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Delivery, Face Presentation, and Brow Presentation: Understanding Fetal Positions and Birth Scenarios

Introduction:.

During childbirth, the position of the baby plays a significant role in the delivery process. While the most common fetal presentation is the head-down position (vertex presentation), variations can occur, such as face presentation and brow presentation. This comprehensive article aims to provide a thorough understanding of delivery, face presentation, and brow presentation, including their definitions, causes, complications, and management approaches.

Delivery Process:

Normal Vertex Presentation: In a typical delivery, the baby is positioned head-down, with the back of the head (occiput) leading the way through the birth canal.
Engagement and Descent: Prior to delivery, the baby's head engages in the pelvis and gradually descends, preparing for birth.
Cardinal Movements: The baby undergoes a series of cardinal movements, including flexion, internal rotation, extension, external rotation, and restitution, which facilitate the passage through the birth canal.

Face Presentation:

Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head).
Causes: Face presentation can occur due to factors such as abnormal fetal positioning, multiple pregnancies, uterine abnormalities, or maternal pelvic anatomy.
Complications: Face presentation is associated with an increased risk of prolonged labor, difficulties in delivery, increased fetal malposition, birth injuries, and the need for instrumental delivery.
Management: The management of face presentation depends on several factors, including the progression of labor, the size of the baby, and the expertise of the healthcare provider. Options may include closely monitoring the progress of labor, attempting a vaginal delivery with careful maneuvers, or considering a cesarean section if complications arise.

Brow Presentation:

Definition: Brow presentation occurs when the baby's head is partially extended, causing the brow (forehead) to lead the way through the birth canal.
Causes: Brow presentation may result from abnormal fetal positioning, poor engagement of the fetal head, or other factors that prevent full flexion or extension.
Complications: Brow presentation is associated with a higher risk of prolonged labor, difficulty in descent, increased chances of fetal head entrapment, birth injuries, and the potential need for instrumental delivery or cesarean section.
Management: The management of brow presentation depends on various factors, such as cervical dilation, progress of labor, fetal size, and the presence of complications. Close monitoring, expert assessment, and a multidisciplinary approach may be necessary to determine the safest delivery method, which can include vaginal delivery with careful maneuvers, instrumental assistance, or cesarean section if warranted.

Delivery Techniques and Intervention:

Obstetric Maneuvers: In certain situations, skilled healthcare providers may use obstetric maneuvers, such as manual rotation or the use of forceps or vacuum extraction, to facilitate delivery, reposition the baby, or prevent complications.
Cesarean Section: In cases where vaginal delivery is not possible or poses risks to the mother or baby, a cesarean section may be performed to ensure a safe delivery.

Conclusion:

Delivery, face presentation, and brow presentation are important aspects of childbirth that require careful management and consideration. Understanding the definitions, causes, complications, and appropriate management approaches associated with these fetal positions can help healthcare providers ensure safe and successful deliveries. Individualized care, close monitoring, and multidisciplinary collaboration are crucial in optimizing maternal and fetal outcomes during these unique delivery scenarios.

Hashtags: #Delivery #FacePresentation #BrowPresentation #Childbirth #ObstetricDelivery

On the Article

Krish Tangella MD, MBA

Alexander Enabnit

Alexandra Warren

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

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Delivery presentations

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

Your baby must pass through your pelvic bones to reach the vaginal opening. The ease at which this passage will take place depends on how your baby is positioned during delivery. The best position for the baby to be in to pass through the pelvis is with the head down and the body facing towards the mother's back. This position is called occiput anterior (OA).

In breech position, the baby's bottom is facing down instead of the head. Your health care provider will most often detect this in an office visit before your labor begins. Most babies will be in the head-down position by about 34 weeks.

Part of your prenatal care after 34 weeks will involve making sure your baby is in the head-down position.

If your baby is breech, it is not safe to deliver vaginally. If your baby is not in a head-down position after your 36th week, your provider can explain your choices and their risks to help you decide what steps to take next.

Occiput Posterior (OP)

In occiput posterior position, your baby's head is down, but it is facing the mother's front instead of her back.

It is safe to deliver a baby facing this way. But it is harder for the baby to get through the pelvis. If a baby is in this position, sometimes it will rotate around during labor so that the head stays down and the body faces the mother's back (OA position).

The mother can walk, rock, and try different delivery positions during labor to help encourage the baby to turn. If the baby does not turn, labor can take longer. Sometimes, the provider may use forceps or a vacuum device to help get the baby out. If the baby stays in the OP position during labor, you have a higher risk of needing to deliver your baby by cesarean delivery (C-section).

Transverse Position

A baby in the transverse position is sideways. Often, the shoulders or back are over the mother's cervix. This is also called the shoulder, or oblique, position.

The risk for having a baby in the transverse position increases if you:

Go into labor early
Have given birth 3 or more times
Have placenta previa

Unless your baby can be turned into head-down position, a vaginal birth will be too risky for you and your baby. A doctor will deliver your baby by cesarean birth ( C-section ).

Less Common Presentations

With the brow-first position, the baby's head extends backward (like looking up), and the forehead leads the way. This position may be more common if this is not your first pregnancy.

Your provider rarely detects this position before labor. An ultrasound may be able to confirm a brow presentation.
More likely, your provider will detect this position while you are in labor during an internal exam.

With face-first position, the baby's head is extended backwards even more than with brow first position.

Most of the time, the force of contractions causes the baby to be in face-first position.
It is also detected when labor does not progress.

In some of these presentations, a vaginal birth is possible, but labor will generally take longer. After delivery, the baby's face or brow will be swollen and may appear bruised. These changes will go away over the next few days.

Alternative Names

Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Thorp JM, Grantz KL. Clinical aspects of normal and abnormal labor. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice . 9th ed. Philadelphia, PA: Elsevier; 2023:chap 40.

Vora S, Dobiesz VA. Emergency childbirth. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care . 7th ed. Philadelphia, PA: Elsevier; 2019:chap 56.

Review Date 11/21/2022

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Management of face presentation, face and lip edema in a primary healthcare facility case report, Mbengwi, Cameroon

Nzozone henry fomukong.

1 Microhealth Global Medical Centre, Mbengwi, Cameroon

2 Department of Medicine and Surgery, Faculty of Health Sciences University of Buea, Buea, Cameroon

Ngouagna Edwin

Mandeng ma linwa edgar, ngwayu claude nkfusai.

3 Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon

4 Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon

Yunga Patience Ijang

5 Department of Public Health, School of Health Sciences, Catholic University of Central Africa, Box 1110, Yaoundé, Cameroon

Joyce Shirinde

6 School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa

Samuel Nambile Cumber

7 Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30 Gothenburg, Sweden

8 Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic facial features usually resolved within 24-48 hours.

Introduction

Face presentation is a rare unanticipated obstetric event characterized by a longitudinal lie and full extension of the foetal head on the neck with the occiput against the upper back [ 1 - 3 ]. Face presentation occurs in 0.1-0.2% of deliveries [ 3 - 5 ] but is more common in black women and in multiparous women [ 5 ]. Studies have shown that 60 per cent of face presentations have one or more of the following risk factors: small fetus, large fetus, high parity, previous caesarean section (CS), contracted pelvis, fetopelvic disproportion, cord around the neck multiple pregnancy, hypertensive disorders of pregnancy, polyhydramnios, uterine or nuchal cord anomaly. But 40 per cent of face presentations occur with none of these factors [ 6 , 7 ]. A vaginal birth at term is possible only if the fetus is in the mentum anterior position. More than half of cases of face presentation are delivered by caesarean section [ 4 ]. Newborn infants with face presentation usually have severe facial edema, facial bruising or ecchymosis [ 8 ]. Repeated vaginal examination to assess the presenting part and the progress of labor may lead to bruises in the face as well as damage to the eyes.

Patient and observation

Case presentation: a 21 year old primigravida at 40 weeks gestation from the last normal menstrual period referred to our facility for prolonged second stage of labor after visiting two health centres. She labored for a total of 14hrs, membrane ruptured spontaneously 12hrs before referral. Amniotic fluid was documented by midwife to be clear. She attended antenatal clinics in Mbengwi health centre 5 times, was diagnosed of hepatitis B during antenatal consultations, received no treatment. She did not do any ultrasound due to financial constraints. On examination, she was healthy, in painful distress, blood pressure 131/76mmhg, pulse 85 beats/min, temperature 37.2 o C SPO2 98%. On abdominal exams, uterus was gravid, fundal height 35cm, lie longitudinal, fetal heart rate 137bpm, cephalic presentation, engaged 2/5, with moderate contractions of 2 in 10 minutes. On vaginal examination, cervix was fully dilated, membranes ruptured, presenting part was face, mentum anterior. The conclusion made was mento-anterior face presentation ( Figure 1 ). Paturient was counseled, labor was augmented with 1 amp of oxytocin in 500ml of glucose 5% and started at 10drops/mins. Ten minutes later she delivered a male baby with Apgar score 6/10, 8/10 on the first and fifth minute. The baby weighed 3.2kg, length was 50cm, and head circumference was 41cm. Syndromic facial appearance with marked edema at the baby's lips, face and scalp was evident and he had bruising on the right nasolabial groove and right cheeks ( Figure 2 ). Physical examination of the infant's respiratory system, cardiovascular system, and his abdominal examination were normal, as was his neurological examination. Placenta was delivered by controlled cord traction 5mins later with all cotyledons. Delivery was complicated by a second degree perineal tear. Perineal tear was repaired with absorbable suture under local anaesthesia. Estimated blood lost was 350ml. baby received Hepatitis B immunoglobulins, hepatitis B vaccine and vitamin K were administered to the baby. 24 hours later, facial swellings resolved ( Figure 3 ), baby breast feeds well. Baby and mother were discharged on day 3 postpartum all fine.

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Men-tum anterior face presentation

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Bruising, marked lip and facial edema

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Baby 24 hours later with all syndromic facial features resolved

Ethics : informed consent: written informed consent was obtained from the patient's parents for the publication of this case report.

Face presentation is a rare obstetric event and most practitioner will go through their carriers without ever meeting one [ 3 ]. We presented a case of face presentation noticed in the delivery room on digital examination in a patient with no risk factors. In a poor resource setting as ours where ultrasound is not readily available, this event is often scary and confusing to most midwives and nurses. This may prompt repeated vaginal exams for confirmation of presentation. This intend will lead to bruising of the baby's face and delay effective management [ 8 ]. Exact knowledge about the fetal position and level is important for providing the correct management of this malpresentation. When face presentation is diagnosed, around 60% of cases are in the mentum anterior position, 25% are mentum posterior and 15% are mentum transverse [ 5 ]. The patient presented the most common form of face presentation (mentum anterior). Labor was augmented, vaginal delivery was attempted and successfully conducted. Facial bruising, lip and face edema are very common complication of face presentation. These complications usually resolve within 24-48 hours [ 9 , 10 ] in this case facial edema completely resolved within 24hours ( Figure 3 ) and baby breastfeed well.

Repeated vaginal exams should be avoided when presenting part is unsure. Vaginal delivery should be attemped only on mentum anterior face presentation, in other cases, emergency ceserian section should be performed. Syndromic facial features in babies born from face presentation resolve completely within 24-48 hours.

Competing interests

The authors declare no competing interests.

Acknowledgements

We thank the participant of this study.

Authors’ contributions

NHF, NE, MMLE, NCN, YPI, FB, JS and SNC conceived the case series, assisted with the study design and participant enrollment, designed the study protocol and collected the data. NE, MMLE, NCN and SNC assisted in interpretation of results and wrote the manuscript. All authors read and approved the final manuscript.

Face presentation

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Diagnosis and management of face presentation

PMID: 7005774

Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different from those of simple vertex presentation, there is no consistent alteration in the duration of labor in the absence of underlying CPD. When disproportion does not exist and gross anomalies are not present, the prognosis for spontaneous vaginal delivery is excellent. The majority of perinatal losses reported in face presentation have resulted from traumatic operative vaginal deliveries, specifically version and extraction and midforceps rotations. Recent experience at this institution with a limited series of face presentations demonstrates that, with careful intrapartum surveillance, delivery can be accomplished with no increase in risk to either mother or fetus.

Publication types

Delivery, Obstetric
Labor Presentation*
Labor, Obstetric

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face presentation

Definition of face presentation

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“Face presentation.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/face%20presentation. Accessed 29 Apr. 2024.

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Face Presentation

It is a cephalic presentation in which the head is completely extended.

About 1:300 labours.

