Try these too. http://www.radmid.demon.co.uk/shoulders.htm Midwife management of shoulder dystocia Someone asked about midwife management to avoid brachial plexus injuries. There are a couple of studies showing very good outcomes for midwife management of shoulder dystocia. See for example [3]
The Farm article on Shoulder Dystocia and use of the all-fours position http://www.thefarm.org/lifestyle/dystocia.html "From 1971 to the present, the midwives have attended 1750 births. Thirty-five of these were complicated by shoulder dystocia, and all of them were managed by midwives .. Three early births were managed with traditional maneuvers, resulting in some birth injuries. The remaining 32 were managed by having the mother assume the all-fours position, with no mortality, no birth injuries, and with excellent Apgar scores. All the babies for whom follow-up was possible (29 of 35) were developmentally normal (ages 9 months to 15 years). These statistics compare favorably with the reported mortality rates of 21% to 29% and morbidity rates of 16% to 48%. In addition, despite frequent recommendations that any maneuvers to deliver the shoulders be preceded by a generous episiotomy or proctoepisiotomy, 23 of the babies were delivered over an intact perineum, and there were no 3rd or 4th-degree lacerations. Finally, though some authors recommend the time-consuming step of administering general anesthesia to the mother before attempting alternative maneuvers, 23 these babies were all delivered without anesthesia." This is a study on The Farm's results for shoulder dystocia, co-authored by Ina Mae Gaskin and a doctor who is trying to 'educate the masses' amongst obstetricians: All-fours maneuver for reducing shoulder dystocia during labor. Bruner JP, Drummond SB, Meenan AL, Gaskin IM http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9610468&form=6&db=m&; Dopt=b Study [18] found comparable outcomes for nurse-midwife practices compared to general medical practice in the USA, but a trend towards fewer incidences of s.d. was noticed when mothers were side-lying (as opposed to the 'obvious' recumbent/lithotomy position I suppose) And this... http://www.radmid.demon.co.uk/shoulderslouise.htm http://www.empoweredchildbirth.com/articles/birth/whatifs/shoulders.html http://www.blueribbonbaby.org/gaskin.shtml http://www.lifepassages.net/ShoulderDystocia.html http://www.thefarm.org/midwives/dystocia.html -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
