Until you’ve seen your first face presentation as a midwife, it’s hard to connect the sensations you feel on an internal exam with what is actually going on.
I have been a midwife for over 2 decades, with thousands of births under my belt, but I had yet, until last week, seen this intriguing complication.
Shani was having her fifth baby, and all 4 previous births had gone smoothly. She was late to care, meeting with me at about 30 weeks, but I was immediately taken with her joyous character and positive outlook. We met three more times during her pregnancy and stayed in touch by phone for updates from time to time.
This was going to be her first homebirth and she couldn’t have been more excited about it. She called me in the middle of the night to attend her. When I arrived, the contractions were still a little short. So, I hung out with her and her doula, doing some reflexology and chatting on the sofa.
The baby was not lying in an ideal position. The head was deflexed (instead of flexed) and it was in the posterior (instead of anterior) position. We did some exercises to encourage a better fetal position and it seemed like baby was starting to turn.
After a good few hours, the contractions became stronger and Shani entered the birth pool. Another couple of hours passed and there was good progress, but the baby was still in a funky position (as we midwives like to say!).
We tried some different, more challenging exercises and positions to encourage baby to move, but this baby wasn’t budging. I tried all the tips and tricks I knew and we were all getting quite worn out.
Eventually, Shani reached the pushing stage. Because baby’s head was still deflexed and posterior, she would have to push really hard to budge the baby. But the pushing wasn’t helping the baby’s head to descend at all. We were both surprised by this, as this hadn’t happened in any of her previous births.
Eventually, I got Shani to labor on the toilet seat. It’s a great place to labor (midwife tip) as we naturally release our pelvic floor there in order to have a bowel movement (sorry for TMI). I got her to really push HARD.
Eventually, eventually, Shani said she felt progress. I did an internal exam. And to my bewilderment I felt all sort of weird folds of the baby’s head (where there hadn’t been before). I really didn’t know what to think, like I said I had never experienced this before and I did not connect the dots. Shani pushed and pushed and baby started to descend.
I put her on the bed so I could get a better look at what was going on and to my utter astonishment, I saw a set of swollen lips and the tip of a nose!! SO that was what all those folds of skin were on the baby’s head!!! It was baby’s face…. It all made sense!!
Delivering face presentation can be a little riskier than a normal delivery, so we immediately arranged for transportation to the hospital. The ambulance drive was challenging for Shani and I remembered why I stopped volunteering in the ambulance service a few years ago. The swerving ambulance had me doing deep breathing so I wouldn’t throw up all over my poor client who was puffing through the pushing contractions valiantly.
Thank the Good L-rd, we got to the delivery suite in one piece. I had managed not to throw up and Shani had managed not to push. They had been notified of our case and we went straight into a room. The diagnosis was confirmed and Shani redoubled her efforts at pushing.
Not too long later, a very swollen face appeared, followed shortly by the rest of the head and body. The baby did great and didn’t need any additional care. Shani was super ecstatic and relieved and the midwife was totally wiped out!!!
After a day, the swelling had reduced completely to reveal a pretty little face, with no resemblance of the grossly swollen features of the day before.
It was quite an experience for me, one that I won’t forget in a hurry. The shock of seeing a baby’s face appearing first instead of a smooth or hairy scalp, was absolutely a lesson in midwifery! It’s super rare and I am pleased I got to learn about it first hand.
At our postnatal visit, we debriefed on the birth. Shani was still happy that she had chosen a homebirth and agreed that it was the right decision to transport. She stated that she couldn’t imagine having to do all those hours of labour tied to a monitor or stuck on the bed. And that she still preferred doing most of the work at home and just arriving in the hospital to deliver. It was a challenging birth. But, these are the ones that teach me humbleness, that there is still plenty yet to learn and that the adrenaline boost that accompanied a complication can be my best friend in times of need!! (Energy for the moment of need, but then you crash BIG TIME!!!)