It is less common.
It occurs during pregnancy.
Anencephaly: due to absence of the bony vault of the skull and the scalp while the facial portion is normal.
Loops of the cord around the neck.
Tumours of the foetal neck e.g. congenital goitre.
Hypertonicity of the extensor muscles of the neck.
Dolicocephaly: long antero-posterior diameter of the head, so as the breadth is less than 4/5 of the length.
Dead or premature foetus.
Idiopathic.
It is more common.
It occurs during labour.
Contracted pelvis particularly flat pelvis which allows descent of the bitemporal but not the biparietal diameter leads to extension of the head.
Pendulous abdomen or marked lateral obliquity of the uterus.
Further deflexion of brow or occipito - posterior positions.
Other causes of malpresentations as polyhydramnios and placenta praevia.
Right mento-posterior (RMP).
Left mento-posterior (LMP).
Left mento-anterior (LMA).
Right mento-anterior (RMA), are the more common positions.
Right mento-transverse (lateral), left mento-transverse, direct mento-posterior and direct mento-anterior are rare and usually transient positions.

The first position (RMP) corresponds to the first normal position (LOA) as the back should be to the left and anterior in the first position. Mento-anterior are more common than mento-posterior as most cases arise from more deflexion of the head in occipito-posterior position usually in flat contracted pelvis.

During pregnancy (difficult)

The back is difficult to feel.
The limbs are felt more prominent in mento-anterior position.
The chin may be felt on the same side of the limbs as a horseshoe-shaped rim in mento-anterior position.
In mento-posterior, a groove may be felt between the occiput and the back particularly after rupture of the membranes.
Second pelvic grip: the occiput is at a higher level than the sinciput.
The FHS are heard below the umbilicus through the foetal chest wall in mento-anterior position.
Ultrasound or X-ray: confirms the diagnosis and may identify associated foetal anomalies as anencephaly.

During labour

Vaginal examination shows the following identifying features for face:

supra-orbital ridges,
the malar processes,
the nose (rubbery and saddle shaped),
the mouth with hard areolar ridges.

Late in labour, the face becomes oedematous (tumefaction) so it can be misdiagnosed as a buttock (breech presentation) where the two cheeks are mistaken with buttocks and the mouth with anus and the malar processes with the ischial tuberosities. The following points can differentiate in-between:

Mechanism of Labour

Mento-anterior position

Engagement by submento-bregmatic diameter 9.5 cm.
Increased extension.
Internal rotation of chin 1/8 circle anteriorly.
Flexion: is the movement by which the head is delivered in mento-anterior position when the submental region hinges below the symphysis. The vulva is much distended by the submento-vertical diameter 11.5 cm.
Restitution.
External rotation.

Engagement is delayed because:

The biparietal diameter does not pass the plane of pelvic inlet until the chin is below the level of the ischial spines and the face begins to distend the perineum.
Moulding does not occur as in vertex presentation.

Mento-posterior position

so the head is delivered as mento-anterior.
Deep transverse arrest of the face: when the chin rotates 1/8 circle anteriorly.
Persistent mento-posterior: when no rotation occurs.
Direct mento-posterior: When the chin rotates 1/8 circle posteriorly.

In the last 3 conditions no further progress occurs and labour is obstructed.

Direct mento-posterior, unlike direct occipito-posterior, cannot be delivered because:

Delivery should occur by extension while the head is already maximally extended.
As the length of the sacrum is 10 cm and that of neck is only 5 cm, the shoulders enter the pelvis and become impacted while the head still in the pelvis, thus the labour is obstructed.

Management of Labour

Exclude: - Foetal anomalies and - Contracted pelvis.

Mento-anterior

First stage: as in occipito-posterior.
Spontaneous delivery usually occurs.
Forceps delivery may be indicated in prolonged 2nd stage.
Episiotomy is necessary because of over distension of the vulva.

Mento-posterior

First stage: as mento-anterior.
Wait for long anterior rotation of the mentum 3/8 circle and the head will be delivered as mento-anterior. During this period oxytocin is used to compete inertia which is common in such conditions as long as there is no contraindication. Failure of this long rotation is more common than in occipito-posterior position so earlier interference is usually indicated.
Caesarean section: which is the safest and the current alternative in modern obstetrics.
Manual rotation and forceps extraction as mento-anterior, or
Rotation and extraction by Kielland forceps.
In the last 2 methods the head should be engaged but they are hazardous to both the mother and foetus so they are nearly out of modern obstetrics.
Craniotomy: if the foetus is dead.

The face of the foetus is oedematous after delivery so the mother is assured that this will be spontaneously relieved within few days.

Complications

See complications of malpresentations and malposition.

Dystocia : Guidelines, reviews

Labour and Delivery Care Module: 8. Abnormal Presentations and Multiple Pregnancies

Study session 8 abnormal presentations and multiple pregnancies, introduction.

In previous study sessions of this module, you have been introduced to the definitions, signs, symptoms and stages of normal labour, and about the ‘normal’ vertex presentation of the fetus during delivery. In this study session, you will learn about the most common abnormal presentations (breech, shoulder, face or brow), their diagnostic criteria and the required actions you need to take to prevent complications developing during labour. Taking prompt action may save the life of the mother and her baby if the delivery becomes obstructed because the baby is in an abnormal presentation. We will also tell you about twin births and the complications that may result if the two babies become ‘locked’ together, preventing either of them from being born.

Learning Outcomes for Study Session 8

After studying this session, you should be able to:

8.1 Define and use correctly all of the key words printed in bold . (SAQs 8.1 and 8.2)

8.2 Describe how you would identify a fetus in the vertex presentation and distinguish this from common malpresentations and malpositions. (SAQs 8.1 and 8.2)

8.3 Describe the causes and complications for the fetus and the mother of fetal malpresentation during full term labour. (SAQ 8.3)

8.4 Describe how you would identify a multiple pregnancy and the complications that may arise. (SAQ 8.4)

8.5 Explain when and how you would refer a woman in labour due to abnormal fetal presentation or multiple pregnancy. (SAQ 8.4)

8.1 Normal and abnormal presentations

8.1.1 vertex presentation.

In about 95% of deliveries, the part of the fetus which arrives first at the mother’s pelvic brim is the highest part of the fetal head, which is called the vertex (Figure 8.1). This presentation is called the vertex presentation . Notice that the baby’s chin is tucked down towards its chest, so that the vertex is the leading part entering the mother’s pelvis. The baby’s head is said to be ‘well-flexed’ in this position.

A baby in the well-flexed vertex presentation before birth, relative to the mother’s pelvis

During early pregnancy, the baby is the other way up — with its bottom pointing down towards the mother’s cervix — which is called the breech presentation . This is because during its early development, the head of the fetus is bigger than its buttocks; so in the majority of cases, the head occupies the widest cavity, i.e. the fundus (rounded top) of the uterus. As the fetus grows larger, the buttocks become bigger than the head and the baby spontaneously reverses its position, so its buttocks occupy the fundus. In short, in early pregnancy, the majority of fetuses are in the breech presentation and later in pregnancy most of them make a spontaneous transition to the vertex presentation.

8.1.2 Malpresentations

You will learn about obstructed labour in Study Session 9.

When the baby presents itself in the mother’s pelvis in any position other than the vertex presentation, this is termed an abnormal presentation, or m alpresentation . The reason for referring to this as ‘abnormal’ is because it is associated with a much higher risk of obstruction and other birth complications than the vertex presentation. The most common types of malpresentation are termed breech, shoulder, face or brow. We will discuss each of these in turn later. Notice that the baby can be ‘head-down’ but in an abnormal presentation, as in face or brow presentations, when the baby’s face or forehead (brow) is the presenting part.

8.1.3 Malposition

Although it may not be so easy for you to identify this, the baby can also be in an abnormal position even when it is in the vertex presentation. In a normal delivery, when the baby’s head has engaged in the mother’s pelvis, the back of the baby’s skull (the occiput ) points towards the front of the mother’s pelvis (the pubic symphysis ), where the two pubic bones are fused together. This orientation of the fetal skull is called the occipito-anterior position (Figure 8.2a). If the occiput (back) of the fetal skull is towards the mother’s back, this occipito-posterior position (Figure 8.2b) is a vertex malposition , because it is more difficult for the baby to be born in this orientation. The good thing is that more than 90% of babies in vertex malpositions undergo rotation to the occipito-anterior position and are delivered normally.

You learned the directional positions: anterior/in front of and posterior/behind or in the back of, in the Antenatal Care Module, Part 1, Study Session 3.

Note that the fetal skull can also be tilted to the left or to the right in either the occipito-anterior or occipito-posterior positions.

Possible positions of the fetal skull when the baby is in the vertex presentation and the mother is lying on her back:

8.2 Causes and consequences of malpresentations and malpositions

In the majority of individual cases it may not be possible to identify what caused the baby to be in an abnormal presentation or position during delivery. However, the general conditions that are thought to increase the risk of malpresentation or malposition are listed below:

Multiple pregnancy is the subject of Section 8.7 of this study session. You learned about placenta previa in the Antenatal Care Module, Study Session 21.

Abnormally increased or decreased amount of amniotic fluid
A tumour (abnormal tissue growth) in the uterus preventing the spontaneous inversion of the fetus from breech to vertex presentation during late pregnancy
Abnormal shape of the pelvis
Laxity (slackness) of muscular layer in the walls of the uterus
Multiple pregnancy (more than one baby in the uterus)
Placenta previa (placenta partly or completely covering the cervical opening).

If the baby presents at the dilating cervix in an abnormal presentation or malposition, it will more difficult (and may be impossible) for it to complete the seven cardinal movements that you learned about in Study Sessions 3 and 5. As a result, birth is more difficult and there is an increased risk of complications, including:

You learned about PROM in Study Session 17 of the Antenatal Care Module, Part 2.

Premature rupture of the fetal membranes (PROM)
Premature labour
Slow, erratic, short-lived contractions
Uncoordinated and extremely painful contractions, with slow or no progress of labour
Prolonged and obstructed labour, leading to a ruptured uterus (see Study Sessions 9 and 10 of this Module)
Postpartum haemorrhage (see Study Session 11)
Fetal and maternal distress, which may lead to the death of the baby and/or the mother.

With these complications in mind, we now turn your attention to the commonest types of malpresentation and how to recognise them.

8.3 Breech presentation

In a b reech presentation , the fetus lies with its buttocks in the lower part of the uterus, and its buttocks and/or the feet are the presenting parts during delivery. Breech presentation occurs on average in 3–4% of deliveries after 34 weeks of pregnancy.

When is the breech position the normal position for the fetus?

During early pregnancy the baby’s bottom points down towards the mother’s cervix, and its head (the largest part of the fetus at this stage of development) occupies the fundus (rounded top) of the uterus, which is the widest part of the uterine cavity.

8.3.1 Causes of breech presentation

You can see a transverse lie in Figure 8.7 later in this study session.

In the majority of cases there is no obvious reason why the fetus should present by the breech at full term. In practice, what is commonly observed is the association of breech presentation at delivery with a transverse lie earlier in the pregnancy, i.e. the fetus lies sideways across the mother’s abdomen, facing a sideways implanted placenta. It is thought that when the placenta is in front of the baby’s face, it may obstruct the normal process of inversion, when the baby turns head-down as it gets bigger during the pregnancy. As a result, the fetus turns in the other direction and ends in the breech presentation. Some other circumstances that are thought to favour a breech presentation during labour include:

Premature labour, beginning before the baby undergoes spontanous inversion from breech to vertex presentation
Multiple pregnancy, preventing the normal inversion of one or both babies
Polyhydramnios: excessive amount of amniotic fluid, which makes it more difficult for the fetal head to ‘engage’ with the mother’s cervix (polyhydramnios is pronounced ‘poll-ee-hy-dram-nee-oss’. Hydrocephaly is pronounced ‘hy-droh-keff-all-ee’)
Hydrocephaly (‘water on the brain’) i.e. an abnormally large fetal head due to excessive accumulation of fluid around the brain
Placenta praevia
Breech delivery in the previous pregnancy
Abnormal formation of the uterus.

8.3.2 Diagnosis of breech presentation

On abdominal palpation the fetal head is found above the mother’s umbilicus as a hard, smooth, rounded mass, which gently ‘ballots’ (can be rocked) between your hands.

Why do you think a mass that ‘ballots’ high up in the abdomen is a sign of breech presentation? (You learned about this in Study Session 11 of the Antenatal Care Module.)

The baby’s head can ‘rock’ a little bit because of the flexibility of the baby’s neck, so if there is a rounded, ballotable mass above the mother’s umbilicus it is very likely to be the baby’s head. If the baby was ‘bottom-up’ (vertex presentation) the whole of its back will move of you try to rock the fetal parts at the fundus (Figure 8.3).

(a) The whole back of a baby in the vertex position will move if you rock it at the fundus; (b) The head can be ‘rocked’ and the back stays still in a breech presentation.

