RE: [ozmidwifery] Manual rotation

[B & G]

Title: Message

Hi Astra, If you read Pauline Scott's book Optimal Foetal Positioning you will see the technique described, at least that's where I think it is in. I have used this technique but you rely on an intact firm pelvic floor. Does not work as well when an epidural is insitu which is often the reason they are posterior. A firm pelvic floor allows the baby's head to rotate itself during a contractions as it has some resistance to turn on. Basically with consent I do a VE usually the woman is at 7-8 cm, place my fingers firmly on baby's head  and maintain that firmness and with at least 3 contractions my fingers act as a foundation or resistance that the baby's head can swivel on to a more favourable position. I do no more than that but I have heard midwives say they move their fingers as well with the contraction. You must be very careful you do not trap or apply pressure to the cervix. Usually it works especially if you are unable to physically move the woman to a different position because of an epidural. I am sure you will hear some wonderful ways midwives 'work with' the uniqueness of the woman's body and using the power within. Barb   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Astra Joynt Sent: Tuesday, 20 June 2006 8:32 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Manual rotation Hi eveyone, I am a first year Bmid student who has recently joined the list, and have been getting a lot out of reading the posts on various subjects. Now I'm wanting to ask advice on an issue that I have been trying to resolve since early on in my clinical experience. Without going into the whole story, I witnessed a digital rotation, or manual rotation of the baby of a woman in late first stage of labour, and a cascade of issues followed. In debriefing with my lecturers at uni, I was told this is not good or safe practice at any time. I then witnessed the same midwife perform this procedure again a few weeks later. Debriefing with a clinical educater, I was told it is an 'old skill', and certain very experienced midwives still practice it. Then my clinical supervisor refuted this and said it is dangerous and has no place in midwifery practice.This is a very brief summary of these conversations, but I hope you get the gist. Anyway, I was happy with this, until I read in Mayes Midwifery the other day that this procedure can be used to help turn a posterior baby!! I am completely confused! Safe, or not? Evidence based, or not? I would really appreciate any light cast on this subject... and just in case no one knows what I mean by digital rotation (if this is not the common term for it) It is the midwife using her fingers internally to sort of hook the baby's head (cervix fully dilated I guess, or close to it) and turn it into a more optimal position, using her own strength and accompanied by the woman actively pushing. I just want to also say that I know this is not something that should be occuring in any normal straightforward birth, but what other information or experience to you have,                                                              warm regards, Astra