# Shoulder Dystocia - Why do these things continue to surprise me?



## Storm Bride (Mar 2, 2005)

I found this in a report on shoulder dystocia written by an OB:

Quote:

All-fours maneuver

In 1976, Ina May Gaskin described a maneuver for the resolution of shoulder dystocia that involves placing the gravid mother on her hands and knees. (Bruner, 1998) used this procedure in 82 deliveries complicated by shoulder dystocia and was able to resolve it in 68 cases (82%) with this maneuver alone. The average time needed to move the mother into this position and to complete delivery was reported to be 2-3 minutes. Unfortunately, there was no detailed description of fetal and maternal outcome in this report. Also, reports about this procedure have generally been in the midwifery literature, involving a patient population less likely to have epidural anesthesia and thus more likely to be fully mobile.

It may be that the "all-fours maneuver" is merely another means of changing the angle of the symphysis in relation to the stuck shoulder, akin to McRoberts maneuver. Since the all-fours maneuver involves a gravid woman at the end of her pregnancy, exhausted by a long labor, often with an epidural in place, being moved quickly out of her delivery position onto all fours on her bed or on the floor, the practicality of this maneuver for a general obstetrical population is open to question. Unless more data is presented as to its efficacy and utility, it cannot be considered a standard procedure for the resolution of shoulder dystocia.
Why am I surprised? The guy goes on to list several protocols for managing shoulder dystocia...which maneuvers should be used first, second, etc. Every one of those protocols includes episiotomy and/or symphysiotomy. How on earth can any medical professional read something like the above, and not even begin to think that _maybe, just maybe_ the epidural and "delivery position" are part of the freaking problem???


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## Seie (Jun 9, 2005)

:eeek

OMG!









Gosh! Now I really really know why I will NOT go to hospital to have babies


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## Storm Bride (Mar 2, 2005)

This guy really likes the McRoberts maneuver and suprapubic pressure...so if you have a problem with shoulder dystocia, you can have your legs "flexed" so that your thigh is pushing into your abdomen (under anesthetic...pulled hamstrings, anybody??) and/or someone's fist pushing into your pelvis to move your baby's shoulder. These two maneuvers combined have a "50-60%" success rate...yet they're preferable to suggesting that a woman get on her hands and knees, with a cited success rate of 82%????


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## liseux (Jul 3, 2004)

That is crazy, but you have to remember that if most women who labor in a hospital do have an epidural, then the Gaskin manuever is going to be a challenge.

I just wrote about this in the midwife under investigation thread, but I know a lot about shoulder dystocia because I lost my 2nd baby to it. Its been 3 years and now I think about many other aspects of my son rather than what happened to him, yet I feel I have to chime in when its mentioned, because I read everything I can about it.

The Gaskin maneuver is not 100% successful though, it didn`t work for us and it was the first thing tried, at home. It does bother me though that hospital "emergency drills" for s.d. rarely include it.


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## Noelia430 (Aug 6, 2003)

Well, it's pretty obvious that a woman with an epidural is not going to be able to hold herself in the hands and knees position, but what about those that DON'T have an epidural? He writes it off completely like there are people that never have natural birth unless they are at the Farm in TN.


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## goosysmom (May 28, 2005)

I had this manuver when I had my dd.....luckily my mw knew about it and I was exhausted after hours of back labor.....I didn't know anything was wrong bc my MW knew I would've flippped out big time so she just suggested we change postions....since the hands and knees thing just wasn't working for us.....It was my first baby so I didn't know that someone pushing on your stomach wasn't normal per se but she's here and she's beautiful.....

It wasn't super successful for us but it helped lessen the dystocia so it was minor...I didn't know anything was wrong until they layed her on me for mere seconds and cut her cord (birthplan of hour to do anything and let cord stop on it's own out the window) and NICU rushed in but I had her 20 mi nutes later...Her first agpar was 1 and her second went to 8 so......If my MW hadn't tried that I know we would've lost her and my heart goes out to you liseux bc you did lose your dear one.....the nurse on hand didn't know what she was doing until the MW yelled at her.....


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## pamamidwife (May 7, 2003)

really, the all fours is an upside down version of McRoberts. sadly, with most women receiving epidurals, it isn't logical to attempt to move a woman numb on a narrow bed.

what i'd like to see is them stopping the practice of cutting an episiotomy for SD - and forced pushing.


