultation or second opinion; the team will advise how to arrange this and which examinations are needed.