Re: episiotomy and shoulder dystocia
From: Ronald Helm (ronhelm@ronhelm.seanet.com)
Wed Apr 30 19:46:26 1997
I think that the trues shoulder dystocia is made in retrospect only. If
the baby is delivered with only a McRoberts maneuver and some supra-pubic
direction to the anterior shoulder, then I think that was "tight
shoulders". If a baby, or Mother suffers injury, i.e. Erb's palsy, etc as
a result of the manipulation required to deliver the baby, be it Wood's,
posterior arm, clavicular fracture, Zavinelli maneuver, or in some
countries a symphysiotomy, then in retrospect THAT was a true shoulder
dystocia. God be willing this never happens to you or anyone else. I fear
shoulder dystocia more than anything in obstetrics and it really deserves
your respect. Ron
--
----------
From: FlynnCNM@aol.com[SMTP:FlynnCNM@aol.com]
Sent: Wednesday, April 30, 1997 1:26 PM
To: Multiple recipients of list
Subject: Re: episiotomy and shoulder dystocia
>It is obvious to me that you have never had a true shoulder dystocia if
you
have never had a third degree, and have delivered them all over an intact
perineum.
Ron<
I didn't say "never", I have certainly had seconds. If the baby turtles
after a slow delivery of the head, the head has molded to 4 cm less than
the
chest (with shoulders to match), and still the baby can be delivered with
suprapubic and McRoberts, ie no Woods screw or post. shoulder sweeping,
does
that mean it wasn't a shoulder dystocia? I often disagree with the RN's
who
are much quicker to call tight shoulders a SD than I am, and I admit I go
as
much by how it feels inside as anything else, but I'd be curious as to what
it takes for you to call it a true SD, for my own information.
Thanks, Cynthia Flynn, CNM, PhD
Private Practice, Kennewick, WA
FlynnCNM@aol.com
begin 600 WINMAIL.DAT
M>)\^(C$``0:0" `$```````!``$``0>0!@`(````Y 0```````#H``$(@ <`
M& ```$E032Y-:6-R;W-O9G0@36%I;"Y.;W1E`#$(`0V ! `"`````@`"``$$
MD 8`% $```$````,`````P``, (````+``\.``````(!_P\!````0P``````
M``"!*Q^DOJ,0&9UN`-T!#U0"`````&]B+6=Y;BUL0&]B9WEN+FYE= !33510
M`&]B+6=Y;BUL0&]B9WEN+FYE= ``'@`", $````%````4TU44 `````>``,P
M`0```!,```!O8BUG>6XM;$!O8F=Y;BYN970```,`%0P!`````P#^#P8````>
M``$P`0```!4````G;V(M9WEN+6Q ;V)G>6XN;F5T)P`````"`0LP`0```!@`
M``!33510.D]"+4“BU,0$]"1UE.+DY%5 `#```Y``````L`0#H!`````@'V
M#P$````$`````````KHO`02 `0`I````4D4Z(%)%.B!E<&ES:6]T;VUY(&%N
M9"!S:&]U;&1E<B!D>7-T;V-I80"-#@$%@ ,`#@```,T'! `>`!$`- `$``,`
M0@$!(( #``X```#-!P0`'@`1`"T`,P`#`&H!`0F `0`A````-C(P.3=&-$4W
M1D,Q1# Q,3DV-C T-#0U-3,U-# P,# `Q08!`Y &`" '```4````"P`C````
M```#`"8```````L`*0```````P`N```````#`#8``````$ `.0! W0/CR56\
M`1X`< `!````*0```%)%.B!213H@97!I<VEO=&]M>2!A;F0@<VAO=6QD97(@
M9'ES=&]C:6$``````@%Q``$````6`````;Q5R>,#!4V]Y,& $="68$1%4U0`
M````'@`># $````%````4TU44 `````>`!\,`0```!L```!R;VYH96QM0')O
M;FAE;&TN<V5A;F5T+F-O;0```P`&$.8OV'8#``<05@4``!X`"! !````90``
M`$E42$E.2U1(05142$544E5%4U-(3U5,1$521%E35$]#24%)4TU!1$5)3E)%
M5%)/4U!%0U1/3DQ924942$5"04)925-$14Q)5D521417251(3TY,64%-0U)/
M0D525%--04Y%558``````@$)$ $```!Y!0````'\)``!,6D9U6\S4-O\`
M"@$/`A4"I /D!>L"@P!0$P-4`@!C: K <V5T[C(&``;#`H,R`\8'$P*#NC,3
M#7T*@ C/"=D[%?]X,C4U`H *@0VQ"V!N\&<Q,#,4( L*%"(,`8)C`$ @22!T
M: N 6FL:\6$%0!L`91KP<E,*4 0@<V@(8&P$@2! 9'ES=&]C!S @_00`( #
M#; =8 .@%@`;\#AO<W %D 5 `B!L>50N(!K09ANC8@&@>6,=8@VP;&EV!) )
M@""7`_ ;`![#(!U036,(`(IB!)!T'8)N974@<34A8&X@L',#<!O0<W4`<')A
M+7!U8FG:8QS0:18`'J!I`B :\'9O&Z,`<'0&<06Q'%8LIQNB`Z :ZW=A!" B
M)&#,9V@%0!Q6<R(?%!U0MQ^R)C %LF\;L261=0W0&RB!'>%J"' I<6DN96$?
