shoulder dystocia

[tunneldiver]

Here is some good info on changing positions during birth to deliver a baby if shoulders become "stuck". Ina Mae Gaskins book "Spiritual Midwifery" has some good info on homebirth and midwife prenatal care.

http://www.thefarm.org/lifestyle/dystocia.html

[RESQDOC]

Dystocia is the pits, second only in my OB nightmares to an unrecognized breech delivery. This article is quite good and should be reviewed by all. They do seem to be under the impression though that no one has ever heard of the “all fours” position, which is incorrect. I was trained on this both for dystocia and as an alternate delivery position, and have had a couple of moms deliver in a modified forward leaning variation, by their choice. Works fine. The all fours is routinely taught in the Advanced Life Support Obstetrics class as well. The traditional flat on the back position is for the convenience of the doctor, not the mom, although most of the time it works just fine. If problems however don’t be afraid to change or vary the mother’s position, and they will often tell you what they think the best position will be. In any dystocia situation knowing what not to do is at least as important as what to do.

The McRoberts “knees high & wide” is very helpful (also very safe and easily remembered – stick this in your mental toolbox), with mom holding her knees up if possible – sometimes she needs help with this. Suprapubic – NOT fundal – pressure can be helpful, as can various rotational maneuvers. Although not mentioned in the article, an episiotomy can be done as well, although I prefer to avoid this as much as possible, as they are rarely necessary. Some of the midwife community takes the position that an epis is never needed under any circumstance, but I do not agree with that – but again, it is rarely necessary and should never be done as a matter of routine, IMO. Interestingly, they do mention symphysotomy, which involves cutting up through the pubic symphysis ligaments to allow the pelvis to spread a bit more. Done at times in remote situations when c-sections are not available. I would do an epis long before I considered this. There is a bit more to the Zavanelli Maneuver than described in this article, and it has been done quite a bit in recent years with good success, if you have c-section capability of course.

[Darkangel]

I think it would be nice if the OB Docs would try the different positions. But I have never seen this happen..... If its a difficult delivery, the first thing the OB Docs do is the episioyomy, followed by suction cup on the head or forceps. If its a dystocia, they will break the childs clavicals, and attempt delievery while the emergency section room is being set up. Most of our patients get epidurals, and I can dose a epidural with 3% nesacaine quick enough to do an emergency section in the patients room, If I had to be done.
I've only seen one patient that actually had a symphysotomy with a previous child. WOW, talk about a skidish women.
This is a very good board, very enjoyable.....thanks for the interesting topics
DA