Re: The 'Infamous' Ina May Gaskin
From: art fougner, md (evsono@pipeline.com)
Wed Sep 27 11:10:58 2000
Thanks Kathi for your personal reality check - i worry about something
which works 100% of the time.
art
At Tue, 26 Sep 2000, Kathi Wilson wrote:
>
>"Anna Meenan, MD" wrote:
>
>> I have seen the Shoulder Dystocia video from
>> the Farm and I would call it a definite shoulder dystocia--positive
>> turtle sign, purple baby head, the works.
>
>Actually, having seen that video as well, it's not even close to what I would
>consider "the works". The works is the birth I had last spring, in which
>*both* shoulders were hung up -- ant on the symphysis and posterior presumably
>on the sacral promentory. I had my hand up the vagina past my wrist before I
>could touch the posterior axilla -- with the mother on hands and knees.
>Previously, I had tried lateral traction w/ McRoberts, symphysis pubis pressure
>and Rubins. That kid didn't budge an iota. Nor did it budge once the mother
>flipped to hands and knees. I cut a huge mediolateral epis, and shoved my
>whole hand in before I could get to that axilla and get some purchase on
>something to start to Woodscrew that kid out. Baby was born w/o heartbeat or
>respirations -- about 5 - 6 minutes from head to body. Full blown resus, with
>the result that the 1 minute Apgar was 3 and the 5 minute Apgar was about 6.
>Sarnet Stage I hypoxic insult. That kid took *years* off my life, but is now a
>healthy BIG six month old. *My* criteria is that I suffered a rotator cuff
>injury and muscle pull getting that baby out that still bugs me. And got
>aggravated w/ the next one (in which I couldn't put the mother in hands and
>knees because she had a broken arm).
>
>> Why is McRobert's maneuver
>> considered a shoulder dystocia maneuver if we are going to say that any
>> shoulder dystocia that resolves with McRoberts maneuver was not a
>> shoulder dystocia in the first place? Obviously it is a matter of
>> degree. There are bad shoulder dystocias and there are not-so-bad
>> shoulder dystocias. The point of the all-fours maneuver is that ALL of
>> the babies in the registry so far were delivered with an almost complete
>> absence of morbidity.
>
>Lots of people in my institution will use McRoberts preemptively if they think
>a baby might have sticky shoulders. Doesn't mean there was one. I still do
>not believe that getting a mother to lie back in McRoberts resolves a true
>shoulder dystocia -- it often means that she wasn't optimally positioned in the
>first place!
>
>Although I haven't attended Betsy's volume of births, I, too, would say that
>I've only had three real SD's, which to me means that you really have to *work*
>to get that kid out. Hands and knees is a valuable trick, but it's not magic,
>and I wouldn't count on it to work if a baby is really, really stuck in there.
>
>--
>Kathi Wilson, RM
>Ilderton, Ontario, Canada
>mailto:wilsonk@gtn.on.ca
>**********************
>Thames Valley Midwives
>**********************
>346 Platts Lane,
>London, Ontario, Canada
>
>http://tvm.on.ca
>mailto:info@tvm.on.ca
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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