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From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Ina May
Gaskin
Sent: Tuesday, February 19, 2008 8:10 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Episiotomy question
The baby doesn't want to slide towards the mother's diaphragm with her on
all-4s. It wants to come out in this position. It's when she's in
knee-chest, with her chest well lowered, that the baby falls up towards her
diaphragm. It's important to make the distinction between all-4s and
knee-chest.
If babies rose in the pelvis (instead of descending), you wouldn't find the
all-4s position so common among indigenous peoples all over the world. (See
George Engelmann's Labor among Primitive Peoples, 1882). Google and you can
find a digitized copy of these illustrations.
All-4s is good for OP labors, too. Sometimes the baby will rotate on its own
or with a little help in this position.
Ina May
On 18 Feb 2008, at 19:44, AllanHo@aol.com wrote:
In a message dated 2/18/2008 10:02:40 PM Eastern Standard Time,
elishyde@att.net writes:
Two, if one makes the assumption that most of the weight of the fetus is in
its trunk, and that gravity is what it is....would it not make sense that to
be on all-4's with hips and knees flexed (enlarging the AP diameter as has
been demonstrated radiographically) that the bulky trunk of the fetus to
follow gravity and "fall" towards the maternal abdomen, therefore moving the
shoulder from behind the pubic symphysis?
Expulsive force is cephalad to caudad, therefore potentially impacting the
shoulder even more, and causing stress on the thin LUS. (Plus fundal
pressure is indefensible in the US courts).
H-K allows more posterior to anterior movement as well as increases the
pelvic diameters.
Betsy Hyde CNM
Branford, CT
=
That's what I thought - getting on all 4's actually makes it less effective
for the mother to push the baby out. The baby wants to slide towards the
mother's diaphram. So how does it make it easier for the mother to breath
like what Ina May said?
Allan
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