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Re: Episiotomy questionFrom: AllanHo@aol.comTue Feb 19 19:52:34 2008
In a message dated 2/19/2008 10:41:39 AM Eastern Standard Time, inamaygaskin@gmail.com writes: 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 I don't know how I got into the middle of this considering I did not even ask the initial question, but it has been a very interesting discussion. It is always nice to learn a new technique. One would never know when it would become useful... This discussion has gotten me thinking - when a fetus is stuck behind a pelvis, three things can help. 1. Make the opening of the pelvis larger. 2. Rotate the fetus that's stuck. 3. Rotate the pelvis that's blocking the shoulder. Now, I know the last point may be difficult for many people to accept, especially since I have neither eminence nor evidence. Just like we sometimes learn from children because of their unindoctrinated minds, I am just offering a fresh look at things. When Ina May have the women draw one knee forward during the Gaskin/ on-all-4 Maneuver, isn't she effectively rotating her pelvis?! And as Betsy discribed the baby's center of mass is up high within the uterus, wouldn't it be easier to rotate the pelvis, instead of the baby, using the mother's legs as a lever while maintaining the McRobert Maneuver? Also, you can rotate the pelvis one way, and rotate the baby another way for a synergistic effect. I have no objection to flipping the patient over if that is what it is going to take to deliver the baby. But if there was an alternative, the less drama the better. I deliver all my babies in a hospital setting. Flipping a patient over is never a pretty sight. There are the basic BP monitor, fetal monitor and pulse oximeter lines to deal with. Often there are the lV and epidural lines. And sometimes the oxygen and amnioinfusion lines too! Not to mention the patient might have received sedation. And the patient may weigh three hundred pounds! And now there is a baby's head in her butt! No wonder they say the first thing to do is to ask for HELP! Help! Lastly, I practice in the United States. My patients are used to sitting in cushy chairs, and sleeping on pillow topped mattresses. I am not sure they would appreciate the idea that their doctor have them delivering their precious ones like some less evolved creatures. So if I can achieve a similar effect without flipping the patient over, I would much rather prefer that. Allan
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