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## CalebsMama05 (Nov 26, 2005)

after my son was born the nurses were looking at me like i was a freak cuz we had no problems whatsoever with fit through the pelvis...the only problem i had was being on my back so it was difficult to push him out. he was 9lbs 10oz. I hope that if i DID have that problem i would be allowed to use the hands & knees position. sheesh. that makes me mad he just wrote it off because it would be *difficult* (notice he didnt say impossible...the mother would just need supported!) for a woman with an epidural to manage it..and i know for ME the epidural did nothing for my legs or vagina...it just numbed my back and stomach. I certainly felt when he snapped my tendon in the side of my vagina (ouch!)


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## CalebsMama05 (Nov 26, 2005)

Quote:


Originally Posted by *CalebsMama05*
after my son was born the nurses were looking at me like i was a freak cuz we had no problems whatsoever with fit through the pelvis...the only problem i had was being on my back so it was difficult to push him out. he was 9lbs 10oz. I hope that if i DID have that problem i would be allowed to use the hands & knees position. sheesh. that makes me mad he just wrote it off because it would be *difficult* (notice he didnt say impossible...the mother would just need supported!) for a woman with an epidural to manage it..and i know for ME the epidural did nothing for my legs or vagina...it just numbed my back and stomach. I certainly felt when he snapped my tendon in the side of my vagina (ouch!)

just reread that and i'm not sure now it was a tendon LoL maybe it was just popped out of where it was supposed to be? I don't have any lingering pain...I'll have to ask about that...


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## Storm Bride (Mar 2, 2005)

I've never had an epidural, but I can certainly understand that it would make it much harder to get up on hands and knees. I also know the hands and knees position isn't 100% successful...almost everything I can find seems to suggest something around 80% or so. There are no guarantees in life...including birth.

What gets me is the whole tone...it's better to go straight to an episiotomy than even _try_ the hands and knees. It's better to hand out epidurals like candy than make sure women know that the limits on their mobility also carry limits on the ability to address possible problems. The report listed three different protocols that have been suggested for how to deal with SD. I can't believe _none_ of them suggested hands and knees at _any_ stage. It's mind-boggling to me that episiotomies and symphisiotomy (sp?) are considered _more_ acceptable than getting someone on their hands and knees!

liseux: Thanks for your input to my "vent". I'm so sorry for your loss.


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## Snowdrift (Oct 15, 2005)

Quote:


Originally Posted by *Storm Bride*
Why am I surprised? The guy goes on to list several protocols for managing shoulder dystocia...which maneuvers should be used first, second, etc. Every one of those protocols includes episiotomy and/or symphysiotomy. How on earth can any medical professional read something like the above, and not even begin to think that _maybe, just maybe_ the epidural and "delivery position" are part of the freaking problem???

So, yeah. I amnever gonna go to a hospital to have a baby. I just looked up 'symphysiotomy' and was thoroughly grossed out that this is considered an option before changing position. I've heard women mention being 'cut open from front to back' and wondered what they meant. This guys's 'recommended' protoccols are *beyond* barbaric!


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *pamamidwife*
really, the all fours is an upside down version of McRoberts. sadly, with most women receiving epidurals, it isn't logical to attempt to move a woman numb on a narrow bed.

what i'd like to see is them stopping the practice of cutting an episiotomy for SD - and forced pushing.









I've had spinals...I hate the numbness so much. I've never experienced any amount of pain that would be preferable to losing communication with half of my body. The McRoberts doesn't seem (from what I've read) to have the same success rate as the "Gaskin". And, getting on hands and knees isn't likely to strain anything...I can easily imagine pulled hamstrings, or at least pain in the hamstrings, from the McRoberts.

One of the protocols listed "generous episiotomy" as the second option - right after the McRoberts. Nice to know how important an intact perineum is to our "care" providers. uke

I'm definitely going for a HBA3C, if I have another baby...


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *tie-dyed*
This guys's 'recommended' protoccols are *beyond* barbaric!

They're not his...one of them is ACOG's. I can't remember where the other two were from.


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## CalebsMama05 (Nov 26, 2005)

Quote:


Originally Posted by *Storm Bride*
It's better to hand out epidurals like candy than make sure women know that the limits on their mobility also carry limits on the ability to address possible problems.

not to mention the fact that it limits your birth positions, causes problems etc etc. I'm hoping and praying I won't need one this time around...last time I had to deliver flat on my back and ended up with an episiotomy.


