Face presentation is a rare but serious childbirth complication that occurs when a baby’s face, rather than the top or back of the head, enters the birth canal first. According to the National Center for Biotechnology Information, this abnormal fetal presentation occurs in approximately 1 in every 500 to 600 deliveries. When medical professionals fail to properly diagnose or manage face presentation during labor and delivery, the results can be devastating—ranging from temporary facial trauma to permanent brain injuries like cerebral palsy and hypoxic-ischemic encephalopathy (HIE).
In New York, families affected by birth injuries caused by medical negligence during face presentation deliveries have legal rights to pursue compensation. However, strict time limits apply. This comprehensive guide explains what face presentation is, how it should be managed, when medical errors constitute malpractice, and your legal options under New York law.
Quick Facts About Face Presentation Birth Injuries:
- Occurs in 1 in 500-600 births
- 53% show abnormal fetal heart rate patterns vs. 14% in normal deliveries
- Mentum posterior position requires cesarean section
- New York families have up to 10 years to file claims for infants
- No damage caps in New York medical malpractice cases
What Is Face Presentation?
Face presentation is an abnormal form of cephalic presentation caused by extreme hyperextension (backward bending) of the fetal neck. In a normal vertex delivery—which accounts for approximately 97% of all births—the baby’s head is flexed forward with the chin tucked toward the chest, allowing the top or back of the head to lead through the birth canal. This position presents the smallest diameter of the baby’s head, facilitating easier passage through the pelvis.
In contrast, face presentation occurs when the baby’s neck is hyperextended backward, causing the face to become the leading part entering the birth canal. The chin (mentum) becomes the presenting point and follows the same course that the back of the head would in normal deliveries.
During a physical examination in the second stage of labor, healthcare providers can identify face presentation by palpating distinctive facial features including the orbital ridges (eye sockets), nose, malar eminences (cheekbones), mouth, gums, and chin. Ultrasound imaging can confirm the diagnosis and help determine the specific position of the chin.
Mentum Anterior vs. Mentum Posterior
The position of the baby’s chin determines the delivery approach and prognosis:
Mentum Anterior (MA)
Chin facing forward toward mother’s front
- Vaginal delivery may be possible
- Labor is often prolonged but manageable
- Requires careful monitoring and patience
- Oxytocin may be used if contractions are inadequate
- Episiotomy usually necessary
- Forceps may be used cautiously if needed
Mentum Posterior (MP)
Chin facing backward toward mother’s spine
- Cesarean section required—vaginal delivery impossible
- Manual or forceps rotation contraindicated (dangerous)
- High risk of obstructed labor
- Emergency C-section necessary to prevent injury
- Attempting vaginal delivery can cause severe trauma
Medical Negligence Alert: Attempting vaginal delivery when a baby is in mentum posterior position, or using forceps to rotate the baby’s face presentation, violates the accepted standard of obstetric care and can result in catastrophic birth injuries.
Risk Factors for Face Presentation
Face presentation results from conditions that cause hyperextension of the fetal neck or prevent normal neck flexion. Understanding these risk factors helps identify high-risk pregnancies that require enhanced monitoring. Research published in medical journals, including Williams Obstetrics and the Acta Obstetricia et Gynecologica Scandinavica, has identified numerous maternal and fetal factors that increase the likelihood of face presentation.
| Category | Risk Factor | Why It Increases Risk |
|---|---|---|
| Maternal Factors | Grand multiparity (many previous pregnancies) | Relaxed uterine muscles provide less guidance for fetal positioning |
| Contracted or small pelvis | Limited space prevents normal fetal positioning and descent | |
| Platypelloid pelvis shape | Flat, wide pelvis shape can cause abnormal fetal positioning | |
| Previous cesarean delivery | Uterine scarring may affect fetal position | |
| Fetal Factors | Prematurity and low birth weight | Smaller fetus has more room for abnormal positioning |
| Fetal macrosomia (large baby) | Size mismatch with pelvis causes positioning difficulties | |
| Anencephaly (absent skull development) | Lack of skull structure prevents normal head flexion | |
| Neck masses (goiter, cystic hygroma) | Physical obstruction prevents neck flexion | |
| Multiple nuchal cords (cord around neck) | Umbilical cord loops can pull the head into extension | |
| Polyhydramnios (excess amniotic fluid) | Excessive fluid allows abnormal fetal movement and positioning | |
| Cephalopelvic disproportion (CPD) | Baby’s head too large for mother’s pelvis prevents proper engagement |
When any of these risk factors are present, obstetric providers should maintain heightened vigilance, perform thorough ultrasound assessments, and be prepared for the possibility of face presentation requiring emergency intervention.
