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Re: The 'Infamous' Ina May GaskinFrom: Anna Meenan, MD (annam@uic.edu)Thu Sep 28 16:24:21 2000
At Tue, 26 Sep 2000, Kathi Wilson wrote: > >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). But does that mean we can't call it a shoulder dystocia unless somebody gets a rotator cuff injury? That's a bit extreme.
>
> My source for the definition of shoulder dystocia was Resnick R. Management of Shoulder Girdle Dystocia. Clin. Obstet. Gynec. 1980;23:559. (I'm back in my office now) I never said that the hands and knees position is the be-all and end-all of shoulder dystocia management. It IS a very useful maneuver that is underutilized and it definitely DOES make other maneuvers, such as Woods screw and delivery of the posterior arm MUCH easier (for babies that are really really stuck in there). I'd be willing to bet that Gonick, Stringer, and Held never took this much flack for their original publication of the McRobert's maneuver in AJOG in 1983 (which by the way they said had been utilized at their institution for many years and was "popularized", not invented, by Dr. William A. McRoberts Jr. Hmmm, sounds familiar). What actually happened was that Gherman et al took the trouble to study the question of how successful and safe is the McRoberts maneuver over 4 years and published it in AJOG in 1997. Their conclusion was that "McRoberts maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers."
-- Anna Meenan, MD, FAAFP > >--
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