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Discussion Starter · #1 ·
Hi

What are some signs that might clue you in that you're dealing with a compound presentation? What tricks do you do to get the baby to move his hand?

thanks!
 

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A slower decent or birth maybe...sometimes there is no difference...always hard to say.

We don't do a lot of exams so sometimes we never know until birth about the wee hand. But I have heard of the hand being in front of the head and people using a piece of ice or pinching it to get the baby to move it. I suppose you could do this in knee chest to help the baby move it with gravity? Or at least make sure whatever side the hand is coming from the mum is off that side.

Did you have a problem with a compound pres at a birth?

Best, Paige
 

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My son was born with a nuchal hand. The MW tried gently pinching his fingers to get him to pull it back. Instead he stuck his whole arm out! Yowch
. But there were no probs. because of it. I had a fairly fast pushing stage and only one tiny tear.
 

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Discussion Starter · #4 ·
Quote:

Originally Posted by Paige, CPM

Did you have a problem with a compound pres at a birth?

Best, Paige
Thanks Paige. We seem to have a lot of nuchal arms lately. Longer then expected labors and harder on mom too. Sometimes mom will complain of pain between contractions that also clues us in to a compound presentatioin. Just wondering if there's anything we can do (besides ice) to get that arm out of the way during (or before) labor.

Any theories on why baby is presenting that way? My preceptor had mentioned that if mom is worried/anxious, that is passed on to the baby, and babies suck their thumb in response to the stress.

Also, any thoughts on waterbirth? Should a suspected nuchal arm prevent them from delivering in the water so that you can provide perineal support?
 

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My first baby was posterior with a nuchal hand. My labor stopped and started a lot, but he came out eventually... face up and hand up.
 

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Hmm I've been wondering about this...my baby was LOA from about 32 weeks on, and she came out that way too, just completely textbook. BUT--I had HORRIBLE back labor for hours and hours. The midwife said it was more like what's typical with a posterior presentation. She has had a mannerism since birth of holding her hands up next to her head...could she have been posed that way during labor and that's what caused my pain? Again, she didn't come out with her hand up there, her head came out followed by one shoulder, then the other. So if it was her hand by her head during labor, she must have moved it at some point. Does this sound like a viable theory to you?
 

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Hi BelgSD,

Your theory sounds great. Also, it could have been your loosy goosy pelvic bones and tissues with babies weight pinching a nerve. I guess it could be several things...but I like your theory best, esp since your daughter likes this position. How precious that must look!
:

Best, Paige
 

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Thumb/hand-suckers usually come down with a compound hand. Sharp pain over or at the pubic bone is a good indication of a baby with hands near the face. IME, a lot of time babies with nuchal hands seem to like to be posterior, as well. More room to get those fingers in their mouths.

So, if I can feel a hand by the face abdominally, like with an OP baby, I can sometimes gently jiggle the hand a bit and baby will move it long enough to get the head down further. Sometimes putting mama on her side and rocking her back and forth will get baby to let go. And sometimes baby simply will not let go, like the baby who was born with not only her hand by her face, but her two first fingers in her mouth, sucking away.
 

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Recently sent to me by a midwife friend:

______________________________________________
COMPOUND PRESENTATIONS
>
>
> SIGNS/SYMPTOMS: Prolonged labor, arrest of descent, PROM, constant
> aching feeling of the side where the hand is positioned, lack of pushing
> urge, suprapubic pain mimicking a cervical lip, asynclitic head, cervical
> os off center (usually to the side of the opposite part)
>
>
> RISKS: PROM, thinning of lower uterine segment, interventions to replace
> the extremity invite uterine rupture, infection, and cord prolapse
>
>
> MANAGEMENT:
>
> 1. Position changes
>
> · Standing, one foot supported: Place foot higher than the
> opposite knee while standing, but not higher than her tuberosity. Hold
> for several contractions, then switch feet and do several more.
>
> · Kneeling on one knee: Keep back straight and bottom elevated.
> Kneel upright on one knee while placing the other foot flat on the floor.
> Hold knee at right angle to the hip.
>
> · Move the pelvis: Belly dancing. Also, swing hips forward
> and sideways as she bends one knee on that side and then goes up on her
> toes. Repeat on other side, making kind of a figure 8 with her hips
>
> · Drop one hip: Step one foot on a stair or other elevated
> surface during contraction.
>
> · Dangle: Supported dangle through several contractions while
> she moves her hips around.
>
> 2. Manual techniques
>
> · Move the arm: If the anterior arm is palpable above the
> symphysis, might be able to apply pressure to sweep the arm up and out of
> the way, esp. if mom is in water. If palpable on internal exam, poke at
> the fingers and explain to baby what you want him to do. As mom
> approaches birth, ask mother to apply counterpressure over the painful
> area, esp. suprapubic from a fetal elbow, which may encourage baby to
> move.
>
> · Open the pelvis: Tuberosity pull: Have mother lie on her
> side opposite the small part on a firm, padded surface. Have her deeply
> flex her upper leg while an assistant supports it. Insert fingers
> vaginally; find the inside surface of the upper tuberosity and pull
> upward during a contraction.
>
> · Replace the small part: If cervix dilated, membranes ruptured,
> and small part palpable, have mom assume the knee-chest position. Using
> sterile technique, push the small part against the pelvic brim and hold
> it there until a contraction begins. As it builds, flatten your hand
> against the baby's head and slowly withdraw it, continuing to monitor
> internally to assess whether the small part stays put. The force of the
> contraction will hopefully push the head down into the pelvis, preventing
> reprolapse of the small part.
 

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Discussion Starter · #11 ·
Quote:

Originally Posted by zoe398
Recently sent to me by a midwife friend:

______________________________________________
COMPOUND PRESENTATIONS
>
.
Thanks a lot! Do you know where the info came from?
 
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