Complications and Birth Injuries from Face Presentation
Face presentation significantly increases the risk of complications for both mother and baby. According to published research, 53% of babies with face presentation exhibit abnormal fetal heart rate patterns, compared to only 14% of babies in normal vertex presentation. This represents a tenfold increase in fetal compromise, underscoring the critical need for continuous monitoring and prompt intervention.
Immediate Delivery Complications
Prolonged Labor
Face presentation inhibits normal descent through the birth canal. The extended head position presents a larger diameter than the flexed vertex position, making engagement and descent more difficult. Prolonged labor itself can trigger fetal distress and dangerous heart rate abnormalities.
Facial Trauma and Edema
Due to the nature of the fetal position and prolonged duration of labor, newborns with face presentation develop significant swelling (edema) of the face and skull. This swelling can be severe enough to affect the baby’s airway, leading to breathing difficulties after birth and potentially requiring intubation.
Obstructed Labor
Particularly in mentum posterior position, the baby cannot descend properly through the birth canal. Without timely cesarean section, obstructed labor can lead to uterine rupture (in mothers with previous cesarean scars), birth asphyxia, and maternal hemorrhage.
Serious Birth Injuries
When face presentation is not properly managed, babies can suffer life-altering injuries:
Hypoxic-Ischemic Encephalopathy (HIE): Prolonged labor with face presentation can deprive the baby’s brain of oxygen. HIE is a serious form of brain damage resulting from insufficiently oxygenated blood reaching the brain. It can cause permanent neurological disabilities, developmental delays, seizures, and cerebral palsy.
- Cerebral Palsy: Oxygen deprivation during mismanaged face presentation deliveries is a known cause of cerebral palsy, a group of permanent movement disorders affecting muscle tone, posture, and coordination.
- Spinal Cord Injury: Improper handling of face presentation can result in spinal cord injury, potentially causing paralysis. The hyperextended position of the neck makes the cervical spine vulnerable to trauma during delivery attempts.
- Facial Nerve Damage: In rare cases, pressure exerted during delivery or improper use of forceps can cause long-term facial nerve damage affecting the baby’s ability to move facial muscles.
- Respiratory Distress: Airway trauma and edema from face presentation can lead to breathing complications requiring mechanical ventilation and extended NICU stays.
- Skull Fractures and Intracranial Hemorrhage: Excessive force during delivery attempts or improper instrument use can fracture the skull or cause bleeding in the brain.
- Perinatal Death: In the most severe cases of mismanaged face presentation, particularly when emergency cesarean section is delayed despite fetal distress, the baby may not survive.
Proper Medical Management of Face Presentation
The medical standard of care for face presentation requires specific protocols to minimize risks. Healthcare providers who deviate from these established guidelines may be liable for medical malpractice if their negligence causes harm.
