Re: Episiotomy question
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Feb 18 19:00:12 2008
Allan the mechanisms of shoulder dystocia - IMHO - are not so clear in
your mind.. the expulsive forces are not the critical factor in SD -
the impingement of the shoulder behind the symphis - or the sacrum in
the cases of the posterior shoulder is the problem.. if you give fundal
pressure to an already stucked shoulder you will further increase damage
- if you release the shoulder - by whatever maneuver you wish - then the
expulsive forces will do the rest.. take care..
Ef
>At Mon, 18 Feb 2008, allanho@aol.com wrote:
>
>I am glad you agree with me that the movement of the patient may be the real mechanism of dislodging the stuck shoulder.? I wonder if just rocking the patient's hip from side to side (now I will proclaim as the "Allan Maneuver", named after myself ;-) can achieve the same result.?
>
>With the McRobert Maneuver, the sacrum should be off the bed, so it should have the same effect as being up-side-down in the air.? I don't understand the part with gravity being in your favor unless the patient is squatting.? And if its the expulsive force that's critical, why is fundal pressure such a taboo?
>
>Allan
>
>-----Original Message-----
>From: Ina May Gaskin <inamaygaskin@gmail.com>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
>Sent: Mon, 18 Feb 2008 9:43 am
>Subject: Re: Episiotomy question
>
>The movement definitely helps, but the antero-posterior diameter increases as you flex the thighs. McRoberts does that too, but all-fours gives the additional help of gravity without interfering with her ability to get a good deep breath (as McRoberts can).
>
>Ina May
>
>On 18 Feb 2008, at 00:05, AllanHo@aol.com wrote:
>
>In a message dated 2/17/2008 10:06:04 PM Eastern Standard Time, inamaygaskin@gmail.com writes:
>
>She won't. It would hurt too much to do that. But it's okay to help her over.
>
>Ina May
>
>On 17 Feb 2008, at 15:33, AllanHo@aol.com wrote:
>
>I have heard of this maneuver, but the thought of?making?a woman flip around with a baby's head between her legs scares me a little bit.? What if she sits on the baby's head by accident??
>
>?
>
>Allan
>
>May be I am thick -?I don't quite understand why flipping the woman up-side-down would change the geometry of her pelvis any more than you can by pushing her legs back and arch her back.? Do you think the reason why your maneuver work has more to do with the movements the patient had to go through to get up?on her hands and knees than the position itself?? May be it is all the wiggling around that disimpact the shoulder.? In any case, it is good to know there is another way to get things done.
>
>?
>
>Allan
>
>Delicious ideas to please the pickiest eaters. Watch the video on AOL Living.
>
>>
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>I am glad you agree with me that the movement of the patient may be the real mechanism of dislodging the stuck shoulder. I wonder if just rocking the patient's hip from side to side (now I will proclaim as the "Allan Maneuver", named after myself ;-) can achieve the same result. <br>
><br>
>With the McRobert Maneuver, the sacrum should be off the bed, so it should have the same effect as being up-side-down in the air. I don't understand the part with gravity being in your favor unless the patient is squatting. And if its the expulsive force that's critical, why is fundal pressure such a taboo?<br>
><br>
>Allan<br>
><br>
>-----Original Message-----<br>
>From: Ina May Gaskin <inamaygaskin@gmail.com><br>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net><br>
>Sent: Mon, 18 Feb 2008 9:43 am<br>
>Subject: Re: Episiotomy question<br>
><br>
>
><div id=AOLMsgPart_2_ab5a0aa0-8746-42e2-acd0-3f35f358500e>The movement definitely helps, but the antero-posterior diameter increases as you flex the thighs. McRoberts does that too, but all-fours gives the additional help of gravity without interfering with her ability to get a good deep breath (as McRoberts can).
>
><div><BR class=webkit-block-placeholder></div>
>
><div>Ina May</div>
>
><div><br>
>
><div>
>
><div>On 18 Feb 2008, at 00:05, <A href="mailto:AllanHo@aol.com">AllanHo@aol.com</A> wrote:</div>
><BR class=Apple-interchange-newline>
><BLOCKQUOTE type="cite"><FONT id=role_document face=Arial color=#000000 size=2>
>
><div>
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><div>In a message dated 2/17/2008 10:06:04 PM Eastern Standard Time, <A href="mailto:inamaygaskin@gmail.com">inamaygaskin@gmail.com</A> writes:</div>
>
><BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: blue 2px solid"><FONT style="BACKGROUND-COLOR: transparent" face=Arial color=#000000 size=2>She won't. It would hurt too much to do that. But it's okay to help her over.
>
><div><BR class=webkit-block-placeholder></div>
>
><div>Ina May</div>
>
><div><br>
>
><div>
>
><div>On 17 Feb 2008, at 15:33, <A title=mailto:AllanHo@aol.com href="mailto:AllanHo@aol.com">AllanHo@aol.com</A> wrote:</div>
><BR class=Apple-interchange-newline>
><BLOCKQUOTE type="cite"><FONT face=Arial color=#000000 size=2>
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><div></div>
>I have heard of this maneuver, but the thought of making a woman flip around with a baby's head between her legs scares me a little bit. What if she sits on the baby's head by accident? </div>
>
><div> </div>
>
><div>Allan</div>
></FONT></BLOCKQUOTE></div>
></div>
></FONT></BLOCKQUOTE></div>
>
><div></div>
>
><div>May be I am thick - I don't quite understand why flipping the woman up-side-down would change the geometry of her pelvis any more than you can by pushing her legs back and arch her back. Do you think the reason why your maneuver work has more to do with the movements the patient had to go through to get up on her hands and knees than the position itself? May be it is all the wiggling around that disimpact the shoulder. In any case, it is good to know there is another way to get things done.</div>
>
><div> </div>
>
><div>Allan</div>
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