The basic premise: To move the baby, move the mother.
When squatting, standing, and the Gaskin Maneuver don't work:
A Running Start
With mother on her hands and knees, she
quickly lifts a knee and sets the foot down flat. [Her assistant may choose to
do this for her because it is difficult for a birthing mom to process verbal
instructions.] The mother now has one knee down and one knee up, like a runner
waiting for the signal to begin. This move rotates the symphysis pubis joint and
rolls the shoulder off and into the open pelvis. The symphysis shrugs off the
shoulder, like the lumberjack rolling of the log. The pelvis widens on the side
that the knee is raised, so the midwife may want to raise the knee on the side
where she suspects the baby's back is on. But in a flurry, just grab a leg and
lift it. The posterior shoulder should immediately slide out and with it, the
baby.
Praying Hands Rotation
If the baby is still stuck, the
next step is for the midwife to slip the fingers of both hands inside. With flat
palms, one hand braces the baby's back and the other hand braces the chest, like
a prayer around the baby. Thumbs are not required and can stay out of the
mother. The baby is rotated so that the posterior shoulder moves toward the
chest. The baby is essentially spiraled out.
Lift the Sacrum
If the posterior arm can't move, it may
be that the baby is too large to rotate easily in the praying-hands rotation.
The midwife uses her dominant hand to attend the posterior shoulder. She uses
the back of that hand like a wedge between baby and sacrum and lifts the sacrum
up with her knuckles while her fingers sweep the posterior arm to baby's chest
(and into the oblique diameter). Opening the sacrum enlarges the pelvic outlet
diameter.
Bring the Posterior Arm Out from the Hands and Knees
Position.
Whenever success in bringing the baby's shoulder into the
oblique fails to bring the baby, the midwife should go after the posterior arm
and bring it out. For the mother already on her hands and knees, it is easy for
the midwife to slip the four fingers of her hand inside along the mother's
thigh. She will want her hand along the baby's back, not the chest. She should
then sweep the fingers upward toward the tailbone. This act alone may move the
posterior arm into the oblique.
Any difficulty getting the posterior arm out now is likely due to the arm's
position. The midwife can reach in to find the posterior shoulder and follow
down the arm with her fingers. It may be that one or both arms are behind the
baby's back! An arm behind the back has to be worked to the chest of the baby
before the shoulder can be rotated into the oblique.
— Excerpted from "Shoulder Dystocia: The
Basics," by Gail Tully, CPM, Midwifery Today Issue 66
Editor's Note: This article
continues to discuss in detail how to extract the posterior arm, lifting the
sacrum if needed, working with the baby's joints. It's an excellent read! TO
ORDER ISSUE 66, click here.
