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Re: episiotomy and shoulder dystocia wasits effects on perineal body/From: Kaycnm@aol.comSun Apr 27 21:49:54 1997
In a message dated 97-04-25 09:54:48 EDT, you write: << Do you in your clinical judgement feel that episiotomy is of benefit and must be performed in cases of shoulder dystocia. >> I have had one bad shoulder dystocia is 13 years and 1500 babies. I have lots of tight shoulders. I have watched CNMs and OBs get impatient and try to deliver the body before the baby restitutes, and call it a dystocia, so I believe that my definition is different than theirs. I have only cut one epis in the last few years, due to an impatient OBs who was called in for bad variables and had poor sphincter control as he watched the delivery. My I also don't believe they solve a dystocia, dystocia is a bone problem. For my one bad shoulder, I cut the epis while the resident was running in responce to my call. I didn't want him to waste time discussing or doing an epis. I pulled the baby out as he came in the door. So my limited experience tells me that intact perineums do not hold babies in and my reasoning tells me that shoulders are not freed from behind pubic bones by cutting the perineum. But I think that if I had tried everthing else, including changing positions, McRoberts, screw maneuvers etc, I would probable cut an epis. Kay Johnson, CNM Atlanta, GA
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