Re: The 'Infamous' Ina May Gaskin
From: art fougner, md (evsono@pipeline.com)
Fri Sep 29 08:33:17 2000
why not simply acknowledge that this is an entity with degrees of
severity? that would avoid the cricularity of many of these attempted
definitions - reminds me of the debate over the sinusoidal fetal heart
rate tracing.
art
At Fri, 29 Sep 2000, Kathi Wilson wrote:
>
>"Anna Meenan, MD" wrote:
>
>> But does that mean we can't call it a shoulder dystocia unless somebody
>> gets a rotator cuff injury? That's a bit extreme.
>
>That was a bit tongue-in-cheek and I apologize for that. However, I think that the
>problem of definition remains. We've had this discussion, as my fellow midwifery
>listers will acknowledge, at length on the midwifery list -- that is, when is an SD
>an SD? People may be "resolving" a problem that wasn't really one in the first
>place, and labelling it shoulder dystocia -- I've seen it happen on more than one
>occasion. There's a real tendency to get panicky about shoulders if they don't
>appear right after the head, and an accompanying tendency to call that shoulder
>dystocia. Most often it's not.
>
>> 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 certainly do not disagree with this, as, of course, I use it myself. However, I
>am concerned that the message being conveyed is that this is *the* solution to
>resolving SD. Your comment re: the registry appeared to me to promote the concept
>that it was. I do wholeheartedly agree that it's another tactic to use and a good
>one. But anyone attending childbirth better have a whole *lot* of tactics up their
>sleeves when it comes to SD, and be prepared to move from one to another pretty
>quickly when the first (or second) doesn't work. As Betsy has noted (and I have
>also found), shoulders can get *stuck* in the hands and knees position, and the
>solution is to roll the mother over into McRoberts.
>
>When I first began practice, I used to call what I now label "sticky shoulders",
>shoulder dystocia. It's all a matter of comparison, I think.
>
>--
>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.
