I am a fairly new birth professional, and have only had the misfortune of seeing two shoulder dystocias so far.
With the first one, the doc was impatient (mom hadn't even been pushing an hour, but I think he had to go assist with a case in the OR), so he vacuumed the baby from way high up. Brought the baby way down and out with one pull. Then, before the head was even out (probably about half way), he called a shoulder dystocia and asked me to do suprapubic pressure and McRoberts. the contraction was long since over, and he was having the mother keep pushing anyway. The body came out pretty quickly, and honestly it didn't seem like any longer than one might have taken to just push when the body was ready.
With the second one, the midwife was being uptight about the heartbeat -- it had been a low baseline (100's to 110's) for the last 30 minutes of labor during which she rapidly progressed from 5-fully. When she started pushing, it was going into the 80's. She was a multip though (4th vaginal delivery), and pushing very effectively, so I thought it was no sweat -- just rapid descent and head compression. Either way, she was calling the shots, so she was having the mom do purple pushing and doing the whole "your baby is in trouble, we need to get it out" thing. So the head started to emerge, and when it was about half way out, the contraction was over. I feel like many other providers would have just let it sit like that until the mom felt the need to push (this mom was unmedicated, BTW), but the midwife said "push hard, give me all you got" etc, etc... So the head laboriously delivered the rest of the way, then we had a one minute shoulder dystocia (episiotomy, McRoberts, suprapubic, no hands an knees even though she was unmedicated!)
SO... I feel like in both of these cases, the providers were very anxious to get the head out, faster than it was ready to come out. Those of you who have seen this more than me -- do you think that sort of rushing to deliver the head can lead to a brief, perceived shoulder dystocia? My sense was that the body just didn't have the time to catch up, -- I mean obviously it will follow along (it is connected, after all), but maybe the rushing prevented the shoulders from maneuvering the way they might have otherwise? And maybe if we had allowed a few seconds, they would have followed on their own?
Thanks for your input!
Cindi
With the first one, the doc was impatient (mom hadn't even been pushing an hour, but I think he had to go assist with a case in the OR), so he vacuumed the baby from way high up. Brought the baby way down and out with one pull. Then, before the head was even out (probably about half way), he called a shoulder dystocia and asked me to do suprapubic pressure and McRoberts. the contraction was long since over, and he was having the mother keep pushing anyway. The body came out pretty quickly, and honestly it didn't seem like any longer than one might have taken to just push when the body was ready.
With the second one, the midwife was being uptight about the heartbeat -- it had been a low baseline (100's to 110's) for the last 30 minutes of labor during which she rapidly progressed from 5-fully. When she started pushing, it was going into the 80's. She was a multip though (4th vaginal delivery), and pushing very effectively, so I thought it was no sweat -- just rapid descent and head compression. Either way, she was calling the shots, so she was having the mom do purple pushing and doing the whole "your baby is in trouble, we need to get it out" thing. So the head started to emerge, and when it was about half way out, the contraction was over. I feel like many other providers would have just let it sit like that until the mom felt the need to push (this mom was unmedicated, BTW), but the midwife said "push hard, give me all you got" etc, etc... So the head laboriously delivered the rest of the way, then we had a one minute shoulder dystocia (episiotomy, McRoberts, suprapubic, no hands an knees even though she was unmedicated!)
SO... I feel like in both of these cases, the providers were very anxious to get the head out, faster than it was ready to come out. Those of you who have seen this more than me -- do you think that sort of rushing to deliver the head can lead to a brief, perceived shoulder dystocia? My sense was that the body just didn't have the time to catch up, -- I mean obviously it will follow along (it is connected, after all), but maybe the rushing prevented the shoulders from maneuvering the way they might have otherwise? And maybe if we had allowed a few seconds, they would have followed on their own?
Thanks for your input!
Cindi