Standard of Care Requirements
Diagnosis and Assessment
- Early detection through digital examination in second stage of labor
- Ultrasound confirmation of face presentation and chin position
- Determination of mentum anterior vs. mentum posterior orientation
- Assessment of pelvic adequacy (size and shape)
- Evaluation for cephalopelvic disproportion
Continuous Monitoring
- Electronic fetal heart rate monitoring throughout labor
- External transducer devices (to protect fetal eyes)
- Close observation for signs of fetal distress
- Regular assessment of labor progression
- Monitoring for maternal complications
Delivery Management Protocol
| Clinical Scenario | Appropriate Management | Contraindicated Actions |
|---|---|---|
| Mentum Anterior + Adequate Pelvis |
• Trial of labor with close monitoring • Patience with slow progression • Oxytocin if contractions inadequate • Episiotomy during delivery • Low forceps if necessary (with caution) • Immediate C-section if distress develops |
• Vacuum extraction • Forceps rotation • Excessive traction or force • Continuing labor with fetal distress |
| Mentum Posterior (any circumstances) |
• Immediate cesarean section • No delay once diagnosed • Surgical team on standby • Neonatal resuscitation team ready |
• Any attempt at vaginal delivery • Manual rotation of chin position • Forceps rotation • Waiting for spontaneous conversion |
| Inadequate Pelvis (contracted/small) |
• Cesarean section regardless of chin position • Documented informed consent • Pre-surgical preparation |
• Attempting vaginal delivery • Using force to overcome obstruction |
| Fetal Distress Develops |
• Emergency cesarean section within 30 minutes • STAT notification to surgical team • Maternal preparation for surgery • Neonatal code team activation |
• Continuing expectant management • Waiting for full dilation • Any delays in surgical intervention |
Informed Consent Requirement
Healthcare providers must extend full informed consent to mothers whose babies are diagnosed with face presentation. According to established medical guidelines, the informed consent discussion should include:
- Explanation of face presentation and the baby’s specific position (MA or MP)
- Risks associated with attempting vaginal delivery vs. immediate cesarean section
- Likelihood of successful vaginal delivery based on individual circumstances
- Potential complications including prolonged labor, fetal distress, and birth injuries
- Need for emergency cesarean section if signs of fetal compromise develop
- Availability of experienced obstetric and neonatal teams
Failing to obtain proper informed consent—or proceeding with a high-risk delivery approach without thoroughly explaining alternatives—can constitute medical negligence.
Neonatal Preparedness
Since respiratory problems commonly occur in babies delivered with face presentation, the delivery team must include:
- Experienced neonatologist or pediatrician
- Neonatal resuscitation equipment immediately available
- Intubation equipment and staff trained to perform emergency airway management
- NICU bed reserved for immediate admission if needed
When Medical Negligence Occurs
Medical malpractice in face presentation cases occurs when healthcare providers fail to follow the accepted standard of care, and this negligence directly causes injury to the baby. Common scenarios that may constitute malpractice include:
Failure to Diagnose Face Presentation
Obstetric providers should identify face presentation through digital examination during labor or via ultrasound. Missing this diagnosis deprives the medical team of critical information needed to plan safe delivery, potentially leading to inappropriate vaginal delivery attempts when cesarean section is required.
Common Malpractice Scenarios
- Delayed Emergency Cesarean Section: When fetal heart rate monitoring shows signs of distress—such as late decelerations, variable decelerations, decreased variability, or bradycardia—the standard of care requires emergency cesarean delivery within 30 minutes. Delays beyond this timeframe can result in hypoxic-ischemic brain injury.
- Attempting Vaginal Delivery with Mentum Posterior: Proceeding with vaginal delivery when the baby’s chin is facing backward is a clear deviation from the standard of care. Mentum posterior position makes vaginal delivery mechanically impossible, and attempting it can cause severe trauma.
- Improper Use of Forceps: Using forceps when the baby’s head is above +2 station (not sufficiently descended), attempting to rotate face presentation with forceps, or applying excessive force can cause skull fractures, intracranial hemorrhage, facial nerve damage, and spinal cord injury.
- Using Vacuum Extraction: Vacuum extractors are contraindicated (should never be used) for live fetuses in face presentation. The suction cup cannot safely attach to the baby’s face, and attempting vacuum extraction can cause severe facial trauma and brain injury.
- Failure to Assess Pelvic Adequacy: Once face presentation is diagnosed, the physician must evaluate whether the mother’s pelvis is adequate for vaginal delivery. When the pelvis is contracted or small, cesarean section is recommended regardless of chin position. Failing to perform this assessment can lead to obstructed labor.
- Inadequate Fetal Monitoring: Given that 53% of face presentation cases show abnormal fetal heart rate patterns, continuous electronic fetal monitoring is essential. Intermittent monitoring or failure to respond to concerning heart rate patterns falls below the standard of care.