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *Storm Bride*
One of the protocols listed "generous episiotomy" as the second option - right after the McRoberts. Nice to know how important an intact perineum is to our "care" providers. uke .

'

I know! It's a BONE dystocia, not a TISSUE dystocia! C'mon!

Silly sOBs!


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## liseux (Jul 3, 2004)

I have to add that it IS totally a bone issue and the bones sometimes don`t budge, but, when they talk about doing a huge episiotomy its often just to get at the baby`s clavicle so it can be broken. That`s whats tried when nothing else works & before they go for the Zavanelli mauver, emergency Csec after pushing head back in. That last one rarely works. Doing an epis at the first sign of s.d. is crazy.


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## Mearaina (May 3, 2005)

I had shoulder dystocia when I was born (my mom had no drugs but was in the "typical" flat on her back postion). I couldn't move my arm away from my body for 6 weeks and still have limited movement. My doctor (another one) thinks my right shoulder (not shoulder - halfway between my shoulder and neck - is that my clavicle?) was once broken and never healed right. My shoulder is sloped and I was told my middle deltoids never developed. My mom says I was sent to get tests on my nerves but no one bothered to do an x-ray. I am grateful to be alive but a little annoyed that no one bothered to do an x-ray....

Oh, and when I was pg with dd1 the OB I was going to tried to talk me into an elective c-section because of my history (this was at 20 wks) and said stuff like, "it runs in families - do you want your baby to be paralyzed?). Needless to say, I stopped going there...


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## MamaTaraX (Oct 5, 2004)

The only thing I can agree with is that epidural moms are pretty hard to get into all-fours position. McRoberts is effective and works great for epidural moms. Episiotomies don't do anything for shoulder dystocia since the shoulders are usually stuck behind the pubic bone. Symphisotomy (sp?) is "better" than episiotomoy for SD ((better in quotes because something like that isn't really better than anything) Gaskin Manuever is most effective and in a natural-birthing woman, more effective than McRoberts. So many care providers (read; doctors/OBs) see drugged moms though that they don't even know to do it, so McRoberts it is.

Namaste, Tara


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## member234098 (Aug 3, 2002)

I am slow today, so tell me what are:

Quote:

...symphysiotomy...

Quote:

...McRoberts manuever....
?


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## candipooh (Jun 22, 2004)

Quote:


Originally Posted by *Storm Bride*
I found this in a report on shoulder dystocia written by an OB:

Does he go on to say how complacated and dangerous the other manovers are? SOme how I dought it. But he is quick to dis on the Gaskin manover.


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## Storm Bride (Mar 2, 2005)

Miriam: McRobert's maneuver is when the doctor flexes the mom's legs up...so that her thigh is pressing against her abdomen. It looks hideously uncomfortable to me, and I have to think there's a definite risk of strain, as the mom having it done is often (usually) under an epidural. The OB who did up the report cited it as having a 50-60% success rate. Apparently, they'd rather cut women up and break the clavicles of babies than try the hands and knees approach, if McRoberts doesn't work.

symphisiotomy...I can't really describe it. I read a description, and I followed it fairly well, but I couldn't express it myself, Maybe try a google search. It's an unpleasant procedure.


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## liseux (Jul 3, 2004)

Symphysisiotomy is not even taught in medical school anymore, it is a very old solution that kind of involves splitting apart tendons in your pubic symphysis area to make more room in your bones. It is super hard to do & most women who have had it done have trouble walking for the rest of their lives. Thats why it was so ludicrous that Abby on ER did one in a s.d. delivery last year. Its just not realistic to do it safely and quickly enough.

Thank you Storm Bride







to you too.


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## doula and mom (Nov 28, 2005)

Oh, for the love of....!







:

Reason #35256 why I plan to have #4 at home -- not that I'm pregnant now, but it's the only way I'll deliver again. I had #3 at a birthing center, and it was nice but it still wasn't the same.


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## member234098 (Aug 3, 2002)

I found a support group for it, but I was unable to download it.

[DOC] The NWCI - who we are and what we do
File Format: Microsoft Word 2000 - View as HTML
Launch of Survivors of Symphisiotomy self help group May. Survivors of
Symphisiotomy (SOS) is a group of women who approached the NWCI for a meeting space ...
www.nwci.ie/documents/annrep03.doc - Similar pages

Thank you Storm Bride.