Once the fetus has engaged and labour has begun, the breech baby’s buttocks can be felt as soft and irregular on vaginal examination. They feel very different to the relatively hard rounded mass of the fetal skull in a vertex presentation. When the fetal membranes rupture, the buttocks and/or feet can be felt more clearly. The baby’s anus may be felt and fresh thick, dark meconium may be seen on your examining finger. If the baby’s legs are extended, you may be able to feel the external genitalia and even tell the sex of the baby before it is born.

8.3.3 Types of breech presentation

There are three types of breech presentation, as illustrated in Figure 8.4. They are:

Complete breech is characterised by flexion of the legs at both hips and knee joints, so the legs are bent underneath the baby.
Frank breech is the commonest type of breech presentation, and is characterised by flexion at the hip joints and extension at the knee joints, so both the baby’s legs point straight upwards.
Footling breech is when one or both legs are extended at the hip and knee joint and the baby presents ‘foot first’.

Figure 8.4 Different types of breech presentation.

8.3.4 Risks of breech presentation

Regardless of the type of breech presentation, there are significant associated risks to the baby. They include:

The fetal head gets stuck (arrested) before delivery
Labour becomes obstructed when the fetus is disproportionately large for the size of the maternal pelvis
Cord prolapse may occur, i.e. the umbilical cord is pushed out ahead of the baby and may get compressed against the wall of the cervix or vagina
Premature separation of the placenta (placental abruption)
Birth injury to the baby, e.g. fracture of the arms or legs, nerve damage, trauma to the internal organs, spinal cord damage, etc.

A breech birth may also result in trauma to the mother’s birth canal or external genitalia through being overstretched by the poorly fitting fetal parts.

Cord prolapse in a normal (vertex) presentation was illustrated in Study Session 17 of the Antenatal Care Module, and placental abruption was covered in Study Session 21.

What will be the effect on the baby if it gets stuck, the labour is obstructed, the cord prolapses, or placental abruption occurs?

The result will be hypoxia , i.e. it will be deprived of oxygen, and may suffer permanent brain damage or die.

You learned about the causes and consequences of hypoxia in the Antenatal Care Module.

8.4 Face presentation

Face presentation occurs when the baby’s neck is so completely extended (bent backwards) that the occiput at the back of the fetal skull touches the baby’s own spine (see Figure 8.5). In this position, the baby’s face will present to you during delivery.

5 Face presentation. (a) The baby’s chin is facing towards the front of the mother’s pelvis; (b) the chin is facing towards the mother’s backbone.

Refer the mother if a baby in the chin posterior face presentation does not rotate and the labour is prolonged.

The incidence of face presentation is about 1 in 500 pregnancies in full term labours. In Figure 8.5, you can see how flexed the head is at the neck. Babies who present in the ‘chin posterior’ position (on the right in Figure 8.5) usually rotate spontaneously during labour, and assume the ‘chin anterior’ position, which makes it easier for them to be born. However, they are unlikely to be delivered vaginally if they fail to undergo spontaneous rotation to the chin anterior position, because the baby’s chin usually gets stuck against the mother’s sacrum (the bony prominence at the back of her pelvis). A baby in this position will have to be delivered by caesarean surgery.

8.4.1 Causes of face presentation

The causes of face presentation are similar to those already described for breech births:

Laxity (slackness) of the uterus after many previous full-term pregnancies
Multiple pregnancy
Polyhydramnios (excessive amniotic fluid)
Congenital abnormality of the fetus (e.g. anencephaly, which means no or incomplete skull bones)
Abnormal shape of the mother’s pelvis.

8.4.2 Diagnosis of face presentation

Face presentation may not be easily detected by abdominal palpation, especially if the chin is in the posterior position. On abdominal examination, you may feel irregular shapes, formed because the fetal spine is curved in an ‘S’ shape. However, on vaginal examination, you can detect face presentation because:

The presenting part will be high, soft and irregular.
When the cervix is sufficiently dilated, you may be able to feel parts of the face, such as the orbital ridges above the eyes, the nose or mouth, gums, or bony chin.
If the membranes are ruptured, the baby may suck your examining finger!

But as labour progresses, the baby’s face becomes o edematous (swollen with fluid), making it more difficult to distinguish from the soft shape you will feel in a breech presentation.

8.4.3 Complications of face presentation

Complications for the fetus include:

Obstructed labour and ruptured uterus
Cord prolapse
Facial bruising
Cerebral haemorrhage (bleeding inside the fetal skull).

8.5 Brow presentation

In brow presentation , the baby’s head is only partially extended at the neck (compare this with face presentation), so its brow (forehead) is the presenting part (Figure 8.6). This presentation is rare, with an incidence of 1 in 1000 deliveries at full term.

8.5.1 Possible causes of brow presentation

You have seen all of these factors before, as causes of other malpresentations:

Lax uterus due to repeated full term pregnancy
Polyhydramnios

8.5.2 Diagnosis of brow presentation

Brow presentation is not usually detected before the onset of labour, except by very experienced birth attendants. On abdominal examination, the head is high in the mother’s abdomen, appears unduly large and does not descend into the pelvis, despite good uterine contractions. On vaginal examination, the presenting part is high and may be difficult to reach. You may be able to feel the root of the nose, eyes, but not the mouth, tip of the nose or chin. You may also feel the anterior fontanel, but a large caput (swelling) towards the front of the fetal skull may mask this landmark if the woman has been in labour for some hours.

Recall the appearance of a normal caput over the posterior fontanel shown in Figure 4.4 earlier in this Module.

8.5.3 Complications of brow presentation

The complications of brow presentation are much the same as for other malpresentations:

Cerebral haemorrhage.

Which are you more likely to encounter — face or brow presentations?

Face presentation, which occurs in 1 in 500 full term labours. Brow presentation is more rare, at 1 in 1,000 full term labours.

8.6 Shoulder presentation

Shoulder presentation is rare at full term, but may occur when the fetus lies transversely across the uterus (Figure 8.7), if it stopped part-way through spontaneous inversion from breech to vertex, or it may lie transversely from early pregnancy. If the baby lies facing upwards, its back may be the presenting part; if facing downwards its hand may emerge through the cervix. A baby in the transverse position cannot be born through the vagina and the labour will be obstructed. Refer babies in shoulder presentation urgently.

8.6.1 Causes of shoulder presentation

Causes of shoulder presentation could be maternal or fetal factors.

Maternal factors include:

Lax abdominal and uterine muscles: most often after several previous pregnancies
Uterine abnormality
Contracted (abnormally narrow) pelvis.

Fetal factors include:

Preterm labour
Placenta previa.

What do ‘placenta previa’ and ‘polyhydramnios’ indicate?

Placenta previa is when the placenta is partly or completely covering the cervical opening. Polyhydramnios is an excess of amniotic fluid. They are both potential causes of malpresentation.

8.6.2 Diagnosis of shoulder presentation

On abdominal palpation, the uterus appears broader and the height of the fundus is less than expected for the period of gestation, because the fundus is not occupied by either the baby’s head or buttocks. You can usually feel the head on one side of the mother’s abdomen. On vaginal examination, in early labour, the presenting part may not be felt, but when the labour is well progressed, you may feel the baby’s ribs. When the shoulder enters the pelvic brim, the baby’s arm may prolapse and become visible outside the vagina.

8.6.3 Complications of shoulder presentation

Complications include:

Trauma to a prolapsed arm
Fetal hypoxia and death.

Remember that a shoulder presentation means the baby cannot be born through the vagina; if you detect it in a woman who is already in labour, refer her urgently to a higher health facility.

8.7 Multiple pregnancy

In this section, we turn to the subject of multiple pregnancy , when there is more than one fetus in the uterus. More than 95% of multiple pregnancies are twins (two fetuses), but there can also be triplets (three fetuses), quadruplets (four fetuses), quintuplets (five fetuses), and other higher order multiples with a declining chance of occurrence. The spontaneous occurrence of twins varies by country : it is lowest in East Asia n countries like Japan and China (1 out of 1000 pregnancies are fraternal or non-identical twins), and highest in black Africans , particularly in Nigeria , where 1 in 20 pr egnancies are fraternal twins. In general, compared to single babies, multiple pregnancies are highly associated with early pregnancy loss and high perinatal mortality, mainly due to prematurity.

8.7.1 Types of twin pregnancy

Twins may be identical (monozygotic) or non-identical and fraternal (dizigotic). Monozygotic twins develop from a single fertilised ovum (the zygote), so they are always the same sex and they share the same placenta . By contrast, dizygotic twins develop from two different zygotes, so they can have the same or different sex, and they have separate placenta s . Figure 8.8 shows the types of twin pregnancy and the processes by which they are formed.

Types of twin pregnancy: (a) Fraternal or non-identical twins usually each have a placenta of their own, although they can fuse if the two placentas lie very close together. (b) Identical twins always share the same placenta, but usually they have their own fetal membranes.

8.7.2 Diagnosis of twin pregnancy

On abdominal examination you may notice that:

The size of the uterus is larger than the expected for the period for gestation.
The uterus looks round and broad, and fetal movement may be seen over a large area. (The shape of the uterus at term in a singleton pregnancy in the vertex presentation appears heart-shaped rounder at the top and narrower at the bottom.)
Two heads can be felt.
Two fetal heart beats may be heard if two people listen at the same time, and they can detect at least 10 beats different (Figure 8.6).
Ultrasound examination can make an absolute diagnosis of twin pregnancy.

Two people listen either side of the pregnant woman. Each taps in rhythm with the heartbeat they can hear. The pregnant woman says that their tapping is different and maybe she is having twins.

8.7.3 Consequences of twin pregnancy

Women who are pregnant with twins are more prone to suffer with the minor disorders of pregnancy, like morning sickness, nausea and heartburn. Twin pregnancy is one cause of hyperemesis gravidarum (persistent, severe nausea and vomiting). Mothers of twins are also more at risk of developing iron and folate-deficiency anaemia during pregnancy.

Can you suggest why anaemia is a greater risk in multiple pregnancies?

The mother has to supply the nutrients to feed two (or more) babies; if she is not getting enough iron and folate in her diet, or through supplements, she will become anaemic.

Other complications include the following:

Pregnancy-related hypertensive disorders like pre-eclampsia and eclampsia are more common in twin pregnancies.
Pressure symptoms may occur in late pregnancy due to the increased weight and size of the uterus.
Labour often occurs spontaneously before term, with p remature delivery or premature rupture of membranes (PROM) .
Respiratory deficit ( shortness of breath, because of fast growing uterus) is another common problem.

Twin babies may be small in comparison to their gestational age and more prone to the complications associated with low birth weight (increased vulnerability to infection, losing heat, difficulty breastfeeding).

You will learn about low birth weight babies in detail in the Postnatal Care Module.

Malpresentation is more common in twin pregnancies, and they may also be ‘locked’ at the neck with one twin in the vertex presentation and the other in breech. The risks associated with malpresentations already described also apply: prolapsed cord, poor uterine contraction, prolonged or obstructed labour, postpartum haemorrhage, and fetal hypoxia and death.
Conjoined twins (fused twins, joined at the head, chest, or abdomen, or through the back) may also rarely occur.

8.8 Management of women with malpresentation or multiple pregnancy

As you have seen in this study session, any presentation other than vertex has its own dangers for the mother and baby. For this reason, all women who develop abnormal presentation or multiple pregnancy should ideally have skilled care by senior health professionals in a health facility where there is a comprehensive emergency obstetric service. Early detection and referral of a woman in any of these situations can save her life and that of her baby.

What can you do to reduce the risks arising from malpresentation or multiple pregnancy in women in your care?

During focused antenatal care of the pregnant women in your community, at every visit after 36 weeks of gestation you should check for the presence of abnormal fetal presentation. If you detect abnormal presentation or multiple pregnancy, you should refer the woman before the onset of labour.

