I was woken by the midwife at 12.30am. A patient had arrived in labour at 6cm cervical dilatation. She was 39 weeks’ gestation and she had had two uncomplicated vaginal deliveries.
She still had intact membranes. The midwife asked me to come as she was starting to get pressure. She concluded the conversation by saying: “I think it is a face presentation”.
I attended at once. She had ruptured her membranes just prior to my arrival. I did an internal examination and sure enough, it was a face presentation with chin being anterior. Her cervix was now fully dilated.
She could feel pressure with contractions so I encouraged them to push. With pushing over two contractions she delivered her baby face first and chin up. With the next contraction, she delivered the rest of the baby. She had a boy weighing 3.8Kg and born in good condition. She had an intact perineum. No stitches were needed.
The incidence of face presentation is reported to be between 1 in 500 deliveries to 1 in 1400 deliveries. It happens when the baby’s head is very extended backwards. Fortunately, it was a mento-anterior face presentation as a mento-posterior face presentation usually needs a Caesarean section. Also, that it was her third vaginal delivery and that the patient could push so well meant it was a very straightforward but different delivery.