The symphisiotomy was done over a hundred years ago and it often left women crippled.


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## Storm Bride (Mar 2, 2005)

I'd thought from things I read here that it wasn't used, anymore. But, it was definitely mentioned in one of the protocols this guy referenced. Maybe I'll try to find the year...


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## Storm Bride (Mar 2, 2005)

Oh, blech...the report is copyrighted 2004, and this is what he says about sympisiotomy:

Quote:

Symphysiotomy is a procedure that had been performed in the past and is now performed only in areas remote from the ability to perform Cesarean sections on a rapid basis. However _it has enjoyed something of a renaissance in the literature in recent years_.
The italics are mine. I think I'm going to puke...again.


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## Peppamint (Oct 19, 2002)

OMG... what a male jerk (the author of the article). Sorry, but I don't want an OB- particularly a male one! Then again, I saw a really bad female OB once too so it goes both ways I guess.

My friend JUST gave birth about six weeks ago and had SD. Hosp. birth no epidural. She was most comfortable laboring and pushing on her side but they kept rolling her onto her back and ended up holding her legs back while the doctor put his hand _inside_ along baby's back to "help" him out and a nurse pushed the top of her uterus.







There was some meconium so they wanted baby out asap. Her third baby- I'm sure the Gaskin would have worked for her.







In the process, she ended up with a small tear and a small uretha tear and her tailbone was broken. Surprisingly







the OB recommends a c/s next time.

I had never heard of symphysiotomy before. YIKES.


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## tinyshoes (Mar 6, 2002)

Enjoying a renaissance...indeed!!!!!

I learned what a sympisiotomy is when what's-her-face did one on ER last year. Ga-ross.

ER is sooooooooooooooooooooooo special. Mostly, I love how _all_ sorts of OB cases are *not* sent up to the OB floor, but rather handled by the bafoons in the ER. Whatever. That show is sooooooo fakey.







:


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## JanetF (Oct 31, 2004)

I've seen sObs and medwives discussing how breaking the baby's clavicle is no biggie. But then people who think cutting a perineum protects it from damage are likely to have all manner of weird ideas in their heads...


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## MamaTaraX (Oct 5, 2004)

There is a lay midwife in my state that is known to do symphisotomy on women, in rare cases. She works in rural areas with women typical of very rural areas. She may not be in this state anymore, I'm not 100% sure, but I think she is. Don't ask her name, I don't remember. What I do remember is a doula coming from a birth with her absolutelyhorrified to watch her perform this...on a full concious, undrugged woman. And it's not the first time she's done it. I felt awful for everyone invloved,but especially the poor mother. One of the reasons it isn't done so much these days is because of access to c/s, but that's based on the assumption that most women arebirthing in a hospital where a stat c/s is a readily available option. I would much rather take my chances having someone break the baby's clavicle than have someone hacking at my pubic bone with a knife. And I think I'd rather have a c/s too... symphisitomies are nasty, painful, often crippling or disfiguring. I was just describing it to my husband a day or so ago and he was completely horrified.

Namaste, Tara


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## mwherbs (Oct 24, 2004)

I have a few comments for this issue- Mc Robert's although somewhat similar as far as bone placement- is different as far as gravity and how it is acting on a baby's body-- but it is also true that it maybe one of the few options available in a hospital with an epidural or other spinal anesthesia in place.
as for symphysisiotomy -- it is the cutting of the cartilage at the symphysis- some women have this tear naturally- and although not common practice here it may be in certain rural areas in 3rd world countries where it can mean saving a mother's and or a baby's life. I would also say that it does not necessarily have to be debilitating as it was once though to be and is not major surgery like a c-section is-- and does not carry the same life risk or danger a c-section does- I knew a very sweet old missionary doctor who had done 1000's of births on missions and she had learned this surgery- if done well and mom is bound and cared for after the birth, the cartilage grows back wider so it can be a cure for some contracted or small pelvises so mom would not have trouble during subsequent births. My old midwifery partner had a natural spreading of her symphysis during each of her pregnancies and spent about 5 months on crutches each time but postpartum healed up after about 6 weeks. I am not advocating this over other manuvers for SD but before c-sections -maybe it isn't so barbaric as we are lead to believe by the critics.


