Brow Presentation – An Overview

Pregnancy is a beautiful experience that is also fraught with a host of complications and risks. One of them concerns the normal orientation of your baby inside your uterus, which is essential for a smooth delivery. This article will explain all about abnormal forehead presentation and its associated causes, complications, diagnosis, treatment and precautions.

What is Brow Presentation?

Babies assume a fixed position in the uterus, that is with their chins tucked firmly into their chests. This position is ideal to exit the uterus smoothly. However, in some cases, the baby’s head and neck will extend backwards away from their chest. This is known as a brow presentation or forehead presentation. It is an extremely rare condition, occurring once in 1500 births. Brow presentation might obstruct vaginal births from occurring as there is less space for the baby to drop down towards the pelvic girdle. However, if brow presentation occurs early in labour, there is still time for them to flex their neck back to the right position. If not, labour might be hindered, causing stress for both, the mother and the baby. In these instances, your doctor might recommend a caesarean section. A brow baby tends to occur in women pregnant for the second or third time, or due to physical defects like an abnormally developed spine.

How Can You Get to Know if Your Baby is in This Position?

Brow babies are rarely detected before labour begins, but around half of them will shift to a face first or crown first presentation suitable for delivery. A brow presentation delivery will take much longer than normal, which is usually when the condition is discovered.

What Are the Causes of Brow Presentation?

There are several potential reasons for your baby to assume this orientation. Some of them are:

• Foetal Size: Babies born preterm, or with low birth weights, raise the likelihood of them presenting brow first. This is also observed in large babies, who usually flex their head outwards rather than in towards their chest. Brow presentation can also be caused if your pelvic girdle and your baby’s head are disproportionate to each other.
• Polyhydramnios: Polyhydramnios is the condition in which there is too much amniotic fluid in your uterus. Thus, it might be tricky for your baby to fix their heads in the correct position.
• Multiple Pregnancy: Carrying twins or more in your womb decreases the amount of space available, making your babies take alternative positions to fit properly.
• Maternal Defects: If your pelvis is not the right shape and size, it might be difficult for your foetus to assume normal presentations. The most common cause of brow presentation is the triangle-shaped android pelvis and the atypically small contracted pelvis. Another maternal defect is a lax uterus, which is not firm enough to hold the baby in place, resulting in different presentations.
• Foetal Defects: If your baby has conditions such as anencephaly and hydrocephalus, their abnormally large heads will not be able to take the right position.

How is the Diagnosis Made?

to diagnose brow presentation, an experienced doctor will be able to help. Ultrasound scans are compulsory for monitoring the situation. Your doctor might even conduct a digital examination to check the orientation of the baby’s facial features. If they find that the baby’s head does not rotate enough for a natural birth, they might recommend a caesarean section.

Complications of Brow Presentation Delivery

Several risks come with brow presentation birth. Some of them are:

• Labour time might be extended as the baby would have a hard time getting past the pelvis.
• Forceps might be required, which could cause cranial damage
• Baby’s head shape might be altered due to difficulty while moving through the birth canal
• Baby may go through stress during delivery as it would be difficult birth and may require a caesarean.
• Injuries may occur to the baby’s spinal cord due to trauma
• Increased risk of cerebral haemorrhage in the baby as the head may take in damage

Alternative for Labour During Brow Presentation

As explained already, a baby in brow presentation might not have enough space to move downwards towards the cervix. If this happens, there are a few methods your doctor might implement to reduce the complications of natural birth. These methods require medical skill and enough space within the cervix to be attempted.

• Ventouse Birth: In this case, your doctor will use a small vacuum extraction device known as a ventouse to pull the baby’s head towards their chest. This method can be used even after you have begun to push.
• Manual Rotation: After the cervix undergoes complete dilation, your doctor might attempt to move the baby’s head into the correct position using their hands.

Precautions to Take Before and After Labour

As there are several complications linked with brow presentations, here are some precautions for you to take before and after labour to have a successful pregnancy.

• Choose a doctor who is accomplished in obstetrics and gynaecology, so they are experienced in dealing with any potential outcome.
• Visit your doctor regularly, especially at the end of your third trimester.
• If you have been diagnosed with brow presentation, do not hesitate to go for a caesarean if strongly recommended by your doctor, as it dramatically reduces the risks involved.

How Will Brow Presentation Affect Your Baby During Labour?

Babies might end up with abnormally shaped heads if they go through vaginal birth with a brow presentation. However, as their heads are malleable, they will return to normal shape in a few days. Extended labour might cause stress in your baby who has been stuck in an uncomfortable position the whole time. This might also lead to vertebral problems, so consult a paediatric osteopath if you are concerned.

Brow presentation can happen to anyone, so not encountering it in your first pregnancy does not mean you will not see during later pregnancies. Consume a balanced, nutritious diet, stay hydrated and get enough sleep. Avoiding tension and anxiety will help you stay strong for when your baby arrives.