- Lack of Informed Consent: Proceeding with a delivery plan without explaining the risks, benefits, and alternatives to the mother—particularly the option of elective cesarean section—violates the patient’s right to informed consent and may constitute negligence if complications result.
- Unprepared Neonatal Team: Failing to have neonatal resuscitation equipment and trained personnel immediately available when delivering a baby with face presentation is negligent, as respiratory distress is a predictable complication requiring prompt intervention.
Legal Rights for Birth Injury Victims in New York
New York law provides families with legal recourse when medical negligence during pregnancy, labor, or delivery causes birth injuries. However, understanding the time limits and procedural requirements is critical to protecting your rights.
New York Statute of Limitations for Birth Injuries
The statute of limitations sets strict deadlines for filing medical malpractice lawsuits. In New York, the rules for birth injury cases involving infants differ significantly from standard medical malpractice claims.
Standard Rule for Adults
Medical malpractice lawsuits in New York must generally be filed within 2 years and 6 months (30 months) from the date of the alleged malpractice or from when the injury was discovered (discovery rule).
Special Rules for Infants and Minors
New York law provides extended time limits for children injured by medical malpractice, but with important restrictions. According to New York statute, when medical malpractice is committed upon a person under the age of 18, the lawsuit must be filed within:
- 10 years from the date of the malpractice OR
- 2.5 years after the child turns 18
- Whichever deadline occurs FIRST
Critical Timing Examples:
- Injury at birth: Parents must file the claim before the child’s 10th birthday
- Injury at age 3: Claim must be filed by age 13
- Injury at age 11: Claim must be filed by age 21 (2.5 years after turning 18, which comes before the 10-year cap)
This means parents cannot always wait until their child turns 18 to decide whether to file a claim. For birth injuries occurring during delivery, the 10-year deadline is absolute—the claim must be filed before the child’s 10th birthday, or the right to compensation is permanently lost.
Special Considerations for Public/Government Hospitals
If the alleged malpractice occurred at a public hospital (such as NYC Health + Hospitals/Bellevue, Kings County Hospital, or other state, city, or county facilities), much shorter deadlines apply:
- Notice of Claim required within 90 days of the incident
- Lawsuit must be filed within 1 year and 90 days after the malpractice
- Federal hospitals follow federal statute of limitations: 2 years from discovery with no infant exception
Missing these shortened deadlines can bar your claim entirely, even if the standard statute of limitations would otherwise allow more time.
Certificate of Merit Requirement
New York law imposes an additional procedural requirement: within 90 days after filing a medical malpractice lawsuit, the plaintiff must obtain and submit a Certificate of Merit from a qualified medical expert. This certificate confirms that the expert has reviewed the medical records and believes there is a reasonable basis to conclude that the defendant healthcare provider deviated from accepted medical standards.
No exceptions or extensions are available for this 90-day deadline. Failure to timely file the Certificate of Merit will result in dismissal of the lawsuit.
Proving Medical Malpractice in Face Presentation Cases
To succeed in a birth injury medical malpractice claim in New York, you must prove four essential elements:
1. Doctor-Patient Relationship
You must show that the healthcare provider owed you a duty of care. This is established by demonstrating that the obstetrician, hospital, nurses, or other medical professionals agreed to provide prenatal care or deliver your baby.
2. Breach of Standard of Care
You must prove that the healthcare provider’s actions fell below the accepted standard of care that a reasonably competent medical professional would have provided under similar circumstances. Expert medical testimony is required to establish what the standard of care was and how it was violated.
3. Causation
You must demonstrate that the breach of the standard of care directly caused your child’s injuries. It is not enough to show that the provider made a mistake—you must prove the mistake caused the specific harm your child suffered.
4. Damages
You must show that your child suffered actual harm and quantifiable losses as a result of the negligence. This includes medical expenses, pain and suffering, disability, future care needs, and other compensable damages.