Summary of Study Session 8

In Study Session 8, you learned that:

During early pregnancy, babies are naturally in the breech position, but in 95% of cases they spontaneously reverse into the vertex presentation before labour begins.
Malpresentation or malposition of the fetus at full term increases the risk of obstructed labour and other birth complications.
Common causes of malpresentations/malpositions include: excess amniotic fluid, abnormal shape and size of the pelvis; uterine tumour; placenta praevia; slackness of uterine muscles (after many previous pregnancies); or multiple pregnancy.
Common complications include: premature rupture of membranes, premature labour, prolonged/obstructed labour; ruptured uterus; postpartum haemorrhage; fetal and maternal distress which may lead to death.
Vertex malposition is when the fetal head is in the occipito-posterior position — i.e. the back of the fetal skull is towards the mother’s back instead of pointing towards the front of the mother’s pelvis. 90% of vertex malpositions rotate and deliver normally.
Breech presentation (complete, frank or footling) is when the baby’s buttocks present during labour. It occurs in 3–4% of labours after 34 weeks of pregnancy and may lead to obstructed labour, cord prolapse, hypoxia, premature separation of the placenta, birth injury to the baby or to the birth canal.
Face presentation is when the fetal head is bent so far backwards that the face presents during labour. It occurs in about 1 in 500 full term labours. ‘Chin posterior’ face presentations usually rotate spontaneously to the ‘chin anterior’ position and deliver normally. If rotation does not occur, a caesarean delivery is likely to be necessary.
Brow presentation is when the baby’s forehead is the presenting part. It occurs in about 1 in 1000 full term labours and is difficult to detect before the onset of labour. Caesarean delivery is likely to be necessary.
Shoulder presentation occurs when the fetal lie during labour is transverse. Once labour is well progressed, vaginal examination may feel the baby’s ribs, and an arm may sometimes prolapse. Caesarean delivery is always required unless a doctor or midwife can turn the baby head-down.
Multiple pregnancies are always at high risk of malpresentation. Mothers need greater antenatal care, and twins are more prone to complications associated with low birth weight and prematurity.
Any presentation other than vertex after 34 weeks of gestation is considered as high risk to the mother and to her baby. Do not attempt to turn a malpresenting or malpositioned baby! Refer the mother for emergency obstetric care.

Self-Assessment Questions (SAQs) for Study Session 8

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 8.1 (tests Learning Outcomes 8.1, 8.2 and 8.4)

Which of the following definitions are true and which are false? Write down the correct definition for any which you think are false.

A Fundus — the ‘rounded top’ and widest cavity of the uterus.

B Complete breech — where the legs are bent at both hips and knee joints and are folded underneath the baby.

C Frank breech — where the breech is so difficult to treat that you have to be very frank and open with the mother about the difficulties she will face in the birth.

D Footling breech — when one or both legs are extended so that the baby presents ‘foot first’.

E Hypoxia — the baby gets too much oxygen.

F Multiple pregnancy — when a mother has had many babies previously.

G Monozygotic twins — develop from a single fertilised ovum (the zygote). They can be different sexes but they share the same placenta.

H Dizygotic twins — develop from two zygotes. They have separate placentas, and can be of the same sex or different sexes.

A is true. The fundus is the ‘rounded top’ and widest cavity of the uterus.

B is true. Complete breech is where the legs are bent at both hips and knee joints and are folded underneath the baby.

C is false . A frank breech is the most common type of breech presentation and is when the baby’s legs point straight upwards (see Figure 8.4).

D is true. A footling breech is when one or both legs are extended so that the baby presents ‘foot first’.

E is false . Hypoxia is when the baby is deprived of oxygen and risks permanent brain damage or death.

F is false. Multiple pregnancy is when there is more than one fetus in the uterus.

G is false. Monozygotic twins develop from a single fertilised ovum (the zygote), and they are always the same sex , as well as sharing the same placenta.

H is true. Dizygotic twins develop from two zygotes, have separate placentas, and can be of the same or different sexes.

SAQ 8.2 (tests Learning Outcomes 8.1 and 8.2)

What are the main differences between normal and abnormal fetal presentations? Use the correct medical terms in bold in your explanation.

In a normal presentation, the vertex (the highest part of the fetal head) arrives first at the mother’s pelvic brim, with the occiput (the back of the baby’s skull) pointing towards the front of the mother’s pelvis (the pubic symphysis ).

Abnormal presentations are when there is either a vertex malposition (the occiput of the fetal skull points towards the mother’s back instead towards of the pubic symphysis), or a malpresentation (when anything other than the vertex is presenting): e.g. breech presentation (buttocks first); face presentation (face first); brow presentation (forehead first); and shoulder presentation (transverse fetal).

SAQ 8.3 (tests Learning Outcomes 8.3 and 8.5)

a. List the common complications of malpresentations or malposition of the fetus at full term.
b. What action should you take if you identify that the fetus is presenting abnormally and labour has not yet begun?
c. What should you not attempt to do?
a. The common complications of malpresentation or malposition of the fetus at full term include: premature rupture of membranes, premature labour, prolonged/obstructed labour; ruptured uterus; postpartum haemorrhage; fetal and maternal distress which may lead to death.
b. You should refer the mother to a higher health facility – she may need emergency obstetric care.
c. You should not attempt to turn the baby by hand. This should only be attempted by a specially trained doctor or midwife and should only be done at a health facility.

SAQ 8.4 (tests Learning Outcomes 8.4 and 8.5)

A pregnant woman moves into your village who is already at 37 weeks gestation. You haven’t seen her before. She tells you that she gave birth to twins three years ago and wants to know if she is having twins again this time.

a. How would you check this?
b. If you diagnose twins, what would you do to reduce the risks during labour and delivery?
Is the uterus larger than expected for the period of gestation?
What is its shape – is it round (indicative of twins) or heart-shaped (as in a singleton pregnancy)?
Can you feel more than one head?
Can you hear two fetal heartbeats (two people listening at the same time) with at least 10 beats difference?
If there is access to a higher health facility, and you are still not sure, try and get the woman to it for an ultrasound scan.
Be extra careful to check that the mother is not anaemic.
Encourage her to rest and put her feet up to reduce the risk of increased blood pressure or swelling in her legs and feet.
Be alert to the increased risk of pre-eclampsia.
Expect her to go into labour before term, and be ready to get her to the health facility before she goes into labour, going with her if at all possible.
Get in early touch with that health facility to warn them to expect a referral from you.
Make sure that transport is ready to take her to a health facility when needed.

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Face Presentation

Pictoral Midwifery, Comyns Berkely, 4th Edition. 1941

Face it. We have a lot to learn about fetal positioning. The old paradigm is fetal positions are random. The new paradigm is that babies match the space available.

Face and brow presentations occur when baby’s spine extended until the head is shifted back so baby’s face comes through the pelvis first.

Baby may settle in a face or brow presentation before labor or they may become a face or brow presentation, usually when a posterior baby has it’s chin pushed further up by the pelvic floor during descent.

A baby who is in a face-first or forehead-first position often started as an extended (chin up) occiput posterior or occiput transverse position. Coming down on to the pelvic floor with the forehead leading then “converted” this baby’s head to the face first position.

The baby’s face may be bruised for a couple days after the birth. The brow presentation may cause a redness but only occasionally will cause a bruise.

Mobility of the pelvis and the freedom of maternal movements often help bring the face-first baby down through the pelvis with good strong, uterine surges.

But not always. Sometimes the labor can’t move baby down. Cesareans are more common, but a portion of the higher surgical rate is because time is not given to the mother to begin or continue labor, or to be out of bed for this labor. Monitoring becomes important. Expect a bit of an unusual heart rate to contraction pattern seen in these labors.

When is Breech an Issue?
Belly Mapping® Breech
Flip a Breech
When Baby Flips Head Down
Breech & Bicornuate Uterus
Breech for Providers
What if My Breech Baby Doesn't Turn?
Belly Mapping ®️ Method
After Baby Turns
Head Down is Not Enough
Sideways/Transverse
Asynclitism
Oblique Lie
Left Occiput Transverse
Right Occiput Anterior
Right Occiput Posterior
Right Occiput Transverse
Left Occiput Anterior
OP Truths & Myths
Anterior Placenta
Body Balancing

What makes labor easier for a face-first baby and you?

Balance the body and the baby will thank you by curling into position to aim, not their face, but the crown of their head.

Flexion is physiological. So support physiology and the baby will change their position. We may need a little physics.

In Labor with a Face or Brow Presentation

Back baby up!

Forward-leaning Inversion with a jiggle of the buttocks right through 1-2 contractions often backs baby up so they can tuck their chin. Then they can aim into the pelvis with an easier position.

Shake the Apples in Forward-leaning Inversion with hands

A little effort can make labor a lot easier!

Only after baby’s crown is first, then do Side-lying Release in labor.

Before Labor with a face or brow presentation

Face presentation may reflect a psoas/pelvic floor imbalance with a collapse in the front body.

Free the piriformis, strengthen the buttocks, lengthen the hamstrings, squat for lengthening the pelvic floor, don’t worry about strengthening the pelvic floor right now. Alignment, walking, stabilizing and lengthening will tone the pelvic floor. Use it by breathing with your whole body.

Before labor, it’s safe to do Side-lying Release when baby’s face-first head isn’t in the pelvis yet.

Free the way

The psoas is the upper guide, the pelvic floor is the lower guide. release spasms and lengthen both.

Make room for the baby by releasing muscles that spasm, lengthen ligaments that are shortened, and support the abdominal muscles by attending to the muscles that interact with them, don’t go directly to the front first.

Contact to Listing Owner

Face Presentation and Birth Injury

Normally, children are born head-first with the chin tucked towards the chest (vertex presentation). In a face presentation, the chin is not tucked and the neck is hyperextended. This can inhibit the engagement of the head and complicate the labor process. In some cases, a baby in face presentation can be delivered vaginally, but in other cases vaginal delivery is difficult and dangerous. Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby. If they suspect an abnormal presentation, they can confirm with an ultrasound and take action to properly handle the delivery of a baby in the face presentation. This includes additional monitoring and in some cases requires a C-Section. Because ventilation issues are more common in babies with face presentation, staff should be ready to intubate immediately after delivery (1).

Risk factors and causes of face presentation

Conditions that may increase the likelihood of a face presentation include the following (1, 2, 3, 4):

Prematurity
Very low birth weight
Fetal macrosomia (large baby)
Cephalopelvic disproportion, or CPD (a mismatch in size between the mother’s pelvis and the baby’s head)
Anencephaly (a birth defect in which the baby is missing part of the brain and skull)
Severe hydrocephalus with enlargement of the head
Anterior neck mass
Multiple nuchal cords (umbilical cord wrapped around baby’s neck more than once)
Maternal pelvis abnormalities
Maternal obesity
Multiparity (the mother has previously given birth)
Polyhydramnios (too much amniotic fluid)
Previous cesarean delivery

Diagnosing face presentation

Face presentation is diagnosed late in the first or second stage of labor by vaginal examination. The distinctive facial features of the chin, mouth, nose, and cheekbones can be felt. Face presentation is sometimes confused with breech presentation (because both are characterized by soft tissues with an orifice), which is why it is imperative that a very skilled physician be present during any potentially risky delivery or malpresentation . Diagnosis can be confirmed by an ultrasound, which reveals a deflexed/hyperextended neck (1).

Face presentation and delivery

There are three types of face presentation:

Mentum anterior (MA) . In this position, the chin is facing the front of the mother, and will be the presenting part of the face. Babies in mentum anterior position are usually delivered vaginally, although in some cases a C-section may be necessary.
Mentum posterior (MP) . In this position, the chin is facing the mother’s back. The baby’s head, neck, and shoulders enter the pelvis at the same time, and the pelvis is usually not large enough to accommodate this (however, the baby may spontaneously rotate into mentum anterior position) . Typically, a C-section is indicated, but there are certain circumstances under which vaginal delivery may be attempted (e.g. the mother is multiparous, the infant in face presentation is relatively small compared to her other children, fetal monitoring is reassuring, and the baby is progressing in labor). Regardless, the medical team should be prepared to perform a prompt C-section if there are any complications.
Mentum transverse (MT) . In this position, the baby’s chin is facing the side of the birth canal. Doctors may recommend a trial of labor under certain circumstances, but they should promptly proceed to a C-section if there are issues. If labor is progressing and the fetal heart monitor is reassuring when face presentation is present, physician intervention may not be necessary since many MP and MT positions convert to MA. Oxytocin (Pitocin) augmentation may be used in a face presentation with a normal fetus and abnormally slow progress, as long as fetal heart rate patterns remain reassuring (although there are certain risks associated with this drug, including uterine tachysystole ). Of course, in any face presentation, if progress in dilation and descent ceases despite adequate contractions, delivery must occur by C-section.

There is an increased risk of trauma to the baby when the face presents first, and the physician should not internally manipulate (try to rotate) the baby. In addition, the physician must not use vacuum extractors or manual extraction (grasping the baby with hands) to pull the baby from the uterine cavity. Furthermore, midforceps ( forcep extraction when the baby’s station is above +2 cm, but the head is engaged) should never be used. Outlet forceps should only be used by experienced physicians who understand the circumstances under which this is appropriate (1).

Abnormalities of the fetal heart rate occur more frequently with face presentation. In one study, 59% of infants in face presentation had variable heart decelerations, and 24% had late decelerations. Of the babies who were born live, 37% had 1-minute Apgar scores lower than 7, and 13% had 5-minute Apgar scores lower than 7. The majority of the low 5-minute Apgar scores were babies that had been in mentum posterior position (5).

