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Re: Episiotomy questionFrom: Betsy Hyde (elishyde@att.net)Mon Feb 18 19:58:08 2008
On Feb 18, 2008, at 9:34 PM, AllanHo@aol.com wrote: > Dude (I mean sir), I am not proposing fundal pressure to deliver a > stuck shoulder! I was asking Ina May why she thought gravity would > help deliver a stuck baby when we know the expulsive force is not a > factor. I am contending that it is the movements that unstick the > shoulder, given that the outlet dimensions are the same when a > woman is in the McRobert position and the on-all-4's position. > Please read what I wrote carefully before you condemn what is in my > mind. Thanks. One, I'm not sure that it is a given that the AP diameter is the same in McRoberts and in all-4's. Two, if one makes the assumption that most of the weight of the fetus is in its trunk, and that gravity is what it is....would it not make sense that to be on all-4's with hips and knees flexed (enlarging the AP diameter as has been demonstrated radiographically) that the bulky trunk of the fetus to follow gravity and "fall" towards the maternal abdomen, therefore moving the shoulder from behind the pubic symphysis? Expulsive force is cephalad to caudad, therefore potentially impacting the shoulder even more, and causing stress on the thin LUS. (Plus fundal pressure is indefensible in the US courts). H-K allows more posterior to anterior movement as well as increases the pelvic diameters.
-- Betsy Hyde CNM Branford, CT
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