Role of Medical Experts
Medical malpractice cases involving face presentation birth injuries require testimony from qualified medical experts, typically including:
- Obstetric Expert: An experienced obstetrician who can explain the standard of care for diagnosing and managing face presentation, and identify how the defendant’s actions deviated from accepted practice
- Neonatal Expert: A neonatologist or pediatrician who can explain the baby’s injuries, their causation, and the immediate medical consequences
- Neurologist: If the baby suffered brain injury (HIE, cerebral palsy), a pediatric neurologist can explain the nature and extent of neurological damage and its long-term effects
- Life Care Planner: An expert who can project the child’s future medical needs, therapies, equipment, and care costs over their lifetime
- Economic Expert: To calculate the present value of future medical expenses, lost earning capacity, and other economic damages
Key Evidence in Face Presentation Cases
Building a strong case requires thorough collection and analysis of medical records and supporting documentation:
- Prenatal care records showing any identified risk factors
- Labor and delivery records documenting progression, examinations, and decision-making
- Fetal heart rate monitoring strips showing patterns of distress
- Ultrasound reports confirming face presentation diagnosis (or absence of diagnosis)
- Informed consent documents (or lack thereof)
- Delivery notes describing the baby’s presentation and delivery method
- Neonatal intensive care unit (NICU) records documenting injuries and treatments
- Imaging studies (MRI, CT scans) showing brain injury or other trauma
- Hospital policies and protocols for managing abnormal presentations
- Medical literature establishing standard of care
Compensation Available in New York Birth Injury Cases
New York does not impose caps on damages in medical malpractice cases, meaning juries can award full compensation for all proven losses. According to the National Practitioner Data Bank, the average New York medical malpractice settlement in 2021 was $460,948.18, but birth injury cases involving permanent disabilities often result in significantly higher awards due to lifetime care needs.
Types of Damages Available
Economic Damages (Quantifiable Financial Losses)
- Past and Future Medical Expenses: Hospital bills, NICU care, surgeries, medications, therapies (physical, occupational, speech), medical equipment (wheelchairs, adaptive devices), home modifications, specialized education costs
- Lost Earning Capacity: If the birth injury causes permanent disability affecting the child’s future ability to work and earn income
- Cost of Lifetime Care: Around-the-clock nursing care, attendant care, or supervision required due to disabilities
- Parental Lost Wages: Income lost by parents who must leave work to care for the injured child
Non-Economic Damages (Subjective Losses)
- Pain and Suffering: Physical pain endured by the child due to the birth injury and subsequent medical treatments
- Emotional Distress: Psychological harm, anxiety, depression, and trauma experienced by the child and family
- Loss of Quality of Life: Diminished ability to engage in normal childhood activities, form relationships, and enjoy life
- Loss of Consortium: Impairment of the parent-child relationship and loss of companionship
Structured Settlements and Special Needs Trusts
Many birth injury cases involving children with permanent disabilities are resolved through structured settlements, which provide regular payments over time rather than a single lump sum. Additionally, Special Needs Trusts can be established to preserve the child’s eligibility for government benefits (Medicaid, Supplemental Security Income) while still providing supplemental funds for care and quality of life.
Frequently Asked Questions
What causes face presentation during childbirth?
Face presentation occurs when the baby’s neck becomes hyperextended (bent backward) instead of flexed forward in the normal position. Risk factors include fetal abnormalities (anencephaly, neck masses), nuchal cords wrapped around the neck, extremes of fetal size (very small or very large babies), polyhydramnios (excess amniotic fluid), contracted maternal pelvis, and multiple previous pregnancies. In many cases, the exact cause is unknown, but healthcare providers should diagnose and properly manage face presentation once identified.
Can a baby be safely delivered vaginally with face presentation?
It depends on the chin position. If the baby’s chin (mentum) is facing forward toward the mother’s front (mentum anterior or MA position), vaginal delivery may be possible with close monitoring, though labor is often prolonged. However, if the chin is facing backward toward the mother’s spine (mentum posterior or MP position), vaginal delivery is mechanically impossible and cesarean section is required. Attempting vaginal delivery with mentum posterior can cause severe birth injuries.
What birth injuries can result from mismanaged face presentation?
