Re: Dystocia was Episiotomy question
From: FRANCES WREN (fwren@shaw.ca)
Tue Feb 19 09:44:16 2008
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agree..certainly with a primip I think one should wait till they have the desire to push as I find where I work often the nurses get them pushing right when fully dilated ...seems to me often pointless as often there is still some asynclitysm or needs to rotate a bit yet or a bit deflexed still... and i think until the head is nicely flexed and "at the ready", they often dont have the desire to push and also it is ineffective and exhuasting.
rather wait till they are ready themsellves.
I fight a losing battle though trying to convince the nurses of that.
opinions?
frances wren
>----- Original Message -----
From: Richard Chudacoff <rchudacoff@mylinuxisp.com>
Date: Tuesday, February 19, 2008 9:22 am
Subject: Dystocia was Episiotomy question
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
> When I did OB (and, alas, it looks like I just may be back in
> that game) I
> never had patients push without desire. From a practical and
> medico-legal
> point (I never wanted to be out of the hospital while a patient
> pushed) I
> always labored my patients down to a 4/5 station. While I did induce
> EVERYBODY at 39 weeks I cannot recall my last dystocia. Do you
> think there
> is any relationship to that technique?
>
> Richard Chudacoff, MD, FACOG
>
> Las Vegas International Center for Advanced Gynecologic Care
>
> (Specializing in minimally and non-invasive surgery)
>
> 2481 Professional Court
> Las Vegas, NV 89128
>
> TEL: 702-485-8893
>
> FAX: 702-974-0945
>
> Assistant Professor
>
> Department of Obstetrics and Gynecology
>
> University of Nevada School of Medicine
>
> 2040 W. Charleston Blvd # 200
>
> Las Vegas, Nevada 89102
>
> www.lasvegasgyncenter.com <http://www.lasvegasgyncenter.com/>
>
> The information in this e-mail may be confidential and/or
> privileged. If you
> are not the intended recipient or an authorized representative
> of the
> intended recipient, you are hereby notified that any review,
> disseminationor copying of this e-mail and its attachments, if
> any, or the information
> contained herein is prohibited. If you have received the e-mail
> in error,
> please immediately notify the sender by return e-mail or phone
> and delete
> this e-mail. Thank you.
>
> _____
>
> 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
>
> _____
>
> Delicious ideas to please the pickiest eaters. Watch
> eater/rachel-campos-du
>
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<DIV>agree..certainly with a primip I think one should wait till they have the desire to push as I find where I work often the nurses get them pushing right when fully dilated ...seems to me often pointless as often there is still some asynclitysm or needs to rotate a bit yet or a bit deflexed still... and i think until the head is nicely flexed and "at the ready", they often dont have the desire to push and also it is ineffective and exhuasting.</DIV>
<DIV>rather wait till they are ready themsellves.</DIV>
<DIV>I fight a losing battle though trying to convince the nurses of that.</DIV>
<DIV>opinions?</DIV>
><DIV>frances wren<BR><BR>----- Original Message -----<BR>From: Richard Chudacoff <rchudacoff@mylinuxisp.com><BR>Date: Tuesday, February 19, 2008 9:22 am<BR>Subject: Dystocia was Episiotomy question<BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net><BR><BR>> When I did OB (and, alas, it looks like I just may be back in <BR>> that game) I<BR>> never had patients push without desire. From a practical and <BR>> medico-legal<BR>> point (I never wanted to be out of the hospital while a patient <BR>> pushed) I<BR>> always labored my patients down to a 4/5 station. While I did induce<BR>> EVERYBODY at 39 weeks I cannot recall my last dystocia. Do you <BR>> think there<BR>> is any relationship to that technique?<BR>> <BR>> <BR>> <BR>> Richard Chudacoff, MD, FACOG<BR>> <BR>> Las Vegas International Center for Advanced Gynecologic Care<BR>> <BR>> (Specializing in minimally and non-invasive surgery)<BR>> <BR>> 2481 Professional Court<BR>> Las Vegas, NV 89128<BR>> <BR>> TEL: 702-485-8893<BR>> <BR>> FAX: 702-974-0945<BR>> <BR>> <BR>>
