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Re: Symphysiotomy for Shoulder DystociaFrom: Anna Meenan, MD (annam@uic.edu)Fri Feb 25 09:25:17 2000
At Tue, 22 Feb 2000, Tonya Von Brooks, CPM wrote: > >Dear Anna , >As COB of the Association for Childbirth at Home International since 1972 It >has been one of my duties to track poor outcomes of home births on a state by >state basis . This has been done to see why where and when midwives are >getting into trouble . In this capacity I have reviewed several shoulder >dystocia cases .We have seen several terrible outcomes with the hands/knees >position (Gaskin ) . In fact I just reviewed a video of a baby born in July >in which this position did not work . Outcome = 11 minutes to deliver a >severely brain damaged infant . Wt.=8lbs 11oz male infant in hospital 6 >weeks. Infant went home on respirator. I have delivered many very large >infants and in my experience in a true sholder dystocia hands knees just >doesn't consistently work. In my experience it is the most dangerous if one >has shoulder dystocia because of a nucal arm .This position may help in some >cases but it can't in my experience be counted on as a maneuver . >Sincerely, >Tonya Brooks M.S. >Midwife > It would be interesting to know what other maneuvers were tried WHILE the moms were in all-fours. I have found that you get SO much extra maneuvering room posteriorly that it is worth doing. I have had my arm halfway up a woman's vagina on more than one occasion reaching for a posterior arm and found that there was plenty of room. The anesthesiologist walked in as I was delivering the lady who had the epidural and was amazed. He said, "You couldn't have gotten your hand in there like that if she didn't have the epidural." And I told him I had had to do it on moms who had no epidural and you gotta do what you gotta do to get the baby out. I am not sure how the all-fours maneuver could be considered "dangerous" at all. It generally takes less than 30 seconds to get the mom repositioned. As for nuchal arms, I don't think I've ever had a shoulder dystocia with a nuchal arm, but I would think it would make it that much easier to reach the arm to deliver it first.
-- Anna Meenan, MD
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