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Re: Episiotomy question From: Ina May Gaskin (inamaygaskin@gmail.com) Tue Feb 19 08:38:53 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Episiotomy question" Previous message: Dr Eberhard W Lisse: "Re: Episiotomy question" In reply to: allanho@aol.com: "Re: Episiotomy question" The mother who is supine or leaning back a lot may not be able to push when the shoulders are impacted. But the same woman, once she turns over, will get a good urge. Correct me if I'm wrong, but if you're doing fundal pressure, you wouldn't really be able to have the woman in McRoberts, would you? I think a good contraction from the uterus does the work better than fundal pressure. I want to be sure that the antero-posterior diameter is big enough for the shoulders to slip out (or for you to reach in and deliver a hand if necessary). Sometimes when the mother is on her hands and knees (whether she was already there before the dystocia or you had her turn over) and the position itself isn't enough to disimpact the shoulder, you can ask her to draw one knee forward and that will do the trick. A midwife I know who was put into McRoberts told me that she was unable to push in this position and that she could barely breathe either. Her point was that she would have preferred moving to all 4's. Ina May On 18 Feb 2008, at 13:34, 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. > > > More new features than ever. Check out the new AOL Mail! Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Episiotomy question" Previous message: Dr Eberhard W Lisse: "Re: Episiotomy question" In reply to: allanho@aol.com: "Re: Episiotomy question"

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