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Re: PositionFrom: Anna Meenan, MD (annam@uic.edu)Thu Jan 20 12:44:23 2005
At Thu, 20 Jan 2005, National Brachial Plexus/Erb's Palsy wrote: > >By simply rolling over to one's side, which can be easily accomplished, even >with an epidural, allows the sacrum the freedom to move back as the baby is >passing through.
>Um, would you tell that to the last shoulder dystocia baby I delivered? (and her lawyers when she hires them?) Delivered using only recommended maneuvers (McRobert's, suprapubic pressure, rolled to left side and delivered posterior arm)--BPP in ANTERIOR arm.
>What is most important to remember is to get the mother off her back! Hold it right there! Where are your statistics to support this statement? I have read just about everything that's ever been published on shoulder dystocia, including most of your recommended readings (and published some myself), and I have NEVER seen a study or series that supports that statement. As a matter of fact, when Ina May and I published the first case series on the use of the Gaskin Maneuver, one of the criticisms from the reviewers was that the reported incidence of shoulder dystocia in her series of births (to women who were encouraged to change positions frequently and deliver in alternative positions), was TOO HIGH. As I recall, it was something like 1.4 or 1.5%. As a matter of fact, I would say it's possible that the use of movement in labor could INCREASE the incidence of shoulder dystocia and BPP. What if all that movement facilitates the descent of babies who would not otherwise have made it that far in labor? What if the baby gets just so far and then gets stuck? By your reasoning, it's possible that many babies who would have a shoulder dystocia if they made it to the perineum would otherwise be sectioned, thus preventing the BPP. Mind you, this is just a theory, backed up by just as much evidence as your theory. And don't get me wrong, I am a big supporter of birth in alternative positions. (Just ask my L&D nurses), and I encourage them whenever possible, but I just don't think that's the whole answer.
--
Anna Meenan, MD, FAAFP
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