Shoulder Dystocia - Why do these things continue to surprise me? - Page 3

[mwherbs]

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

[Mama Dragon]

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!

[MamaChel]

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.

[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)

[sevenkids]

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.

[liseux]

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.

[Storm Bride]

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!

[turtlewomyn]

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.

[liseux]

"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.

[pamamidwife]

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!

[Storm Bride]

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!

[Storm Bride]

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