Brow Presentation and Birth Injury
In an ideal vaginal delivery, infants are born in the vertex position. This means that they emerge head-first, with the chin tucked toward the chest. Brow presentation is one of many abnormal positions that can lead to labor and delivery complications and subsequent birth injuries. A fetus in brow presentation has the chin untucked, and the neck is extended slightly backward. It is similar to face presentation, except the neck is less extended. As the term “brow presentation” suggests, the brow (forehead) is the part that is situated to go through the pelvis first. Vaginal delivery can be difficult or impossible with brow presentation, because the diameter of the presenting part of the head may be too big to safely fit through the pelvis (1).
Risk factors and conditions associated with brow presentation
Brow presentation has been linked to several risk factors and co-occurring conditions. These include (1):
- Multiparity (having previously given birth)
- Premature delivery
- Fetal anomalies such as anencephaly (an absence of major parts of the brain and skull) or anterior neck mass (a growth on the front of the neck)
- Previous cesarean delivery
- Polyhydramnios (excessive amniotic fluid: infants swallow amniotic fluid while in utero, but this may be difficult if their neck is extended)
Diagnosis of brow presentation
Brow presentation can often be diagnosed through a vaginal examination during labor. If there are no conclusive signs from the physical examination alone, an ultrasound can also be used (1). Warning signs of brow presentation may include signs of fetal distress or lack of labor progression.
Management of brow presentation
Infants who assume a brow presentation early in labor may spontaneously move into a more optimal position during the delivery process. Additionally, safe delivery in brow presentation may be possible if the infant is unusually small and/or the mother’s pelvic opening is unusually large. For these reasons, physicians occasionally recommend vaginal delivery of infants in brow presentation (1).
Doctors attempting vaginal delivery of a baby in brow presentation must be very careful to watch for signs of fetal distress (such as an abnormal heart rate), and to monitor the progression of labor. Prolonged labor can cause extended periods of fetal oxygen deprivation, which can cause birth asphyxia and permanent injury. Signs of fetal distress can indicate that a baby is in danger of sustaining serious brain damage (see “Complications of Brow Presentation”) if action is not quickly taken to prevent this. If an infant in brow presentation begins to show signs of distress, or if labor progress stops or slows significantly, physicians should be ready to move on to a cesarean delivery (1).
Labor induction or augmentation with the drug Pitocin (synthetic oxytocin) is very dangerous in cases of brow presentation. Pitocin can lead to excessive uterine contractions, which can put pressure on the infant’s head and cut off their oxygen supply; this is especially risky when safe fetal descent is already compromised, such as in cases of brow presentation (1).
Complications of brow presentation
If brow presentation is diagnosed in a timely fashion and is appropriately managed, there are typically no serious negative effects on the mother or baby. However, if medical professionals fail to recognize brow presentation and intervene as necessary, there can be lasting consequences. Infants may suffer oxygen deprivation due to prolonged labor, or traumatic injuries from a difficult delivery. Some of the most severe conditions resulting from mismanaged brow presentation births include (1):
- Hypoxic-ischemic encephalopathy
- Cerebral palsy
- Periventricular leukomalacia
- Seizure disorders
- Developmental disabilities
Legal help for birth injuries resulting from brow presentation
Informed consent is very important during labor and delivery. This means that medical professionals must explain the risks and benefits of various courses of action, and discuss any alternative options with the mother. Vaginal delivery with brow presentation may be possible, but the risks of this should be carefully communicated. Moreover, if doctors proceed with a vaginal delivery of an infant in brow position, they need to carefully monitor fetal health and labor progress. If they fail to do either of these things, it is negligence. If this negligence leads to injury, it is medical malpractice.
If your child was delivered in brow presentation and sustained permanent damage, the award-winning attorneys at Reiter & Walsh ABC Law Centers can help. Our lawyers have decades of experience handling complex birth injury cases and have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. We give personal attention to each child and family we represent.
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Video: Face presentation
The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about brow presentation, please consult with a medical professional.
- Julien, S., and Galerneau, F. (2017). Face and brow presentations in labor. Retrieved from https://www.uptodate.com/contents/face-and-brow-presentations-in-labor.
- Health&. (2016). Face and Brow Presentation. Retrieved from https://healthand.com/us/topic/general-report/fetal-position-during-pregnancy.