Shoulder Dystocia - Why do these things continue to surprise me? - Page 2 - Mothering Forums
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#31 of 52 Old 12-13-2005, 03:59 AM
 
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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.
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#32 of 52 Old 12-13-2005, 12:28 PM
 
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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.
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#33 of 52 Old 12-13-2005, 03:19 PM
 
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OMG... that was a little too detailed I think. :Puke
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#34 of 52 Old 12-13-2005, 07:34 PM
 
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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
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#35 of 52 Old 12-14-2005, 12:08 AM - Thread Starter
 
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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??

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#36 of 52 Old 12-14-2005, 12:32 AM
 
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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---
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#37 of 52 Old 12-14-2005, 12:46 AM
 
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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!:
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#38 of 52 Old 12-14-2005, 12:58 AM
 
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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!
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#39 of 52 Old 12-14-2005, 01:01 AM
 
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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)
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#40 of 52 Old 12-14-2005, 02:07 AM - Thread Starter
 
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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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#41 of 52 Old 12-14-2005, 02:25 AM
 
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Quote:
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
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#42 of 52 Old 12-14-2005, 02:29 AM
 
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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.
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!

Amy ~ Web Designing Single Mom to 4: DD14, DS12, DS5, DS3
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#43 of 52 Old 12-14-2005, 02:42 AM
 
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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.
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#44 of 52 Old 12-14-2005, 03:09 AM
 
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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)

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#45 of 52 Old 12-14-2005, 10:13 AM
 
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Quote:
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.
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#46 of 52 Old 12-14-2005, 11:00 AM
 
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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.

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#47 of 52 Old 12-14-2005, 01:25 PM - Thread Starter
 
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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!

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#48 of 52 Old 12-14-2005, 01:44 PM
 
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Quote:
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.
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#49 of 52 Old 12-14-2005, 02:04 PM
 
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"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.

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#50 of 52 Old 12-14-2005, 02:34 PM
 
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Quote:
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!
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#51 of 52 Old 12-14-2005, 02:34 PM - Thread Starter
 
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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!

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#52 of 52 Old 12-14-2005, 02:35 PM - Thread Starter
 
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Kristina: Yes - that's the site. I can't believe I didn't even notice the "dynamicdoula" photo credit!

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
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