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## turtlewomyn (Jun 5, 2005)

I just looked up symphysiotomy. OMG! It looks horrible.
http://www.who.int/reproductive-heal...y_P53_P56.html

I checked out this thread because I had an "elective" c/s 10 weeks ago due to suspected fetal macrosomia which the medwife/doctors felt would lead to SD. I need to quit looking at this stuff or I will never get pregnant again.


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## Peppamint (Oct 19, 2002)

OMG... that was a little too detailed I think. uke


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## mwherbs (Oct 24, 2004)

thanks for that post--- I thought is was very clear illustration of what is done and the long term pain on walking was 2% this is not too bad


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## Storm Bride (Mar 2, 2005)

I'm not really objecting to any of the strategies for dealing with shoulder dystocia. I just found that guy's attitude about it really scary. Dismissing the hands and knees thing, but being willing to do all these other things just strikes me as really bizarre. Even if all fours isn't feasible for moms with epidurals, the epi rate isn't _quite_ 100% yet. Why do they put invasive and uncomfortable procedures ahead of the all fours??


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## mwherbs (Oct 24, 2004)

yep storm bride on that end of it I agree with you- I think that since it wasn't invented by a doc it isn't going to be adopted easily--- I also think that at panic button time is not when they are going to try anything new- now if they were to see or assist someone who was doing it already they would learn from that experience and it could come into the realm of something to try---


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *Storm Bride*
I've had spinals...I hate the numbness so much. I've never experienced any amount of pain that would be preferable to losing communication with half of my body. The McRoberts doesn't seem (from what I've read) to have the same success rate as the "Gaskin". And, getting on hands and knees isn't likely to strain anything...I can easily imagine pulled hamstrings, or at least pain in the hamstrings, from the McRoberts.

One of the protocols listed "generous episiotomy" as the second option - right after the McRoberts. Nice to know how important an intact perineum is to our "care" providers. uke

I'm definitely going for a HBA3C, if I have another baby...

Amen sister! You also totally crack me up with your comment about the episiotomy! You are so right, after all, aren't they surgeons, first? They *have* to cut, cuz that is what they were trained to do! Funny how if you are trained to do something, all of a sudden you see the need to do it, even if the need wasn't there 15 min before!







:


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *turtlewomyn*
I just looked up symphysiotomy. OMG! It looks horrible.
http://www.who.int/reproductive-heal...y_P53_P56.html

I checked out this thread because I had an "elective" c/s 10 weeks ago due to suspected fetal macrosomia which the medwife/doctors felt would lead to SD. I need to quit looking at this stuff or I will never get pregnant again.

Quite an interesting site. Now who is gonna pay for a 5 day hospital stay in a poor country?(WHO primarily works with poorer/developing countries)
Now if you had been at home, there is a good possiblility you would have been able to birth the baby just fine. The pubic bone is designed to separate normally for a few seconds as the baby's head goes under and you don't have the debilitating aftereffects of surgery!!









I am sorry you had a section, but the good news is you are educating yourself, and you will be a far more discriminating consumer next time!








PS, I worked at a birth a few weeks ago, and we did Gaskins manuver when I saw how big the baby's head was- he rotated fine and came right out- he weighed well over 11 lbs!


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *mwherbs*
thanks for that post--- I thought is was very clear illustration of what is done and the long term pain on walking was 2% this is not too bad

hi. I have a question. Have you ever seen a SD that was not being resolved by Gaskins and corkscrew manuver, and what was able to be done about it? I have only seen one SD, so am curious.(I think it was a mild one)


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *mwherbs*
yep storm bride on that end of it I agree with you- I think that since it wasn't invented by a doc it isn't going to be adopted easily---

When I found the report, I read the quote at the beginning of the thread to dh. His only comment was "NIH". I asked him what that meant, and he said "not invented here". I think that really sums things up.


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *cathicog*
hi. I have a question. Have you ever seen a SD that was not being resolved by Gaskins and corkscrew manuver, and what was able to be done about it? I have only seen one SD, so am curious.(I think it was a mild one)

Yes and you keep moving-- like navelgazing said lunge- squat, standing, hands and knees again
If you cant get your hand inside you cant corkscrew-- you can however try to get the baby to turn from the outside


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## Mama Dragon (Dec 5, 2005)

Quote:


Originally Posted by *turtlewomyn*
I just looked up symphysiotomy. OMG! It looks horrible.
http://www.who.int/reproductive-heal...y_P53_P56.html

I checked out this thread because I had an "elective" c/s 10 weeks ago due to suspected fetal macrosomia which the medwife/doctors felt would lead to SD. I need to quit looking at this stuff or I will never get pregnant again.