Mismanaged face presentation can cause serious injuries including hypoxic-ischemic encephalopathy (HIE) from oxygen deprivation, cerebral palsy, spinal cord injury leading to paralysis, facial nerve damage, skull fractures, intracranial hemorrhage, respiratory distress requiring mechanical ventilation, and in severe cases, perinatal death. Prolonged labor with face presentation carries a tenfold increased risk of fetal compromise compared to normal deliveries.
How long do I have to file a birth injury lawsuit in New York?
For birth injuries occurring at delivery in New York, you generally have 10 years from the date of birth to file a medical malpractice lawsuit on behalf of your child, OR 2.5 years after the child turns 18, whichever comes first. For injuries at birth, the 10-year deadline controls—you must file before the child’s 10th birthday. Important exceptions apply for public/government hospitals (90-day notice of claim required, 1 year and 90 days to file suit). Consulting with an experienced birth injury attorney as soon as possible is critical to protecting your rights.
What is the Certificate of Merit requirement in New York medical malpractice cases?
New York law requires that within 90 days after filing a medical malpractice lawsuit, you must obtain and submit a Certificate of Merit from a qualified medical expert. This certificate confirms that the expert has reviewed the relevant medical records and believes there is a reasonable basis to conclude that the defendant healthcare provider departed from accepted medical standards. No exceptions or extensions are available—failure to timely file the Certificate of Merit results in dismissal of the case.
Are there caps on damages in New York birth injury cases?
No. Unlike many other states, New York does not impose caps or limits on damages in medical malpractice cases. This means that juries can award full compensation for all economic damages (medical expenses, lost earning capacity, lifetime care costs) and non-economic damages (pain and suffering, loss of quality of life) without artificial limits. Birth injury cases involving permanent disabilities often result in multi-million dollar verdicts and settlements to cover lifetime care needs.
What does it cost to hire a birth injury lawyer in New York?
Most birth injury attorneys in New York work on a contingency fee basis, meaning they receive a percentage of the settlement or verdict only if you win your case. If you don’t recover compensation, you typically pay no attorney fees. Contingency fees generally range from 30% to 40% of the recovery, though the exact percentage may vary. Initial consultations are usually free, allowing families to discuss their case without financial obligation.
How do I know if my child’s birth injury was caused by medical negligence?
Determining whether a birth injury resulted from negligence requires expert medical review of the records. Warning signs that may indicate malpractice include: failure to diagnose face presentation during labor, delayed emergency cesarean section despite fetal distress on monitor strips, attempting vaginal delivery with mentum posterior position, improper use of forceps or vacuum extractor, lack of informed consent discussion about risks and alternatives, and absence of neonatal resuscitation team when respiratory distress was predictable. An experienced birth injury attorney can arrange for medical experts to review your records and provide an assessment.
Protecting Your Family’s Legal Rights
Face presentation is a challenging obstetric complication that requires skilled diagnosis, careful monitoring, and prompt intervention to prevent birth injuries. When healthcare providers fail to meet the standard of care—whether through failure to diagnose, delayed cesarean section, improper delivery techniques, or inadequate informed consent—they can be held accountable through medical malpractice claims.
If your child suffered a birth injury during a face presentation delivery in New York, time is critical. The statute of limitations creates strict deadlines, and collecting evidence while medical records and witness memories are fresh significantly strengthens your case. Early consultation with an experienced birth injury attorney allows you to understand your legal options, protect your rights, and pursue the compensation your child needs for lifetime care.
Need Help with a Birth Injury Claim?
We are an educational resource that connects New York families affected by birth injuries with qualified medical malpractice attorneys—completely free of charge. There is no cost to use our service, and attorneys we connect you with work on contingency (no fees unless you win).
Connect with Qualified NY Attorney
Free case evaluation • No obligation • Confidential consultation
Disclaimer: This article is provided for educational purposes only and does not constitute legal or medical advice. Every birth injury case is unique and outcomes depend on specific facts. We are not a law firm and do not provide legal representation. Consult with a qualified New York medical malpractice attorney for advice about your specific situation.