M$$5R8B<$( JP;/YS*7$2`"/P)X$=4!8`(U#^;!ZQ'U0#@04@'( ;@"1R^18`
M<74D(2"P)+$@-1]GSR8P(= =8 5 5V\$<"O 728P<!Y@)44*P&TF,&-]"V!V
M(^ N(07 `U `T'2U"'!E)C!:,G$B4&P@4-\B)RF#'?$C`P6@=0(P"('C++(L
M(&UP:!SP)' =$ YM*7$F4QW\5$A!5*\G8QU0&_(<3V$?$4<$</\P<@/P- $9
M`!KR!" B4"*"W1' <!Z !C$DL7D(8"F2_P!P/0`B4"Q0+! K81K1*G#_"L$Y
M?QV0!; ;T1' `Z ]<;\;`CN '?$AP#&!-=%C++%_(M$PL18`!T A00VP$?!R
M_R!P!" ]`07 +/$>@A\1'R =" !N"H4*BR!0,3@PP0+1:2TQ-#0-\ S0\T:#
M"UDQ-@J@`V E0!ZAOBU(IPJ'1UL,,$@F1@-AOCI)KD@F#()+,![P;@A 4$Y-
M0&$&\"X%H&U 6U--5% Z36Y=OTE/2ET&8 (P2X],FU<)@-$B4'-D82EQ02-P
M`Q&$,S F,#$Y.3=5,, Z,C8@4$U/WTI=;%1O4A],FTTM(04@;/\;T"0Q!2 (
MD (P!" M82!0[QT`5@]0[B/ :AZ16"],FZ1295X@4D5>(&5:T)\VM2*T/MY$
MKT6S,S9')_,:-4@F/DD%0!UQ(< R@/\(8#RS(R$;8ST"$< @<#OG_R"P.0\<
M]Q]0/0(*A6=O&P'_"R @(0G")C BPFK#(#@;L?YM(6 T`![ (H0=X0&0'J'/
M"H4>@ 40(E%M+F*,1''>/&*,&N D$%00)R@!5&"[)Z [\R(F,!K@:L-C(>&_
M"W$A06@2$? %H"+0<Q\=U3-!=%I@<PJ%80& (I+_:+ 5D ?@(#4?X"UE&\ ML'\F,WD3/$$=@0;P#; O$S3_,D!N$':Q/+% 0ANQ"H41L/L'D 5 *"#3*"=F
M8QN $;#>*6R4'0`[,1]H8P.1,('_(#P*A2-3([0BPB&7*R%GD?\DP##B'#$%
M``?1!;$Q8A\0/VC'`^ )X%K0&0`F,&1O_W;'&V,'@&[")U-RLC8Q:-[^/SXR
M+6 E0 .@)!!R\ G"TR#$&[)23BO!=VC0=N8I0 %M=1&P("[!8VL_+[(DP'_
M?P(GW"%A4T0[0"0:X&$R(2+"CQ%D;?LPL1K@9R3 )X *A8PC']'_:- 'X#"Q
M*G ]X1WA`) =P:\LHD"6/>(P8760$2<ZT_\RH"5A9D$G@22QBT ;@ J%_S"Q
M`9",L 0@`A %P#T"C/;_,+%H58Z0)C"6PF$!=_ W<J^6P7X1)'%P751 06LQ
M,?P@0TV &P$=4$UC)C!-L5$F,%!H1 J%4 40=K\;@!O0G6 S(2/@,W%+"?#/
M(E #\(R@)C!700J%36Y_8HQB_T<G$O)DV0J%%2$``:3@`````P`0$ `````#
M`!$0`````$ `!S" )M($R56\`4 `"#" )M($R56\`1X`/0`!````!0```%)%
0.B ``````P`--/TW``!N,56\
`
end