0;BR>> Assistant Professor<BR>> <BR>> Department of Obstetrics and Gynecology<BR>> <BR>> University of Nevada School of Medicine<BR>> <BR>> 2040 W. Charleston Blvd # 200<BR>> <BR>> Las Vegas, Nevada 89102<BR>> <BR>> <BR>> <BR>> <BR>> <BR>> http://www.lasvegasgyncenter.com <http://www.lasvegasgyncenter.com/> <BR>> <BR>> <BR>> <BR>> The information in this e-mail may be confidential and/or <BR>> privileged. If you<BR>> are not the intended recipient or an authorized representative <BR>> of the<BR>> intended recipient, you are hereby notified that any review, <BR>> disseminationor copying of this e-mail and its attachments, if <BR>> any, or the information<BR>> contained herein is prohibited. If you have received the e-mail <BR>> in error,<BR>> please immediately notify the sender by return e-mail or phone <BR>> and delete<BR>> this e-mail. Thank you.<BR>> <BR>> <BR>> <BR>> _____ <BR>>
#091;mailto:ob-gyn-l@obgyn.net] On Behalf <BR>> Of Ina May<BR>> Gaskin<BR>> Sent: Tuesday, February 19, 2008 8:10 AM<BR>> To: Multiple recipients of list OB-GYN-L<BR>> Subject: Re: Episiotomy question<BR>> <BR>> <BR>> <BR>> The baby doesn't want to slide towards the mother's diaphragm <BR>> with her on<BR>> all-4s. It wants to come out in this position. It's when she's in<BR>> knee-chest, with her chest well lowered, that the baby falls up <BR>> towards her<BR>> diaphragm. It's important to make the distinction between all-4s and<BR>> knee-chest.<BR>> <BR>> <BR>> <BR>> If babies rose in the pelvis (instead of descending), you <BR>> wouldn't find the<BR>> all-4s position so common among indigenous peoples all over the <BR>> world. (See<BR>> George Engelmann's Labor among Primitive Peoples, 1882). Google <BR>> and you can<BR>> find a digitized copy of these illustrations.<BR>> <BR>> <BR>> <BR>> All-4s is good for OP labors, too. Sometimes the baby will <BR>> rotate on its own<BR>> or with a little help in this position.<BR>> <BR>&#
038;gt; <BR>> <BR>> Ina May<BR>> <BR>> <BR>> <BR>> <BR>> <BR>> On 18 Feb 2008, at 19:44, AllanHo@aol.com wrote:<BR>> <BR>> <BR>> <BR>> <BR>> <BR>> In a message dated 2/18/2008 10:02:40 PM Eastern Standard Time,<BR>> elishyde@att.net writes:<BR>> <BR>> Two, if one makes the assumption that most of the weight of the <BR>> fetus is in<BR>> its trunk, and that gravity is what it is....would it not make <BR>> sense that to<BR>> be on all-4's with hips and knees flexed (enlarging the AP <BR>> diameter as has<BR>> been demonstrated radiographically) that the bulky trunk of the <BR>> fetus to<BR>> follow gravity and "fall" towards the maternal abdomen, <BR>> therefore moving the<BR>> shoulder from behind the pubic symphysis?<BR>> <BR>> <BR>> <BR>> Expulsive force is cephalad to caudad, therefore potentially <BR>> impacting the<BR>> shoulder even more, and causing stress on the thin LUS. (Plus fundal<BR>> pressure is indefensible in the US courts).<BR>> <BR>> H-
K allows more posterior to anterior movement as well as <BR>> increases the<BR>> pelvic diameters. <BR>> <BR>> <BR>> <BR>> Betsy Hyde CNM<BR>> <BR>> Branford, CT<BR>> <BR>> =<BR>> <BR>> That's what I thought - getting on all 4's actually makes it <BR>> less effective<BR>> for the mother to push the baby out. The baby wants to slide <BR>> towards the<BR>> mother's diaphram. So how does it make it easier for the mother <BR>> to breath<BR>> like what Ina May said? <BR>> <BR>> Allan<BR>> <BR>> <BR>> <BR>> <BR>> <BR>> _____ <BR>> <BR>> Delicious ideas to please the pickiest eaters. Watch<BR>> <http://living.aol.com/video/how-to-please-your-picky-<BR>&00300000002598> the video on AOL Living.<BR>> <BR>> <BR>> <BR>> </DIV>
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