For these reasons, it is crucial that babies are continuously monitored during labor, ideally with an external heart monitoring device. An internal device may cause facial or eye injuries if improperly placed. If internal monitoring is needed, the electrode should be cautiously placed over a bony structure such as the forehead, jaw or cheekbone to minimize the risk of trauma (1).

It is always critical that doctors obtain a mother’s informed consent , which means discussing delivery options (vaginal, C-section, enhanced with oxytocin, etc.) with her and explaining the potential risks and benefits of each. Failure to do so constitutes negligence.

Complications and side effects of face presentation

Complications associated with face presentation include the following:

Prolonged labor
Facial trauma
Facial edema (fluid build up in the face, often caused by trauma)
Skull molding (abnormal head shape that results from pressure on the baby’s head during childbirth)
Respiratory distress /difficulty in ventilation due to airway trauma and edema
Spinal cord injury
Abnormal fetal heart rate patterns
Low Apgar score

A baby may be at increased risk of complications if forceps or oxytocin are used during labor. Forceps can cause traumatic injury to the head, and oxytocin can deprive a baby of oxygen due to uterine tachysystole/hyperstimulation (strong, frequent contractions). Hyperstimulation increases pressure on the blood vessels in the womb, which can deprive the baby of oxygen-rich blood.

Trauma to the head and decreased oxygenation can cause permanent brain damage, such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP) , as well as fetal deaths.

Our team is here to help.

Call ABC Law Centers today to secure your child’s care and reclaim their future.

Standards of care, medical malpractice, and face presentation

Informed consent must be given during all medical procedures. This means that when a mother has a baby with face presentation, she must be given the option of a C-section versus a vaginal birth. One of the reasons a mother may opt for a C-section is to avoid the extensive facial bruising/trauma that is common in babies with face presentation. In addition to thoroughly explaining the risks and benefits of each type of delivery method, the physician must explain and obtain consent from the mother if forceps or oxytocin are used.

Because there are many complications associated with face presentation, it is essential that the baby be closely monitored and that delivery is handled by a physician with experience in this area. Furthermore, the physician must quickly proceed to a C-section delivery if there are any signs of fetal distress , labor is not progressing, or the baby fails to convert (rotate) to MA position. In addition, once a face presentation is diagnosed, the physician must check for pelvic adequacy. When the pelvis is inadequate (contracted/small), a C-section is recommended (1).

Since respiratory problems can occur in babies with face presentation, equipment and staff to perform intubation of the baby (placement of a breathing tube) should be readily available at the time of delivery.

Failure to follow any of these standards of care is negligence. If this negligence results in injury to the baby, it is medical malpractice .

Trusted birth injury attorneys

If your baby has HIE, cerebral palsy, periventricular leukomalacia (PVL), developmental delays , a seizure disorder , or any other birth injury , we may be able to help. Unlike other firms, the attorneys at ABC Law Centers (Reiter & Walsh, P.C.) focus solely on birth injury cases and have been helping children throughout the nation since 1997. During your free legal consultation, our attorneys will discuss your case with you, determine if negligence caused your loved one’s injuries, identify the negligent party, and discuss your legal options with you. Moreover, you pay nothing throughout the entire legal process unless we win or favorably settle your case.

“Reiter and Walsh goes above and beyond the norm in getting their clients the best possible results. Each client is treated with respect and compassion, and they are truly sensitive to what it means to help a family whose child has been injured.” -Client review from 11/23/2015

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Testimonials
Julien, S., Lockwood, C. J., & Barss, V. A. (2014). Face and brow presentations in labor. Up to date.
Duff, P. (1981). Diagnosis and management of face presentation. Obstetrics and gynecology, 57(1), 105-112.
S. BHAL NJ DAVIES T. CHUNG, P. (1998). A population study of face and brow presentation. Journal of Obstetrics and Gynaecology, 18(3), 231-235.
Shaffer, B. L., Cheng, Y. W., Vargas, J. E., Laros Jr, R. K., & Caughey, A. B. (2006). Face presentation: predictors and delivery route. American journal of obstetrics and gynecology, 194(5), e10-e12.
Benedetti, T. J., Lowensohn, R. I., & Truscott, A. M. (1980). Face presentation at term. Obstetrics and gynecology, 55(2), 199-202.

The above information is intended to be an educational resource. It is not meant to be, and should not be interpreted as, medical advice.

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Powerful and Effective Presentation Skills: More in Demand Now Than Ever

When we talk with our L&D colleagues from around the globe, we often hear that presentation skills training is one of the top opportunities they’re looking to provide their learners. And this holds true whether their learners are individual contributors, people managers, or senior leaders. This is not surprising.

Effective communications skills are a powerful career activator, and most of us are called upon to communicate in some type of formal presentation mode at some point along the way.

For instance, you might be asked to brief management on market research results, walk your team through a new process, lay out the new budget, or explain a new product to a client or prospect. Or you may want to build support for a new idea, bring a new employee into the fold, or even just present your achievements to your manager during your performance review.

And now, with so many employees working from home or in hybrid mode, and business travel in decline, there’s a growing need to find new ways to make effective presentations when the audience may be fully virtual or a combination of in person and remote attendees.

Whether you’re making a standup presentation to a large live audience, or a sit-down one-on-one, whether you’re delivering your presentation face to face or virtually, solid presentation skills matter.

Even the most seasoned and accomplished presenters may need to fine-tune or update their skills. Expectations have changed over the last decade or so. Yesterday’s PowerPoint which primarily relied on bulleted points, broken up by the occasional clip-art image, won’t cut it with today’s audience.

The digital revolution has revolutionized the way people want to receive information. People expect presentations that are more visually interesting. They expect to see data, metrics that support assertions. And now, with so many previously in-person meetings occurring virtually, there’s an entirely new level of technical preparedness required.

The leadership development tools and the individual learning opportunities you’re providing should include presentation skills training that covers both the evergreen fundamentals and the up-to-date capabilities that can make or break a presentation.

So, just what should be included in solid presentation skills training? Here’s what I think.

The fundamentals will always apply When it comes to making a powerful and effective presentation, the fundamentals will always apply. You need to understand your objective. Is it strictly to convey information, so that your audience’s knowledge is increased? Is it to persuade your audience to take some action? Is it to convince people to support your idea? Once you understand what your objective is, you need to define your central message. There may be a lot of things you want to share with your audience during your presentation, but find – and stick with – the core, the most important point you want them to walk away with. And make sure that your message is clear and compelling.

You also need to tailor your presentation to your audience. Who are they and what might they be expecting? Say you’re giving a product pitch to a client. A technical team may be interested in a lot of nitty-gritty product detail. The business side will no doubt be more interested in what returns they can expect on their investment.

Another consideration is the setting: is this a formal presentation to a large audience with questions reserved for the end, or a presentation in a smaller setting where there’s the possibility for conversation throughout? Is your presentation virtual or in-person? To be delivered individually or as a group? What time of the day will you be speaking? Will there be others speaking before you and might that impact how your message will be received?

Once these fundamentals are established, you’re in building mode. What are the specific points you want to share that will help you best meet your objective and get across your core message? Now figure out how to convey those points in the clearest, most straightforward, and succinct way. This doesn’t mean that your presentation has to be a series of clipped bullet points. No one wants to sit through a presentation in which the presenter reads through what’s on the slide. You can get your points across using stories, fact, diagrams, videos, props, and other types of media.

Visual design matters While you don’t want to clutter up your presentation with too many visual elements that don’t serve your objective and can be distracting, using a variety of visual formats to convey your core message will make your presentation more memorable than slides filled with text. A couple of tips: avoid images that are cliched and overdone. Be careful not to mix up too many different types of images. If you’re using photos, stick with photos. If you’re using drawn images, keep the style consistent. When data are presented, stay consistent with colors and fonts from one type of chart to the next. Keep things clear and simple, using data to support key points without overwhelming your audience with too much information. And don’t assume that your audience is composed of statisticians (unless, of course, it is).

When presenting qualitative data, brief videos provide a way to engage your audience and create emotional connection and impact. Word clouds are another way to get qualitative data across.

Practice makes perfect You’ve pulled together a perfect presentation. But it likely won’t be perfect unless it’s well delivered. So don’t forget to practice your presentation ahead of time. Pro tip: record yourself as you practice out loud. This will force you to think through what you’re going to say for each element of your presentation. And watching your recording will help you identify your mistakes—such as fidgeting, using too many fillers (such as “umm,” or “like”), or speaking too fast.

A key element of your preparation should involve anticipating any technical difficulties. If you’ve embedded videos, make sure they work. If you’re presenting virtually, make sure that the lighting is good, and that your speaker and camera are working. Whether presenting in person or virtually, get there early enough to work out any technical glitches before your presentation is scheduled to begin. Few things are a bigger audience turn-off than sitting there watching the presenter struggle with the delivery mechanisms!

Finally, be kind to yourself. Despite thorough preparation and practice, sometimes, things go wrong, and you need to recover in the moment, adapt, and carry on. It’s unlikely that you’ll have caused any lasting damage and the important thing is to learn from your experience, so your next presentation is stronger.

How are you providing presentation skills training for your learners?

Manika Gandhi is Senior Learning Design Manager at Harvard Business Publishing Corporate Learning. Email her at [email protected] .

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Conversations, negotiations and presentations

17 tips for facial expressions in speeches and presentations

The importance of facial expressions in public speaking

When the topic of body language appears in presentation skills training, the question comes up “Where to put my hands while speaking?”

Mimic is discussed rarely, if at all, with the hint of having a smile on your face. This is a pity because facial expressions can support the message. When facial expressions aren’t right, they can cause damage. What does not fit the personality and role of the speaker is unintentionally funny, damages credibility, and distracts.

This article deals with what it is worth paying attention to as a speaker concerning facial expressions.

Body language, facial expressions, and public speaking

So facial expressions are no longer important, 17 tips for facial expressions in your speeches and presentations, just ask me personally, related articles.

In addition to the content of the speech, as a verbal part, the way of presentation and the non-verbal behavior are of particular importance. These include gestures, eye contact, eye direction, body tension, leg posture, volume, intonation, and, often forgotten, pauses. Pauses before a message produce tension and after a message, they let the message work. In modern rhetoric, facial expressions have become less important than in the past. A facial expression that is too pronounced quickly has a theatrical and posed effect on the audience.

Mimic is important because public speakers who want to convince have to be authentic. And that includes lively facial expressions. Instead of orienting the facial expressions to Asian theater masks or the pantomime from the pedestrian zone, Method-Acting delivers better results. If you mean what you say, this also includes the corresponding emotional states. If you experience inwardly with all your senses what you verbalize, then your face provides the appropriate facial expression anyway. At least as long as you haven’t stopped it with nerve poison against wrinkles.

Leave that deadpan expression to poker players and some politicians. A good presenter realizes that appropriate facial expressions are a significant part of effective communication. Facial expressions are often the key determinant of the meaning behind the message. The audience is watching a speaker’s face during a presentation. When you speak, your face tells more clearly than any other part of your body about your attitudes, feelings, and emotions.

Your impact as a speaker depends heavily on your body language . You probably have control over the words you speak, are you sure you have control over what you say with your body language?

1. Authentic, authentic, authentic

Effective body language supports the message and conveys a strong image of the speaker. Anything that does not fit the personality and role of a public speaker and the message will unintentionally appear funny, damage credibility, and distract from the content and message. Those who mean what they say can automatically display the appropriate facial expressions. This is a frequent topic in my presentation training . Few speakers know how they affect the audience. Professional analysis is very revealing here.

2. Smiling is contagious

Unfortunately, many people lose their lively facial expressions under the pressure of speaking in front of an audience. Their faces solidify into a mask. Free your face right at the beginning. For example, when you are welcoming the audience, smile!

With a smile or even a laugh, it is easier to build a bridge with other people. This looks open and friendly. A real smile comes from within and is based on the right mental attitude and not on a mask. Such a permanent grin looks different from a real smile, which is called a Duchenne smile . The Duchenne smile is named after Guillaume Duchenne , a French anatomist who studied many expressions of emotion, focusing on the smile of pure enjoyment. He identified the facial movements that make this genuine smile different from artificial types of smiles. A Duchenne smile is a natural smile of enjoyment, made by contracting the zygomatic major muscle and the orbicularis oculi muscle. In my words; the mouth, the eyes, and the wrinkles around the eyes are involved, and the smile, the cheeks lifting.

3. Emotions

It is the presenter’s connection to the words that can bring them to life for the audience. Experience inwardly intensively what you want to convey, and the facial expressions will reflect it. Less is more! Please do not grimace.