OMG. I'm in utter SHOCK. I showed this to DH and he said that's nearly the same thing he does when butchering a deer or whatever. He also said if any doctor tried to do that to me, that the doctor...well, I'll just say he wouldn't allow it to happen. That's hideous.

As for the original article - it does surprise me, but in the same way that so many other "common knowledge" things are swept under the rug. Pathetic and sad!


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## MamaChel (Mar 28, 2003)

It seems to me that physicians have difficulty with anything they cannot directly control. Patients are encouraged to have an epidural to tie them to the bed and monitors so the physician can have better control over the process, c-sections are often recommended based on the physician's desire to control the process and outcome, interventions are used with increasing frequency based again on a dr's need for control. (AROM, pitocen, etc) The hands and knees maneuver would put 'control' of the birth back in the mother's body by requiring some participation from her in terms of changing positions where the other options seem to be more like things done to the mother while the physician maintains control. There are no guarantees in anything and one would like to hope that a physician would be open to new ideas that may assist in preserving the health of their patient. It just seems like physicians are more interested in maintaining strict control over everything.

A physician's mishandling of SD almost cost my SS and his mother their lives. We are lucky in that SS is "only" perminantly disabled (total hearing loss in L ear, significant loss of movement and use of L arm/shoulder and unknown behavioral, learning and emotional disorders) but alive. the physician in charge took SS by the arm and PULLED to get him out of the birth canal after a generous episiotomy was performed. No other methods were attempted and c-section was not considered an option.


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## dynamicdoula (Jun 11, 2004)

I've attended an SD birth and it was by far the most traumatic birth I've attended in three years. She was pushing on her back (no epidural) and I really believe that contributed largely to her SD, along with the 10#13oz little man she pushed out, after a 4th degree episiotomy, suprapubic pressure, and McRoberts.

After the birth I wrote a two page letter to the hospital, nursing director and doctor sharing with them about the Gaskin maneuver and Ina May's website. No response from them (not that I anticipated one), but at least it was written, and hopefully they'll consider it.

For the record, the photo from the birth I attended is on the site that I think the OP is quoting - www.shoulderdystociainfo.com. Here's the link to my photo. (Graphic)


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## sevenkids (Dec 16, 2002)

Quote:


Originally Posted by *cathicog*
hi. I have a question. Have you ever seen a SD that was not being resolved by Gaskins and corkscrew manuver, and what was able to be done about it? I have only seen one SD, so am curious.(I think it was a mild one)


Yes, two of the worst SD I have ever seen were 13 minutes and 14 minutes. Ironically, both were pushing in a squat, slow descent of head, classic turtling of the head. It was easy to get them into H&K's since they were squatting on the floor. Didn't work, up into a lunge with one foot on bed, didn't work, lunge other foot, didn't work, call EMT's at 4 minutes, back into H&K's on bed, didn't work, Screw of Woods in H&K's, didn't work, side lying, didn't work, Screw of Wood's and Rubin's in McRobert's, didn't work, back to side, back to H&K's. Finally resolved with McRobert's and supra pubic. (Both babies are fine, thank the birthing goddesses, with only transient brachial plexus injuries that resolved spontaneously by 6 weeks)

The thing with shoulder dystocia is there's no magic manouvre that resolves it, not H&K's, not McRobert's. It's the series of motion that flexes and deflexes the mother's pelvis that eventually gets the baby to rotate the anterior shoulder out from under the pubic arch or the posterior shoulder out from the sacrum. Certainly if she's in a position that isn't working you move her ASAP into another. Don't get stuck in the mindset that H&K's is going to resolve all SD's or that McRobert's will do the same.

McRobert's actually does increase the AP diameter of the pelvis _maybe_ allowing the attendant to free the anterior shoulder. H&K's throws the bulk of the baby's body weight over the pubic arch _maybe_ allowing the attendant to free the posterior shoulder.

Just want to add, I never, ever put downward traction on a slow coming head if it looks like shoulders are going to get stuck. Don't want to jam those shoulders in any further.


