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Shoulder Dystocia - Why do these things continue to surprise me? - Page 2

post #21 of 52
Thread Starter 
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.
post #22 of 52
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.
post #23 of 52
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.
post #24 of 52
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.
post #25 of 52
Thread Starter 
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...
post #26 of 52
Thread Starter 
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.
post #27 of 52
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.
post #28 of 52
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. :
post #29 of 52
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...
post #30 of 52
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
post #31 of 52
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.
post #32 of 52
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.
post #33 of 52
OMG... that was a little too detailed I think. :Puke
post #34 of 52
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
post #35 of 52
Thread Starter 
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??
post #36 of 52
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---
post #37 of 52
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. :Puke

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!:
post #38 of 52
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!
post #39 of 52
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)
post #40 of 52
Thread Starter 
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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