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Re: Shoulder dystocia and 'All fours'From: Jason Gardosi (jason.gardosi@nottingham.ac.uk)Mon Oct 2 08:09:30 1995
I agree. There is nothing magical about the 'all fours' position though - any posture where the weight is taken off the sacrum is an improvement. There have been several radiological studies suggesting that recumbent and lithotomy positions reduce the pelvic outlet. Ironically, this is the position in which many women end up for instrumental delivery due to failed progress - a particularly high risk situation for real shoulder dystocia! Many so called 'shoulder dystocias' are just difficult deliveries caused by a recumbent position. Apart from the sacrum being pushed upward, reducing the AP diameter, it is difficult to allow lateral flexion when the presenting shoulder abuts on the mattress. Rx: lateral, kneeling, or squatting. Squatting is by far the best for spontaneous deliveries generally, as we have found - though the egyptians already knew this over 4000 years ago. jason.gardosi@nottingham.ac.uk Ob/Gyn, Queen's Medical Centre University of Nottingham, UK
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