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## liseux (Jul 3, 2004)

Originally Posted by cathicog
"hi. I have a question. Have you ever seen a SD that was not being resolved by Gaskins and corkscrew manuver, and what was able to be done about it? I have only seen one SD, so am curious.(I think it was a mild one) "

Yes, mine. I posted about it at the beginning of the thread.
I was in full squat the entire time, never once laid down in the entire 12 hour labor. None of the maneuvers worked and all were tried, esp. the Gaskin. In the end, it took breaking his arm to get him out. And since we already discussed that this is a bone issue, not a skin issue, his bones were extremely strong and this was very hard to do.

Sometimes I think that maybe on the Farm, when they did their studies on sd and Gaskin maneuver, maybe they never saw a true case of sd. Perhaps they only saw mild cases and "sticky" shoulders. I have heard many inexperienced mw`s say they can "always" resolve sd with h&k positioning. Maybe they`ve never been tested. Its like going to the beach and seeing a big wave. You may even think you`ve seen such a big wave that it was a tsunami & you got away. But then, maybe you`ve never seen a real tsunami, a real force of nature where you couldn`t escape. That`s how I think of severe sd.


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## Storm Bride (Mar 2, 2005)

liseux: You could be right, but the author of the quote in my OP also mentioned another study. That study only involved 82 women, but also showed an 82% success rate. 82% isn't 100% - not by a long shot. But, that same OB only cited a 50-60% success rate for the McRoberts. They don't even want to try hands and knees...probably because they'd have to cut back on monitoring and epidurals if they want women to be mobile. I think it's obvious from your experience and a couple of others mentioned that there is no sure-fire way to deal with SD. But, it's still mind-boggling that something as straightforward and with as high a success rate as hands and knees isn't even being tried!


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## turtlewomyn (Jun 5, 2005)

Quote:


Originally Posted by *cathicog*
Quite an interesting site. Now who is gonna pay for a 5 day hospital stay in a poor country?(WHO primarily works with poorer/developing countries)
Now if you had been at home, there is a good possiblility you would have been able to birth the baby just fine. The pubic bone is designed to separate normally for a few seconds as the baby's head goes under and you don't have the debilitating aftereffects of surgery!!









I am sorry you had a section, but the good news is you are educating yourself, and you will be a far more discriminating consumer next time!








PS, I worked at a birth a few weeks ago, and we did Gaskins manuver when I saw how big the baby's head was- he rotated fine and came right out- he weighed well over 11 lbs!









Thanks, the sad thing is that I thought I was educated this time, I should have done better research on the medwife and the practice she was in. My doula knows a good VBAC doctor for next time. I don't think I have the guts to do a HBAC, and I doubt DH would be supportive of that.


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## liseux (Jul 3, 2004)

"But, it's still mind-boggling that something as straightforward and with as high a success rate as hands and knees isn't even being tried!" Stormbride

StormBride, I couldn`t agree more. The thing that probably makes this the most helpful position for most people is the effect of gravity. I think what they do with s.d. in the hospital is pretty scary. I know its not uncommon to see uterine rupture with severe s.d. in the hospital because one of the first things they do is jump on the woman`s abdomen for subrapubic pressure. I think midwives actually have an advantage in most s.d. deliveries.


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *dynamicdoula*
I've attended an SD birth and it was by far the most traumatic birth I've attended in three years. She was pushing on her back (no epidural) and I really believe that contributed largely to her SD, along with the 10#13oz little man she pushed out, after a 4th degree episiotomy, suprapubic pressure, and McRoberts.

After the birth I wrote a two page letter to the hospital, nursing director and doctor sharing with them about the Gaskin maneuver and Ina May's website. No response from them (not that I anticipated one), but at least it was written, and hopefully they'll consider it.

For the record, the photo from the birth I attended is on the site that I think the OP is quoting - www.shoulderdystociainfo.com. Here's the link to my photo. (Graphic)


kristina, what is shocking about that picture is the provider's hands are UNDER the baby's head, thereby pushing it UP - further impacting the shoulder against the pubic bone!


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## Storm Bride (Mar 2, 2005)

Having had three c-sections, the description of suprapubic pressure made me cringe! And, I'd bet a doctor who didn't want me to VBAC in the first place wouldn't hesitate to use it!


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## Storm Bride (Mar 2, 2005)

Kristina: Yes - that's the site. I can't believe I didn't even notice the "dynamicdoula" photo credit!


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