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.