Shoulder Dystocia

By Midwifery Today

An important read for midwives, doulas, doctors and nurses about how to handle a shoulder dystocia. Filled with articles previously published in Midwifery Today magazine, this e-book contains top-notch information from the brightest minds in natural childbirth, including Ina May Gaskin, Gail Tully and Michel Odent.
Table of Contents:
Chapter 1: “Shoulder Dystocia: The Basics” by Gail Tully
Chapter 2: “Preventing Shoulder Dystocia” by Michel Odent
Chapter 3: “Shoulder Dystocia: The Perils and Possibilities” by Sister MorningStar
Chapter 4: “Management of True Shoulder Dystocia at Attended Homebirth” by Judy Slome Cohain
Chapter 5: “How Being a Homebirth Midwife Enabled Me to Learn about Shoulder Dystocia” by Ina May Gaskin
Chapter 6: “Once a Shoulder Dystocia...” by Marion Toepke McLean
Chapter 7: “Capable Hands and Calm Eyes: My 60 Seconds of Shoulder Dystocia” by Mary Ann Lieser
Chapter 8: “FlipFLOP: Four Steps to Remember” by Gail Tully
Chapter 9: “Managing Shoulder Dystocia” by Marion Toepke McLean
Chapter 10: “Shoulder Dystocia: A Heart-stopping Moment” by Brenda Matea
Chapter 11: “Waiting for Shoulders” by Gail Hart
Chapter 12: “Arm Behind the Back: A Shoulder Dystocia Complication” by Gail Tully

• Language: English
• Publisher: Midwifery Today
• Release date: Aug 16, 2013

Midwifery Today

Midwifery Today publishes a quarterly print magazine for midwives and other birth professionals. We also put on two or more conferences each year, publish books, e-books and offer a free e-mail newsletter.

Book preview

Shoulder Dystocia

A Collection of Articles from Midwifery Today Magazine

Edited by

Nancy Halseide

Copyright 2013 Midwifery Today, Inc.

Published by Midwifery Today, Inc.

Smashwords Edition

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Cover photo by Emily Robinson

www.emilyrobinsonphoto.com

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Smashwords Edition, License Notes

This e-book is licensed for your personal enjoyment only. This e-book may not be re-sold or given away to other people. If you would like to share this e-book with another person, please purchase an additional copy for each recipient. If you’re reading this e-book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work that went in to compiling this e-book.

Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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Table of Contents

Chapter 1: Shoulder Dystocia: The Basics by Gail Tully

Chapter 2: Preventing Shoulder Dystocia by Michel Odent

Chapter 3: Shoulder Dystocia: The Perils and Possibilities by Sister MorningStar

Chapter 4: Management of True Shoulder Dystocia at Attended Homebirth by Judy Slome Cohain

Chapter 5: How Being a Homebirth Midwife Enabled Me to Learn about Shoulder Dystocia by Ina May Gaskin

Chapter 6: Once a Shoulder Dystocia… by Marion Toepke McLean

Chapter 7: Capable Hands and Calm Eyes: My 60 Seconds of Shoulder Dystocia by Mary Ann Lieser

Chapter 8: FlipFLOP: Four Steps to Remember by Gail Tully

Chapter 9: Managing Shoulder Dystocia by Marion Toepke McLean

Chapter 10: Shoulder Dystocia: A Heart-stopping Moment by Brenda Matea

Chapter 11: Waiting for Shoulders by Gail Hart

Chapter 12: Arm Behind the Back: A Shoulder Dystocia Complication by Gail Tully

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CHAPTER 1

Shoulder Dystocia: The Basics

by Gail Tully

Copyright 2003 Midwifery Today, Inc. All rights reserved.

Editor’s note: This article first appeared in Midwifery Today, Issue 66, Summer 2003.

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The head had come out, mostly. The chin pressed deep into the mother; it didn’t emerge in the way expected. The baby grimaced, but stayed tight. His chin didn’t arch and swing to the side so that he could face his mother’s thigh. My mentor said softly but firmly, Check for the cord. Slipping my finger out of sight, I felt an odd crease around the baby’s neck, but couldn’t get under it; so, no cord, I thought. I placed the same finger on his shoulder and pressed gently to corkscrew the baby. I worried that pressure could cause him discomfort. My finger pressed tentatively. No movement resulted at all.

I quickly withdrew my hand. Immediately, my mentor’s more experienced hands flew silently to work. How fast her fingers circled around the baby’s neck and back again! Not one, but two loops of cord came off the neck though they had been so tight that my fingers couldn’t perceive their presence. The baby’s face was now darkening. Instantly her hands slipped in, sandwiching his back and chest. Her hands held him as if in prayer. One quick quarter turn and she brought him out. All in about the time it took me to withdraw my own hands and straighten my back!

Ahh, a piece of the puzzle snapped in place—I must be deliberate. The books might give instructions, but they can’t relay vigor. Even so, gentleness accomplished this child’s exit. My mentor’s calm served the parents so they were never separated from their joy by a senseless aggrandizement on past danger.

As birth attendants, we have a personal journey to understanding birth that gives each of us a unique perspective. Some of us are presented with challenges early in our journey and some have the opportunity to work up to skill development. In the matter of stuck shoulders, I was led gently from one lesson to the next in increasing difficulty until—graduation!

Shoulder dystocia happens when the head is born and the shoulders stay inside. One shoulder is caught above the pubic bone and, often, the other shoulder is held by the curve of the tailbone. The shoulders must slide away from their bony shelves so that mother can push her baby out. If the physics of the pelvis and baby’s shoulders and the position of the birthing mother are used to advantage, success is virtually ensured.

Traditional Midwifery Solutions

Obstetrical solutions for stuck shoulders evolved without the advantage of listening to midwives. Thankfully, midwives have traditional strategies of their own for shoulder dystocia. Though these are widely known, they bear repeating. Many involve moving the mother. To move the baby, move the mother. They may rotate either the baby’s shoulders, as in flipping to hands and knees, or rotate the symphysis pubis, as when shifting the pelvis or the legs.

Squatting and Standing

Squatting during birth has been around since antiquity and still enjoys widespread popularity. Squatting opens the pelvic outlet and closes the brim slightly. Moving into a squat may shift the pubic bone and roll the shoulder out from under the pubic bone. The widening of the ischial spines will increase room in the transverse. In this vertical position, uterine contractions may be stronger and more efficient. Moving the mother to a standing position can work as well. The pelvis may be more mobile when a mother stands with knees slightly bent. A strong helper can hold her under the arms to stabilize and support her. Standing allows a hand in, if needed, more than squatting.

The Gaskin Maneuver

Ina May Gaskin, midwifery historian and author of Spiritual Midwifery, found a technique used by Guatemalan midwives