One really shouldn't try and do a manual rotation before full dilation. I'm surprised the woman agreed, especially the second time, it must have been very painful. One doesn't usually push back the last cm. One may try and slip an anterior lip over. Seems pretty dodgy to me. I saw a midwife push on the fundus with one hand while pulling on the baby's head with the other, (her knuckles were going white) to speed up a birth. After all, it was getting on for knock-off time. Maureen
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of [EMAIL PROTECTED] Sent: Wednesday, 28 June 2006 10:12 AM To: [email protected] Subject: Re: [ozmidwifery] Manual rotation Quoting Susan Cudlipp <[EMAIL PROTECTED]>: > Did this incident cause some adverse outcomes? > > Regards, Sue > Thanks for everyone's reply's.. Yes, this particular time, the outcome was forceps and a third degree tear which obviously not a direct result of the manouvre, but from the maternal exhaustion which ensued. In this case I think, it wasn't just the procedure, but the reasons for, and manner in which it was done. The midwife suggested it to the woman as a means of speeding up her labour (even though she was nine cm and had only been in the hospital for two hours!!), and had already performed an ARM for the same reason. She suggested that she could push the cervix back that last cm and rotate the baby, to save the baby doing so, and thereby reducing the overall time of the labour!! I couldn't believe what I was hearing! The woman agreed (???!!!) and this went ahead, with the woman instructed to push afterwards as she was apparantly now 10 cms. When no head appeared in due time, the woman was checked again and it was discovered that the cervix had gone back to 9cm.(suprise suprise) This scenario was repeated several times, with the woman encouraged to actively push in between. She eventually was so exhausted that the same midwife determined that forceps would be required... etc etc.Why not leave well enough alone in the first place? Anyway, the question I really wanted answered was that of safety. Obviously this was not a good illustration of appropriate of necessary use of this kind of technique, but my dilemma is that I have been told on the one hand that this kind of thing is dangerous and unnecessary, and then I read about it in Mayes, and several of you have replied that it is something you would do on occasion. I guess this is something I need to look into further. Thanks for all your help, regards, Astra. > ----- Original Message ----- > From: Astra Joynt > To: [email protected] > Sent: Tuesday, June 20, 2006 6:31 PM > 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 > > > -------------------------------------------------------------------------- ---- > > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.1.394 / Virus Database: 268.9.1/369 - Release Date: 19/06/2006 > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
