MIdwives, shoulder dystocia, and forceps....

[tilly2321]

Hi there,
Kind of an odd post, I know. i am definitely going to deliver in a hospital since I had a postpartum hemmorrhage (this is not up for debate),but I am trying to figure out which hospital and it is kind of a big decision since DH and I are definitely moving next June. Depending on when we TTC will determine what hospital we will go to (the one here in VA or another on the east coast) Anyhow, our previous hospital had 24 hour in house anesthesia and doctor backup. I had to use the doc backup since I was passed out in a pile of blood and had to be revived. So, the hospital here doesn't have either of those things "in house" and has to call out for them. I delivered a huge baby (almost 10 pounds) and also worry about shoulder dystocia. If my baby is stuck and there isn't a physican in house and the "gaskin" maneuver doesn't work, can a midwife use the forceps and/or vacuum. Yes, I know I am freaking out and not trusting birth, but I never thought I would hemmorrhage either. I think when a woman feels safe, she will birth better and i want all of my bases covered. Did any of you have shoulder dystocia with a midwife and how was it handled??

[pamamidwife]

First, the Gaskin maneuver does work.

Forceps and vacuum extractors cannot help with shoulder dystocia. Both use force on the baby's head and with SD, the head is out. It's the shoulder that is caught behind.

The best advice? Birth upright in a squat or on all fours. By all means do not push on your tailbone.

I think these questions are best handled and directed to your care provider, since I dont' think you'd like what else I have to say.

I've handled a shoulder dystocia with a 13lb baby and I just got the mom on hands and knees and worked the baby out. It was all I could do - it's the same procedure (aside from the position change and most docs feel it necessary to cut your vagina open) that they do in the hospital. And it worked.

[Artisan]

I agree with what Pam said. With SD (which it seems unlikely you would have since you delivered a large baby before without it), you can't use forceps/vaccum anyway. The way most OBs would handle it would be to make a giant episiotomy, and they would be much less likely to use the Gaskin maneuver. On the other hand, a midwife might be more likely to have you turn on all fours, might be more likely to have you pushing in an effective position to begin with, and if nothing works, she can do an episiotomy.

[tilly2321]

thank you all

Hi again,
Thanks so much for all of your input. Every now and then the "fear" monster creeps up and makes me doubt my ability to birth another big baby. I don't know why, but it just does. I think I am exposed to too many negative birth stories these days and have to keep away from them.
Thanks again.
Elle