Hand Maneuvers

[Mina]

Question for the midwives out there: Do you routinely use hand maneuvers at births? By hand maneuvers, I mean specifically the kind of maneuvers outlined in Varneys, for example; holding the baby by the head and applying pressure first downward, and then upward. If you do, what happens if the mother's partner wants to catch the baby? And if you don't, what kinds of things do you do?

[JunipersMom]

I dont use manuevers ~ if partner wants to catch I may help out for perineal support for head or shoulders or both if the situation calls for it.

[doctorjen]

No particular maneuvers, here. If dad wants to catch, I put gloves on, but keep my hands to myself unless there is a problem. Babies come out if no one touches them at all, it turns out!

[mwherbs]

I put on gloves- dad just puts his hands there , I stand poised incase the baby slips or he needs help - I really like moms to catch if they will-- we don't check for cord- and if it seems like there is a tight cord I tell dad to hold the head near the perineum and the body tumbles out-- we usually tell dad that if we need to move a shoulder that would be the time we would say something like we are going to need to help with the shoulders and I have never had a problem with a dad not moving--
I know other midwives who tell dad to put a little counter pressure on so the head doesn't just blast out-- because that is the way they catch and dads seem to grasp the concept quickly-- the delivery of the anterior or posterior shoulder is not the way the majority of midwives I have worked with catch babies-- some do perineal massage or a combo of counter pressure and massage- or hands off

[homemademomma]

i dont do hand maneuvers as outlined in varneys or oxorn/foote etc. what i do varies situation to situation, depending on how involved/hands off mom wants me to be wrt catching the baby. lol i remember when i first started being interested in midwifery, i memorized the hand maneuvers! i dont even remember them now.

although if mom wants me right there, i do have a pretty specific way of providing counter support to the perineum.


:
i am actually at a birth right now~ mom is resting in fairly active labor.


send her good birth vibes please!

[MsBlack]

Pretty darn hands-off here. One exception is that with a large baby and either a first time vag birther and/or a perineum that seems real tight, I will put the tiniest amount of downward pressure with a fingertip on the baby's head right below mom's clit (unless she is reaching there herself, some will, some won't). This is to keep any possible tearing from going upward. Last time I did this, mom did have a tiny flesh wound down low--no problems with it, only a little pain for a few days. Can't help but think how much more it would have hurt, and impacted her sex life, if that tear had been at the clit instead, as it seemed likely to do before I put my finger there.

All that said, like mwherbs I encourage moms to be in hand contact w/baby as it emerges, if not actually catching; I also encourage dads to catch but it seems often that the moms want dads otherwise holding onto her. And also, there are some moms who really want my hands on the perineum, and/or massaging just on the inside--they find that this helps key them to relaxing the area maximally as babyburn happens. If my hands are on outside, then it's as little pressure as I can manage and still be touching them--it's NOT counterpressure, just a 'touch relaxation' thing. If on the inside, it's a gentle but firmish massage pressure, moving around the circle slowly.

[pamamidwife]

My hands do not touch the woman or baby at birth. I do not check for nuchal cords. I think hands off is best for mom, baby.

wanted to add more because I'm not on my phone anymore, but actually on my laptop:

In nearly all the births I do, I don't usually see the mothers vagina until AFTER the birth. There are times where I don't see the baby's head emerge - the mother usually says, "oh, there's the head". I don't think there is a need for pressure on the occiput - women naturally do that themselves because they feel so much pressure by their clit. In fact, when we apply pressure anywhere on the vagina as the baby is crowning, we are creating more pressure (reducing slack) in other places that the body wouldn't normally allow. I think that women naturally will have their hands on their baby's head if they're left alone to their own devices.

I wrote an article on this topic and I feel pretty strongly about it. Here's the article: http://midwiferytoday.com/articles/h...ng+body+wisdom

In addition, I really think we need to get away from this belief that tearing is something horrible or to be avoided. Many times the body naturally "gives" in safe areas (like the upper inner labia) to prevent larger tears like on the perineum or clitoris. This idea that somehow midwives prevent tears is erroneous. The evidence shows that hands off is not likely to cause any more tearing than hands on. In fact, I think that hands-on perineal massage and stretching by a provider can cause tears that wouldn't have normally occurred. I rarely suture - but that doesn't mean I don't see small grazes or small tears. I just happen to think that whether my hands were there or not, those would have still happened.

[Jane]

I do use hand manuevers, though not quite what is described in Varney's. I do a counter pressure whatever direction the baby is going to slow the birth of the head. I do try to keep the baby from throwing out an elbow as it's born. As a student, I have to check for cord (at the direction of my preceptors), but I prefer not to...it hurts them for no reason, IMO.
There's a study (HOOP, hands on or poised) that shows that didn't find a significant differencein outcomes from the maneuvers.

[Mina]

Thanks for all the responses. This has been very reassuring! Homemademama, I hope the birth you are at is unfolding smoothly for the family; pamamidwife, thank you for the link to your article. I read it a while ago, and as I was pondering hand maneuvers it came back to me but I didn't have it here with me and didn't think to look online to reread it. And Apricot, thank you for mentioning that study - I'm trying to find it right now and see lots of references to it, but not it itself just yet. I'll keep looking!