4. Lead with your gaze

The audience will register where you’re looking. In this way, you can direct the attention of the audience with your gaze. Look where the audience should look.

And be careful with misunderstandings. If you keep looking at the door, it will look as if you would like to escape.

5. Eye contact is connecting

If they don’t fit, they can undermine any of your words.

Good speakers know how important facial expressions are. Effective presenters engage one person at a time, focusing long enough to complete a natural phrase and watch it sink in for a moment. With a smile, they convey appreciation to the audience.

Keep looking at all faces, and be attentive. Return a smile. Use clues such as a frown as an occasion to repeat or inquire about a statement in other words.

6. Pulling up the corners of your mouth on one side

Some facial expressions can irritate. One-sided lifting of the corners of the mouth can be interpreted as a sign of superiority, and the speaker is then accused of arrogance or cynicism.

7. Enduring smile

A permanent smile seems artificial, complacent, or even debilitating. Speakers don’t do themselves any favors.

Such behavior is reminiscent of bad show presenters or used car salesmen from US films. If you smile without a break, you make your counterpart suspicious. Beware of bad facial expressions, i.e. a superimposed smile.

If there are moments during your speech when you want to make the audience think, then that doesn’t fit. When you put on an artificial smile, nobody takes you seriously.

8. A tense jaw

Someone who presses their teeth vigorously against each other may look angry and aggressive, or at least cramped.

9. Smiling and showing teeth

What is more common in the USA is more irritating in Germany, for example, than piranha smiles. Superficiality and an unfair sales mentality are easily assumed.

10. Grasping the nose or the mouth

Do not touch your nose, mouth, or chin during your speech. This is a classic sign of insecurity and is quickly perceived as negative by your audience.

Since Pinocchio this has been considered a sign of lies, and why should you voluntarily sow doubt?

11. Other delicate facial expressions

In my articles, Body Language Soothes or harms in delicate situations and 12 tips on how to promote confidence through body language, you will find advice on how body language can help and how it can hurt.

12. Adapt your facial expressions to the size of the group.

As your audience grows, your facial expressions should become more pronounced. If the audience in the last row is not able to read your face, your facial expression will be perceived as a neutral expression and thus as your lack of interest.

13. Explore the effect of facial expressions

The facial expression usually has a small part in the presentation, which is why its role tends to be underestimated. It plays an important role in convincing the speaker and the message. It is worth exploring the impact.

Using all the various muscles that precisely control the mouth, lips, eyes, nose, forehead, and jaw, the human face is estimated to be capable of more than 10,000 different expressions. Explore different ways to use facial expressions. Start with the most common facial expressions and emotions.

There are seven universally recognized emotions shown through facial expressions:

Regardless of culture, these expressions are the same all over the world. They may differ in intensity.

14. Observe your audience

Just as your facial expressions provide insight into your emotions, your audience’s facial expressions provide insight into their emotional world.

Read the facial expressions of your audience. If the audience’s expressions are expressionless, for example, there is a possibility that they are intellectually elsewhere because they are bored. Or their facial expressions convey joy and excitement, or they are eagerly receptive or…

By reading your audience’s facial expressions, you are better able to make spontaneous decisions and adjustments to capture attention.

15. Using a lectern or manuscript

Wherever your speech manuscript is located, whether as a pile of paper on the lectern or as key point cards in your hand, always avoid looking at the notes all the time. Learn from me how to keep in touch with the audience.

16. Practice, practice, practice

As with any presentation skill, facial expression requires practice to develop it to be both authentic and effective. Presenters who care deeply about their message tend to use their entire bodies to support the message.

Practice your presentation and the things you have experienced with me in front of a mirror to concentrate exclusively on your facial expressions during a rehearsal. While practicing in front of the mirror, see if your facial expressions convey the mood you want to create. If your face isn’t showing any emotion, stop, refocus, and do it again. This will help you to explore your expression playfully. The best way to do this is with professional support.

17. Support

As a professional speech coach , I will not practice masks with you but will point out potential misunderstandings and promote corresponding situations from within.

Preparation of important speeches and presentations

Those who do not speak are not heard, and even those who speak up are not always successful. There are a few more steps that need to be mastered.

Do you want to convince with your message and also as a personality? Then I will help you to prepare your speeches and presentations. You determine the scope. At least, I recommend a test run with professional feedback for you and your message. Then you will know how you and your content are perceived, what you should do, and what you should leave out, where there is potential. Why do you want to get such helpful feedback so late after your real performance? Then it is too late for adjustments. Benefit from the advantage. My definition of luck: Preparation meets opportunity.

You can best estimate for yourself where the effort is worthwhile concerning the expected benefit. Here you will find the fees for my support (communication, psychology, language, structure, voice, body language, storytelling, rhetorical means, media such as PowerPoint and Co., etc.)

You are not in Berlin right now? Then choose meetings with me via telephone or video support . Whereby, there are quite good reasons for a trip to Berlin .

By the way, many people suffer from such intense stage fright in front of an audience, and therefore their performance lags behind their possibilities. Too bad, because with my help performance in a good condition is possible. Just in case...

A good start: Professional feedback with suggestions for improvement

How persuasive are you and your messages in speeches and presentations? How good are you at the 111+ most important presentation skills? I have been analyzing speeches since 1998. After evaluating 14,375 speeches and presentations, and numerous mistakes of my own, most of which I only discovered after a delay, I can tell you exactly what works with which audience. Let me give you the feedback that will help you get ahead. You will receive essential feedback and recommendations, as well as the impulses you need to persuade your audience in concrete situations.

Are you interested? If so, here is how to get helpful feedback with recommendations for improving your speeches and presentations.

Please post any questions that may be of interest to other readers in the comments. Looking for professional help?

If you are interested in coaching, training or consulting, if you have organizational questions, or if you want to make an appointment, you can reach me best via this contact form (you can choose if you want to enter your personal data) or via e-mail ( [email protected] ). You can also reach me by phone at +49(0)30 864 213 68 or by cell phone at +49(0)1577 704 53 56 from Monday to Thursday from 9:00 to 18:00. Most of the time I am in sessions, so please leave a message with your phone number in Germany. Please remember to be very specific about the reason for your call. I will get back to you as soon as possible. The privacy policy can be found here.

Transparency is important. That is why you will find answers to frequently asked questions already here , for example about me ( profile ), the services , the fees and getting to know me . If you like what you see, I look forward to working with you.

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What do you pay attention to in facial expressions during conversations, speeches, and presentations?

Those are many factors.

You make an important point that if the subject you are speaking on does not excite you then it will not excite the audience. Listening to a speaker talks about something and you can tell that they have no passion, it will be incredibly difficult to be able to hold attention. The facial expression plays a big role in showing the enthusiasm. When you speak, your face – more clearly than any other part of your body – communicates to your audience your attitudes, feelings, and emotions.

What can facial expressions like microexpressions tell us?

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Persuading without arguments, assertiveness, winning without consideration, knockout by nasty tricks, black magic, manipulating. It is a coveted feeling to be right.

Grounding for presence and confidence in speeches and presentations

Use grounding for presence and a feeling confident in speeches and presentations. More than just a remedy for stage fright.

Body language: What can actually be read from the eyes? Not only wishes!

What can be read from the eyes? More than wishes! The eyes have a big part in human facial expressions. There is a reason why the eyes are called the mirror of the soul. They reveal a lot about our feelings and thoughts, no matter if we want it or not. Eyes can smile, radiate joy, permeate, agree, question, doubt or reject. Learn to read body language.

15 tips on how to stand up for your conviction: Be brave, speak up!

Some people have an opinion that deserves attention. Often, however, this opinion is not heard. Then it is time to decide whether to keep it that way or to share the point of view more clearly with others. Not everyone dares this step. What about you?

20 tips for humor in speeches and presentations

Do you want the attention of your audience? Humorously move your audience before the seat hurts. Humor relaxes. It resolves tense, stressful situations. Humor has some positive effects. Appropriate humor can be used effectively in many situations. Find out what is worth paying attention to.

This article is a short excerpt from the more comprehensive course materials my clients receive in group or individual training or coaching .

Published: June 27, 2019 Author: Karsten Noack Revision: October 6, 2021 Translation: ./. German version: https://www.karstennoack.de/rhetorik-mimik-koerpersprache/ K: H: T: RR #124710

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Technical Considerations When Presenting Face-to-Face

First Online: 20 May 2023

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Can Cemal Cingi 4 ,
Nuray Bayar Muluk 5 &
Cemal Cingi 6

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Face-to-face (hereafter referred to as F2F) is amongst the most effective of all ways to present and provide information to an audience. The reason for the high degree of communicative efficacy of this mode of presentation is that it involves simultaneous transmission of multiple cues to the intended meaning, unlike many other modes of communication. The principal mass media used in broadcasting, such as television, have the advantage that they can replicate many of the features of F2F, so that the audience can attend to non-verbal signals or cues, such as posture, body language, tone of voice and the expression on the presenter’s face. A further advantage of F2F is the ease with which visual aids can be incorporated into a presentation and the way it facilitates use of rhetorical techniques (emphasis, pathos, mnemonics, etc.). These factors all come together to mean F2F presentations are often more memorable and convincing than other types. F2F presentations may occur in a variety of settings, ranging from presentations to an individual or small group through to a large public lecture. The venue for the presentation and the number of attendees will, of course, vary depending on the purpose for which the presentation was arranged. There have been profound alterations in everyday communication which have come about through digitalization. These changes affect personal as well as healthcare marketing communication. It might be tempting to assume that the plethora or technologies which support virtual communication, such as e-mail, WhatsApp or Zoom, have put F2F communication in second place.

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Cingi, C.C., Bayar Muluk, N., Cingi, C. (2023). Technical Considerations When Presenting Face-to-Face. In: Improving Online Presentations. Springer, Cham. https://doi.org/10.1007/978-3-031-28328-4_2

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Perfect presentations: Face-to-face and virtual

Business leaders are determining how to host successful meetings in this “new normal” environment created by the COVID-19 pandemic.

While people have been holding virtual meetings during lockdown, hybrid meetings look set to be a popular trend in the future.

The challenge is to create perfect presentations for both face-to-face and virtual settings. The importance of presentations within meetings can’t be over-emphasised, as they grab delegates’ interest and inspire people to reach team goals.

Honing presentation skills Presentation skills will help the speaker to communicate often complex information in an interesting and simple way that will keep the audience engaged. Rather than just talking all the time, they can use different means, such as audio-visual content and images.

With many companies booking a meeting room for later in the year, when hopefully the pandemic will have abated, it seems likely that more hybrid meetings will be taking place, to avoid packing too many delegates into the venue and to enable people who may not be able to attend, due to travel or other restrictions, to take part.

You can create the perfect presentations for both face-to-face and virtual settings with some careful planning. If you’re preparing for a presentation, always consider you may need to speak to delegates who are there in person and others that might be taking part through a video link.

Face-to-face meetings One of the key elements of a good presentation is maintaining an audible tone so that every audience member can hear you, no matter where they are in the room. This might sound obvious, but make a conscious effort to articulate the words as carefully and clearly as possible, maintaining an easily-audible voice-level throughout.

Also, maintain an optimal pace, giving listeners time to understand and absorb the information. Learn not to speak too fast, as people may switch off. Similarly, don’t speak too slowly, or it will appear to drag. Maintain a normal speaking pace, without racing through the speech.

Vary your tone of voice, putting the emphasis on enthusiasm and using gestures appropriately to keep the audience involved. No amount of technology, no matter how good, will ever replace an enthusiastic and articulate speaker who’s a great communicator. This encourages the audience to ask questions, collaborate and communicate, as it makes them feel more motivated.

Using gestures emphasises the points you’re making as a speaker. If you stand still in one spot and communicate in a flat tone, it won’t keep the audience’s interest for long. Obviously, don’t move about and gesture so much that it becomes a distraction. Just keep the tone and your manner professional and enthusiastic, without going over the top.

Virtual meetings When you’re presenting to a virtual audience as well, there are other factors you must take into account. One is getting the lighting right, to make sure your audience can see you properly. Of course, this applies to the in-person delegates too.

You need bright front-lighting, so the light shines on your face. If your back is to a window, your face can appear to be in the shade, unless you close the blinds. Natural light is a popular choice, as it’s less harsh, but if your meeting room doesn’t have windows, use the appropriate artificial lighting to enhance your face.

Choose a background that looks professional, avoiding clutter and distractions. Find out whether your virtual presentation platform permits the use of virtual backgrounds, such as Zoom, or whether it can blur your background, as with Microsoft Teams.

