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Re: Shoulder DystociaFrom: Anna Meenan, MD (annam@uic.edu)Fri Jan 7 19:26:53 2005
Baby doesn't always just slide out. I fact, in the times I've used it, I can only recall once (the first time, actually), where the baby came very easily. In that case, the baby pretty much came shooting out when I inserted my hand into the vagina posterior to the baby (between the posterior shoulder and the sacrum). I suspect that I therefore released the posterior shoulder by lifting the sacrum up off of it. I've had a couple of times where steady gentle traction ultimately delivered the posterior shoulder (though I would not say that the baby "slid right out", and a couple of times where I had to deliver the posterior arm. to get the rest of the baby. What I find when I use the Gaskin Maneuver is that it gives me much more space to work posteriorly. The most recent shoulder dystocia that I had was in a lady with an extremely dense epidural. When we didn't get the anterior shoulder with gentle traction, McRoberts, and suprapubic pressure, I had her roll on her side and delivered the posterior arm ( I can't do any maneuvering posteriorly with mom sitting on her butt.). Unfortunately, baby ended up with an Erb's Palsey of the ANTERIOR arm. It would be interesting to measure forces involved in delivering the posterior arm, or in delivering the posterior shoulder with the Gaskin Maneuver, as Art suggested. I have never had much success with rotational maneuvers, and I find it difficult to do much of anything with the anterior shoulder, as you need to get up under the pubic symphysis to get at it in order to push it in either direction, and with the baby's cheeks plastered against the introitus, I find that difficult to do.
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Anna Meenan, MD
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