One of the pitfalls in the birth of a large infant is urging the mother
to "push a little more" for the chin to be birthed. I'm talking about
those faces that creep over the perineum and stop with the upper lip of
the baby out of the perineum and the lower lip still inside. There's
something "tidy" about getting that face completely born BUT this is
where you will get the turtlenecking effect and, it's here that the
shoulders get impacted. If you wait for the next contraction and just
be patient and let that chin stay inside, you'll avoid the shoulder
dystocia because on the next big sensation, there will still be room
above the woman's pelvis for that baby's shoulders to turn. The chin
and the shoulders will roll out together. I find that, while waiting
for that next push, giving the mother a big slurp of water helps to
hydrate her and ,like a plant, she'll perk up for that final great
heave-ho push to get the baby out. Getting the father to do some nipple
stim helps, too. We always have to wonder if any manouevres actually
get the baby out or whether it's just that time is passing and the
fundus has some time to thicken, rally and piston down on the baby's bum
while everyone is flinging the mother about. Gloria Lemay, Vancouver,
BC Canada
Janet Fraser wrote:
http://midwiferytoday.com/enews/enews0416.asp#main
Shoulder Dystocia
The explanation for the success of the all-fours [Gaskin] maneuver probably
lies in movement at the sacroiliac joints at term, which can result in a
l-cm to 2-cm increase in the sagittal diameter of the pelvic outlet. The
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