It’s important to understand your technology in general, as nothing will spoil your presentation faster than a blip with the technical side. Have a dry run, so you’ll feel comfortable with the platform you’re using.

It’s preferable to have someone assist you with the tech during the actual meeting, allowing you to focus on your presentation. Make sure the camera is placed at eye-level – if it’s too low, you may appear to have a double chin if you’re continually looking down. If too high, it won’t seem like you’re talking directly to virtual delegates.

Being animated and enthusiastic will enhance a virtual presentation too. In fact, it’s even more important to be lively and grab delegates’ interest when you’re video-conferencing, as it’s easier for people at remote locations to just switch off when they’re looking at a computer screen.

Whether you’re presenting in-person or virtually, or even at a hybrid meeting merging both styles, remember it’s like giving a performance. People’s time is valuable, so make sure you create an authentic audience connection and don’t leave them feeling short-changed.

& Meetings offers a range of affordable meeting rooms and training rooms in London which are available for future hire. We’re taking bookings now for future meetings and will put in place the necessary measures to enhance COVID-19 safety procedures.

Give us a call now on 0800 073 0499 to book an affordable venue for your future events.

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Biden Administration Releases Revised Title IX Rules

The new regulations extended legal protections to L.G.B.T.Q. students and rolled back several policies set under the Trump administration.

President Biden standing at a podium next to Education Secretary Miguel Cardona.

By Zach Montague and Erica L. Green

Reporting from Washington

The Biden administration issued new rules on Friday cementing protections for L.G.B.T.Q. students under federal law and reversing a number of Trump-era policies that dictated how schools should respond to cases of alleged sexual misconduct in K-12 schools and college campuses.

The new rules, which take effect on Aug. 1, effectively broadened the scope of Title IX, the 1972 law prohibiting sex discrimination in educational programs that receive federal funding. They extend the law’s reach to prohibit discrimination and harassment based on sexual orientation and gender identity, and widen the range of sexual harassment complaints that schools will be responsible for investigating.

“These regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights,” Miguel A. Cardona, the education secretary, said in a call with reporters.

The rules deliver on a key campaign promise for Mr. Biden, who declared he would put a “quick end” to the Trump-era Title IX rules and faced mounting pressure from Democrats and civil rights leaders to do so.

The release of the updated rules, after two delays, came as Mr. Biden is in the thick of his re-election bid and is trying to galvanize key electoral constituencies.

Through the new regulations, the administration moved to include students in its interpretation of Bostock v. Clayton County, the landmark 2020 Supreme Court case in which the court ruled that the Civil Rights Act of 1964 protects gay and transgender workers from workplace discrimination. The Trump administration held that transgender students were not protected under federal laws, including after the Bostock ruling .

In a statement, Betsy DeVos, who served as Mr. Trump’s education secretary, criticized what she called a “radical rewrite” of the law, asserting that it was an “endeavor born entirely of progressive politics, not sound policy.”

Ms. DeVos said the inclusion of transgender students in the law gutted decades of protections and opportunities for women. She added that the Biden administration also “seeks to U-turn to the bad old days where sexual misconduct was sent to campus kangaroo courts, not resolved in a way that actually sought justice.”

While the regulations released on Friday contained considerably stronger protections for L.G.B.T.Q. students, the administration steered clear of the lightning-rod issue of whether transgender students should be able to play on school sports teams corresponding to their gender identity.

The administration stressed that while, writ large, exclusion based on gender identity violated Title IX, the new regulations did not extend to single-sex living facilities or sports teams. The Education Department is pursuing a second rule dealing with sex-related eligibility for male and female sports teams. The rule-making process has drawn more than 150,000 comments.

Under the revisions announced on Friday, instances where transgender students are subjected to a “hostile environment” through bullying or harassment, or face unequal treatment and exclusion in programs or facilities based on their gender identity, could trigger an investigation by the department’s Office for Civil Rights.

Instances where students are repeatedly referred to by a name or pronoun other than one they have chosen could also be considered harassment on a case-by-case basis.

“This is a bold and important statement that transgender and nonbinary students belong, in their schools and in their communities,” said Olivia Hunt, the policy director for the National Center for Transgender Equality.

The regulations appeared certain to draw to legal challenges from conservative groups.

May Mailman, the director of the Independent Women’s Law Center, said in a statement that the group planned to sue the administration. She said it was clear that the statute barring discrimination on the basis of “sex” means “binary and biological.”

“The unlawful omnibus regulation reimagines Title IX to permit the invasion of women’s spaces and the reduction of women’s rights in the name of elevating protections for ‘gender identity,’ which is contrary to the text and purpose of Title IX,” she said.

The existing rules, which took effect under Mr. Trump in 2020, were the first time that sexual assault provisions were codified under Title IX. They bolstered due process rights of accused students, relieved schools of some legal liabilities and laid out rigid parameters for how schools should conduct impartial investigations.

They were a sharp departure from the Obama administration’s interpretation of the law, which came in the form of unenforceable guidance documents directing schools to ramp up investigations into sexual assault complaints under the threat of losing federal funding. Scores of students who had been accused of sexual assault went on to win court cases against their colleges for violating their due process rights under the guidelines.

The Biden administration’s rules struck a balance between the Obama and Trump administration’s goals. Taken together, the regulation largely provides more flexibility for how schools conduct investigations, which advocates and schools have long lobbied for.

Catherine E. Lhamon, the head of the department’s Office for Civil Rights who also held the job under President Barack Obama, called the new rules the “most comprehensive coverage under Title IX since the regulations were first promulgated in 1975.”

They replaced a narrower definition of sex-based harassment adopted under the Trump administration with one that would include a wider range of conduct. And they reversed a requirement that schools investigate only incidents alleged to have occurred on their campuses or in their programs.

Still, some key provisions in the Trump-era rules were preserved, including one allowing informal resolutions and another prohibiting penalties against students until after an investigation.

Among the most anticipated changes was the undoing of a provision that required in-person, or so-called live hearings, in which students accused of sexual misconduct, or their lawyers, could confront and question accusers in a courtroom-like setting.

The new rules allow in-person hearings, but do not mandate them. They also require a process through which a decision maker could assess a party or witness’s credibility, including posing questions from the opposing party.

“The new regulations put an end to unfair and traumatic grievance procedures that favor harassers,” Kel O’Hara, a senior attorney at Equal Rights Advocates. “No longer will student survivors be subjected to processes that prioritize the interests of their perpetrators over their own well being and safety.”

The new rules also allow room for schools to use a “preponderance of evidence” standard, a lower burden of proof than the DeVos-era rules encouraged, through which administrators need only to determine whether it was more likely than not that sexual misconduct had occurred.

The renewed push for that standard drew criticism from legal groups who said the rule stripped away hard-won protections against flawed findings.

“When you are dealing with accusations of really one of the most heinous crimes that a person can commit — sexual assault — it’s not enough to say, ‘50 percent and a feather,’ before you brand someone guilty of this repulsive crime,” said Will Creeley, the legal director of the Foundation for Individual Rights and Expression.

The changes concluded a three-year process in which the department received 240,000 public comments. The rules also strengthen protections for pregnant students, requiring accommodations such as a bigger desk or ensuring access to elevators and prohibiting exclusion from activities based on additional needs.

Title IX was designed to end discrimination based on sex in educational programs or activities at all institutions receiving federal financial assistance, beginning with sports programs and other spaces previously dominated by male students.

The effects of the original law have been pronounced. Far beyond the impact on school programs like sports teams, many educators credit Title IX with setting the stage for academic parity today. Female college students routinely outnumber male students on campus and have become more likely than men of the same age to graduate with a four-year degree.

But since its inception, Title IX has also become a powerful vehicle through which past administrations have sought to steer schools to respond to the dynamic and diverse nature of schools and universities.

While civil rights groups were disappointed that some ambiguity remains for the L.G.B.T.Q. students and their families, the new rules were widely praised for taking a stand at a time when education debates are reminiscent to the backlash after the Supreme Court ordered schools to integrate.

More than 20 states have passed laws that broadly prohibit anyone assigned male at birth from playing on girls’ and women’s sports teams or participating in scholastic athletic programs, while 10 states have laws barring transgender people from using bathrooms based on their gender identity.

“Some adults are showing up and saying, ‘I’m going to make school harder for children,” said Liz King, senior program director of the education equity program at the Leadership Conference on Civil and Human Rights. “It’s an incredibly important rule, at an incredibly important moment.”

Schools will have to cram over the summer to implement the rules, which will require a retraining staff and overhauling procedures they implemented only four years ago.

Ted Mitchell, the president of the American Council on Education, which represents more than 1,700 colleges and universities, said in a statement that while the group welcomed the changes in the new rule, the timeline “disregards the difficulties inherent in making these changes on our nation’s campuses in such a short period of time.”

“After years of constant churn in Title IX guidance and regulations,” Mr. Mitchell said, “we hope for the sake of students and institutions that there will be more stability and consistency in the requirements going forward.”

Zach Montague is based in Washington. He covers breaking news and developments around the district. More about Zach Montague

Erica L. Green is a White House correspondent, covering President Biden and his administration. More about Erica L. Green

The Meaning Behind “Tragedy” by the Bee Gees and the Disco Demolition that Followed

Six months after the Bee Gees released “Tragedy,” culture war in the U.S. ignited … literally.

They were one of the biggest acts in the world, but the Gibb brothers and their prolific songwriting would soon face a virtual radio ban. They went from chart-topping stars to pariahs and the butt of jokes as “Tragedy” became one of their final hits before the storm.

Trying to Stay Alive

“Tragedy” follows an emotional breakdown from a breakup. Barry Gibb sings in a wailing falsetto voice about the despair of one suddenly finding themselves alone.

In a lost and lonely part of town

Held in time

In a world of tears, I slowly drown

I just can’t make it all alone

I really should be holding you

Holding you

Loving you, loving you

Barry and his brothers Robin and Maurice Gibb co-wrote the song, which appeared on their 15th album Spirits Having Flown (1979). The album was the first to follow their collaboration on the Saturday Night Fever soundtrack, which featured Bee Gees classics “Stayin’ Alive,” “How Deep Is Your Love,” “Night Fever,” “Jive Talkin’,” “More than a Woman,” and “You Should Be Dancing.”

The chart-topping album marked the cultural peak of disco, and soon, the backlash would target the Bee Gees.

When the feeling’s gone, and you can’t go on

It’s tragedy

When the morning cries, and you don’t know why

It’s hard to bear

With no one to love you

You’re goin’ nowhere

Backlash and a Radio Blackout

The Bee Gees’ commercial peak ended with Spirits Having Flown . Though the album reached No. 1 in both the U.S. and UK, 1979 and 1980 marked the end of disco’s commercial reign.

However, it was only a rebranding as record companies began labeling similar recordings as dance music. But the Bee Gees, especially in the U.S., faced a near-total radio blackout of their music. Following the success of Saturday Night Fever , they had become disco’s avatar.

The group attempted to counter the narrative by releasing the ballad “Too Much Heaven” as the first single from Spirits Having Flown , but the critical description persisted.

Disco Demolition Night

A July 1979 radio promotion dreamed up the idea to blow up a crate of disco records at Comiskey Park in Chicago between games of a doubleheader—it was dubbed Disco Demolition Night. The televised event of mostly young white men storming the field ended disco’s commercial viability.

Meanwhile, there was much more to the hostility toward disco. Beyoncé’s 2022 Renaissance album details how disco provided a safe space for Black, Latino, gay, and feminist communication.

In the early ’70s, disco began in gay dance clubs, but Saturday Night Fever later converted the scene into the mainstream’s consciousness. The PBS documentary The War on Disco explains the grievance of blue-collar white kids who weren’t hip enough to enter clubs like Studio 54. It was a flash point for class, race, gender, and sexuality.

It Began With a Disgruntled DJ

Steve Dahl, a DJ for Chicago’s WDAI, lost his job on Christmas Eve in 1978 when the station switched formats from album rock to disco. Dahl moved to a new station, WLUP, and launched a “Disco Sucks” campaign.

He devised the Disco Demolition Night with the Chicago White Sox promotions director Mike Veeck. They planned for 20,000 fans, but 50,000 showed up instead. The White Sox were scheduled to play a doubleheader against the Detroit Tigers.

During the first game, the crowd became agitated, and fans threw records, firecrackers, and bottles onto the playing field. After exploding a crate of disco records, fans stormed the field, and the White Sox forfeited the second game as the field became unplayable.

Resurrection

Though the Bee Gees’ commercial career suffered, they instead focused on songwriting. Barry and Robin Gibb wrote Barbra Streisand’s 1980 hit “Woman in Love.” Also, Dionne Warwick recorded “Heartbreaker,” written by Barry, Robin, and Maurice Gibb—reaching No. 10 on the Billboard Hot 100 chart.

