Face presentation is an uncommon presentation at birth. The identification of a fetus with a hyperextended neck on ultrasound antenatally warrants close scrutiny for other anomalies. A fetus who presents as a face presentation in labor that is of average estimated fetal weight and has no anomalies in a woman with an adequate pelvis is likely to deliver vaginally if the mentum rotates to anterior prior to birth. Persistent mentum posteriors are best left alone without manual intervention and delivered by cesarean section. Prolonged labor is common. The clinician must be patient and closely monitor descent and rotation. Infants born as face presentations should be assessed closely after birth for normal respiratory transition and the presence of significant pain warranting analgesics.