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epis for shoulder dystociaFrom: Betsy Hyde (elishyde@connix.com)Fri Apr 25 09:15:17 1997
>How many of you feel that episiotomy is actually of any benefit in the >management of shoulder dystocia ? How many feel that it is not of any >benefit? I do not believe episiotomy is of benefit in the resolution of shoulder dystocia, and do not do them for this indication. SD is not generally a soft tissue problem, and I do not see any reason why an episiotomy would be of benefit (except to CYA and buff the chart so the attorneys are kept at bay). I can always get my whole hand into the vagina for various manipulations, and feel that there has always been plenty of room. I would cut an epis, however, if I couldn't get my hand in... Now, if we could also define what we *mean* by shoulder dystocia! I see lots of tight shoulders that need MacRoberts, compression and rotation of the bisacromial diameter, and sometimes delivery of the posterior arm, but have not yet had a compromised infant by calmly and deliberately performing the above maneuvers.
-- Betsy Hyde CNM Branford, CT midwife in private OB/CNM practice assistant clinical professor, Yale University
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