Yet, disco didn’t die; it evolved. The 1980s became dominated by dance-oriented pop music from Michael Jackson, Prince, and Madonna, among many others. It thrived in late ’80s and early ’90s Manchester, England, with its baggy “Madchester” rave scene and new forms of global electronic music, including EDM.

When the Bee Gees released “Tragedy,” they couldn’t have known how prescient the song’s title would be. However, if disco died, no one told Daft Punk, Pharrell, Mark Ronson, or Dua Lipa.

Dua Lipa’s “Dance the Night” from the Barbie soundtrack is nearing a billion streams. You can’t blow those up on a baseball field.

When you purchase through links on our site, we may earn an affiliate commission.

Photo by Michael Ochs Archives/Getty Images

The post The Meaning Behind “Tragedy” by the Bee Gees and the Disco Demolition that Followed appeared first on American Songwriter .

Why Jessica Really Got Her Face Tattooed In Dune 2

The world of "Dune" is rich with symbolism, lush aesthetics, and characters of questionable sanity. All three are present in the case of Lady Jessica (Rebecca Ferguson), mother to Paul Atreides and, in "Dune: Part Two," a Bene Gesserit Reverend Mother among the Fremen of Arrakis. Jessica goes through quite a transformation in the sequel, adorning herself with all of the rich regalia befitting her new station. She even begins tattooing her face extensively — a "Dune: Part Two" detail that director Denis Villeneuve has now explained in an interview with The New York Times .

"She's trying to play on the symbolism that was put in the prophecy," Villeneuve told the Times. "She's supposed to be the mother of the Messiah, so I wanted to bring the idea that she was like the pope of the reverend mothers on Arrakis. There's some kind of madness in writing elements of the prophecies on her face. Frankly, I think when you drink the worm poison, it affects your sanity — and the same with Paul. I like the idea that we feel she's going too far."

It's interesting to learn that the words on Jessica's face are directly connected to the Lisan al Gaib prophecy. Like most members of the Bene Gesserit, Jessica is a sharp strategist, trained in the ways of manipulating people. The manner in which that intense intellect collides and interacts with a growing kind of madness makes her a particularly fascinating character in "Dune: Part Two."

What's next for Jessica in Dune?

If Denis Villeneuve gets to make a "Dune Messiah" movie , fans who haven't read the books may be surprised to discover that Jessica recedes to the background of the story. In Frank Herbert's second "Dune" novel, the story jumps forward in time about 12 years, putting the universe in a very different place politically and culturally. The second book is also much shorter than the first and focuses primarily on Paul as he struggles with the ramifications of his past actions.

If Villeneuve follows the novel closely (assuming that "Dune Messiah" gets greenlit), Jessica may not be present at all. However, there are indications that the director could take a different path through the story. "Dune: Part Two" changes a lot of things from the book , and that trend could easily continue into an adaptation of "Messiah." For example, it might make sense to show more of the Fremen's holy war up close and personal rather than immediately jumping 12 years ahead. That would allow for more scenes dissecting the new balance of power, of which Jessica is a key player.

In the novels, she returns to the Atreides homeworld of Caladan. Given how entrenched she becomes in the Fremen culture in the films, though — right down to the marks on her face — that transition wouldn't be easy. It would be great to get some more insight into Jessica's story if the "Dune" films continue, especially since Rebecca Ferguson has been one of the best parts of the whole franchise since the first movie.

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What the New Overtime Rule Means for Workers

Collage shows four professionals in business casual clothing.

One of the basic principles of the American workplace is that a hard day’s work deserves a fair day’s pay. Simply put, every worker’s time has value. A cornerstone of that promise is the Fair Labor Standards Act ’s (FLSA) requirement that when most workers work more than 40 hours in a week, they get paid more. The Department of Labor ’s new overtime regulation is restoring and extending this promise for millions more lower-paid salaried workers in the U.S.

Overtime protections have been a critical part of the FLSA since 1938 and were established to protect workers from exploitation and to benefit workers, their families and our communities. Strong overtime protections help build America’s middle class and ensure that workers are not overworked and underpaid.

Some workers are specifically exempt from the FLSA’s minimum wage and overtime protections, including bona fide executive, administrative or professional employees. This exemption, typically referred to as the “EAP” exemption, applies when:

1. An employee is paid a salary,

2. The salary is not less than a minimum salary threshold amount, and

3. The employee primarily performs executive, administrative or professional duties.

While the department increased the minimum salary required for the EAP exemption from overtime pay every 5 to 9 years between 1938 and 1975, long periods between increases to the salary requirement after 1975 have caused an erosion of the real value of the salary threshold, lessening its effectiveness in helping to identify exempt EAP employees.

The department’s new overtime rule was developed based on almost 30 listening sessions across the country and the final rule was issued after reviewing over 33,000 written comments. We heard from a wide variety of members of the public who shared valuable insights to help us develop this Administration’s overtime rule, including from workers who told us: “I would love the opportunity to...be compensated for time worked beyond 40 hours, or alternately be given a raise,” and “I make around $40,000 a year and most week[s] work well over 40 hours (likely in the 45-50 range). This rule change would benefit me greatly and ensure that my time is paid for!” and “Please, I would love to be paid for the extra hours I work!”

The department’s final rule, which will go into effect on July 1, 2024, will increase the standard salary level that helps define and delimit which salaried workers are entitled to overtime pay protections under the FLSA.

Starting July 1, most salaried workers who earn less than $844 per week will become eligible for overtime pay under the final rule. And on Jan. 1, 2025, most salaried workers who make less than $1,128 per week will become eligible for overtime pay. As these changes occur, job duties will continue to determine overtime exemption status for most salaried employees.

Who will become eligible for overtime pay under the final rule? Currently most salaried workers earning less than $684/week. Starting July 1, 2024, most salaried workers earning less than $844/week. Starting Jan. 1, 2025, most salaried workers earning less than $1,128/week. Starting July 1, 2027, the eligibility thresholds will be updated every three years, based on current wage data. DOL.gov/OT

The rule will also increase the total annual compensation requirement for highly compensated employees (who are not entitled to overtime pay under the FLSA if certain requirements are met) from $107,432 per year to $132,964 per year on July 1, 2024, and then set it equal to $151,164 per year on Jan. 1, 2025.

Starting July 1, 2027, these earnings thresholds will be updated every three years so they keep pace with changes in worker salaries, ensuring that employers can adapt more easily because they’ll know when salary updates will happen and how they’ll be calculated.

The final rule will restore and extend the right to overtime pay to many salaried workers, including workers who historically were entitled to overtime pay under the FLSA because of their lower pay or the type of work they performed.

We urge workers and employers to visit our website to learn more about the final rule.

Jessica Looman is the administrator for the U.S. Department of Labor’s Wage and Hour Division. Follow the Wage and Hour Division on Twitter at  @WHD_DOL and LinkedIn . Editor's note: This blog was edited to correct a typo (changing "administrator" to "administrative.")

Wage and Hour Division (WHD)
Fair Labor Standards Act
overtime rule

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COMMENTS

Delivery, Face and Brow Presentation
The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The most common ...
Delivery, Face Presentation, and Brow Presentation ...
Face Presentation: Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head). Causes: Face presentation can occur due to factors such as abnormal fetal positioning, multiple pregnancies, uterine abnormalities, or maternal pelvic anatomy. ...
Fetal Presentation, Position, and Lie (Including Breech Presentation
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head. In brow presentation, the neck is moderately arched so that the brow presents first. Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or ...
Face and Brow Presentation: Overview, Background, Mechanism ...
Face presentation is diagnosed late in the first or second stage of labor by examination of a dilated cervix. On digital examination, the distinctive facial features of the nose, mouth, and chin, the malar bones, and particularly the orbital ridges can be palpated. This presentation can be confused with a breech presentation because the mouth ...
Face and brow presentations in labor
The vast majority of fetuses at term are in cephalic presentation. Approximately 5 percent of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face ( figure 1A-B ), or brow ( figure 2) [ 1 ]. Diagnosis and management of face and brow presentations will be reviewed here.
Delivery presentations: MedlinePlus Medical Encyclopedia
Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery. Your baby must pass through your pelvic bones to reach the vaginal opening. The ease at which this passage will take place depends on how your baby is positioned during delivery. The best position for the baby to be in to pass through the ...
Management of face presentation, face and lip edema in a primary
Introduction. Face presentation is a rare unanticipated obstetric event characterized by a longitudinal lie and full extension of the foetal head on the neck with the occiput against the upper back [1-3].Face presentation occurs in 0.1-0.2% of deliveries [3-5] but is more common in black women and in multiparous women [].Studies have shown that 60 per cent of face presentations have one or ...
Managing Face Presentation In Delivery
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 ...
Face Presentation
1 Definition. A type of cephalic presentation in which the presenting part is the face, the area between chin and glabella. The incidence varies from 1 in 500 to 1 in 1000 deliveries. Primary face presentation is rare. Secondary face presentation caused by extension of head during labor is common.
Face presentation
presentation. breech birth, in childbirth, position of the fetus in which the buttocks or feet are presented first. About 3 to 4 percent of babies are in a breech presentation at the onset of labour. In nearly all other cases, babies born vaginally are born headfirst, since they are in a head-down position in the mother's uterus.
Diagnosis and management of face presentation
Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different from those ...
Face presentation Definition & Meaning
The meaning of FACE PRESENTATION is presentation of the fetus face first at the mouth of the uterus during parturition.
Face Presentation
Definition. It is a cephalic presentation in which the head is completely extended. Incidence. About 1:300 labours. Aetiology. Primary face: It is less common. It occurs during pregnancy. It is usually due to foetal causes which may be: Anencephaly: due to absence of the bony vault of the skull and the scalp while the facial portion is normal.
Labour and Delivery Care Module: 8. Abnormal Presentations and Multiple
8.1 Normal and abnormal presentations 8.1.1 Vertex presentation. In about 95% of deliveries, the part of the fetus which arrives first at the mother's pelvic brim is the highest part of the fetal head, which is called the vertex (Figure 8.1).This presentation is called the vertex presentation.Notice that the baby's chin is tucked down towards its chest, so that the vertex is the leading ...
Face Presentation Birth: Is it Dangerous? Birth Injuries Legal Help
Face Presentation Causes & Risk Factors. These conditions may increase the likelihood of a face presentation birth: A Very Big Baby (Fetal Macrosomia): Larger babies may have trouble fitting into the birth canal in the standard position, leading to alternative presentations. Prematurity: Premature infants are more likely to have non-standard presentations, including face presentation, because ...
Face Presentation
Face presentation may reflect a psoas/pelvic floor imbalance with a collapse in the front body. Free the piriformis, strengthen the buttocks, lengthen the hamstrings, squat for lengthening the pelvic floor, don't worry about strengthening the pelvic floor right now. Alignment, walking, stabilizing and lengthening will tone the pelvic floor.
Face Presentation
Face presentation is sometimes confused with breech presentation (because both are characterized by soft tissues with an orifice), which is why it is imperative that a very skilled physician be present during any potentially risky delivery or malpresentation. Diagnosis can be confirmed by an ultrasound, which reveals a deflexed/hyperextended ...
Powerful and Effective Presentation Skills
Effective communications skills are a powerful career activator, and most of us are called upon to communicate in some type of formal presentation mode at some point along the way. For instance, you might be asked to brief management on market research results, walk your team through a new process, lay out the new budget, or explain a new ...
17 tips for facial expressions in speeches and presentations
Practice your presentation and the things you have experienced with me in front of a mirror to concentrate exclusively on your facial expressions during a rehearsal. While practicing in front of the mirror, see if your facial expressions convey the mood you want to create. If your face isn't showing any emotion, stop, refocus, and do it again.
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Face-to-face (hereafter referred to as F2F) is amongst the most effective of all ways to present and provide information to an audience. The reason for the high degree of communicative efficacy of this mode of presentation is that it involves simultaneous transmission of multiple cues to the intended meaning, unlike many other modes of communication.
Perfect presentations: Face-to-face and virtual
Face-to-face meetings One of the key elements of a good presentation is maintaining an audible tone so that every audience member can hear you, no matter where they are in the room. This might sound obvious, but make a conscious effort to articulate the words as carefully and clearly as possible, maintaining an easily-audible voice-level ...
The Changing Faces of "Present" and "Presentation"
presentation [prĕz'ən-tā'shən] n. - the act of presenting. A presentation can be a gift, or it can be something like a lecture or a slide presentation. Evidence that the cropped form present for presentation may have already caught on with some users appears in these headlines used to introduce slide shows on the web: OM slide Present.
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