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Re: Shoulder Dystocia and the "all fours maneuver"From: IVD@aol.comSun Oct 1 22:08:38 1995
In a message dated 95-10-01 18:11:48 EDT, VladimirT@aol.com writes:
> The "all fours" was described as a maneuver which could be used to treat Vladimir, The "all fours" is a position which many midwives see in home births. When a mother is allowed to choose her most comfortable position for birthing, she will often choose the all fours position. Midwives know that this position increases the pelvic outlet, and may suggest the position if the baby is expected to be big. Using this position may prevent shoulder dystocia with a baby that would have been "stuck" in another position, but I've seen babies get "stuck" in the all fours position, too. The technique that seems to help the most is to get the mother to change positions. If she is semi-reclined when the shoulders get stuck, then turning over to the all fours will almost always release the shoulders. But sometimes even that doesn't do the trick and she must try a standing squat, or even return to the lithotomy and pull the legs way back. It is the changing of positions that rotates the mother around the shoulders, similar to but more effective than trying to get your hands inside to rotate the shoulders. For a good description of the technique, check out midwifery books such as Ina May Gaskin's SPIRITUAL MIDWIFERY. The all fours position is not usually found in obstetric texts, because obstetric patients are more likely to be medicated, strapped into delivery stirrups, or otherwise unable to change positions during delivery. Most midwifery texts (and basically all books related to home birth) will have a description and diagram of the all fours position. Ida Darragh licensed lay midwife Little Rock, Arkansas, USA
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