November 11, 2009
Volume 11, Issue 23
Midwifery Today E-News
“Shoulder Dystocia”
Subscribe • Print Page
Search Archive • Index

Welcome to Midwifery Today E-News !


Midwifery Today Online Store

Learn shoulder dystocia management, techniques and experiences.

MT online store

The Shoulder Dystocia Handbook will help prepare you for this complication. Authors include Marion Toepke McLean, Gloria Lemay, Gail Hart, Mayri Sagady, Sara Wickham and Jill Cohen.
To order



online holiday coupon pageHoliday Shopping?

Check out the Online Holiday Coupon Page to find out how you can save $10 or $20 on your Midwifery Today order. Or, save $5 on a Midwifery Today subscription. Be sure to take advantage of these and other special offers during the Holiday shopping season.



This issue of Midwifery Today E-News is brought to you by:

Look below for more info!



Midwifery Today Conferences

A full-day workshop is a great way to learn more about birth.

When you attend our conference in Philadelphia, April 2010, you can choose from a variety of full-day classes, including a two-day class on Traditional Midwifery Skills. There are also single-day classes such as Beginning Midwifery, Herb Workshop, Spanish Language for Birth, Breech Workshop, and First and Second Stage Difficulties.

Learn more about the Philly 2010 conference and get a complete program.


Ina May Gaskin ~ Elizabeth Davis ~ Michel Odent

Learn about birth from these great teachers when you attend our conference in Strasbourg, France, September 29 – October 3, 2010. Planned classes include Prolonged Pregnancy, Prolonged Labor, Managing Hemorrhage, Posterior Position and Preventing and Managing Birth Complications at Home.

Learn more about the Strasbourg conference.

To receive a printed program by mail when it becomes available, please e-mail admin@midwiferytoday.com with your name and postal address.

In This Week’s Issue:


Quote of the Week

"Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom on your time line."

Gloria Lemay


How can you make shopping for that perfect gift this holiday season even more perfect?

Use iGive, where with every transaction a portion goes to benefit Midwifery Today, Inc. Raise a penny (or more) per search and generate donations from any of the 700+ stores listed with iGive, ranging up to 26%. Also, check out the new searchable coupons and deals, where you will find all available, up-to-the-minute offers and specials.

Start here: http://www.igive.com/ and select Midwifery Today, Inc., as your cause in step 1. (It only takes a minute.)


The Art of Midwifery

Protocols [commonly] require mothers who are anticipating large babies to leave the bath [in a waterbirth]. Now there is a growing body of experience that suggests shoulder dystocia can be managed more easily in the pool. Canadian midwife Gloria Lemay has written a protocol for management of shoulder dystocia in the water. It appears that tight shoulders happen more often because of a practitioner or a mom trying to push before the baby fully rotates. There is no harm in waiting for a few contractions to allow baby to rotate, especially since the baby is not going to be taking a breath. Position changes in the water are so much easier to effect and the mother doesn't panic but remains calm. A quick switch to hands and knees or even to standing up with one foot on the edge of the pool if shoulders are really tight can help maneuver baby out.

Barbara Harper
Excerpted from "Waterbirth Basics: From Newborn Breathing to Hospital Protocols," Midwifery Today, Issue 54
View table of contents / Order the back issue


ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.


RSS Feed Subscribe to the Birth Products RSS feed for information about the products available from Midwifery Today. Find out what's new, what's on sale and more.

RSS Feed Subscribe to the Web Updates RSS feed to stay on top of what's new or highlighted on the Midwifery Today Web site. Be alerted when conference programs go online, new articles are posted and more.

Research

According to a study published in the New England Journal of Medicine, infants who have been starved of oxygen at birth may benefit from gentle cooling of their body temperature for their first 72 hours. Researchers conducted a randomized trial involving 325 babies who were less than 6 hours postpartum, had a gestational age of at least 36 weeks, and had suffered perinatal asphyxial encephalopathy. Roughly half of the infants received body cooling in addition to standard intensive care procedures; the remaining infants received intensive care alone.

While body cooling did not reduce the rate of death or disability associated with the asphyxia, it did appear to reduce the risk of cerebral palsy and improve neurological function in those infants to whom it was applied.

The full text of the study is available by subscription to the New England Journal of Medicine Online. The abstract can be read here: http://content.nejm.org/cgi/content/abstract/361/14/1349

New England Journal of Medicine 361(14): 1349–1358, 2009


Please support our advertisers!
advertiser

Consider chiropractic care for safer, easier births.

Our doctors offer special care for pregnant women and infants. Specialties include the Webster technique for optimal fetal positioning and gentle cranial and spinal techniques for your baby. Visit www.icpa4kids.org.



Managing Shoulder Dystocia

Following are some suggestions for dealing with shoulder dystocia:

First, don't overdiagnose. The rate of shoulder dystocia is 1.7% in babies over 8-1/2 lb. Shoulder dystocia occurs when the anterior shoulder of the baby lodges above the pelvic brim and won't enter the pelvis. Very slow delivery of the head, face and chin suggests shoulder dystocia but may not always lead to it. Note the time of delivery of the head. While it is true that complications tend to cluster, if you have experienced shoulder dystocia four times in your last 50 births you are probably overdiagnosing.

When you suspect shoulder dystocia, encourage the mother to push and be sure her legs are widely separated, drawn up and back, positioned as if she were in a squat. An assistant can apply suprapubic pressure, which may dislodge the shoulders. Watch for the neck! If the neck appears, the shoulder is not impacted.

Communicate. Tell the mother the baby's shoulders are stuck and that she must push hard to get the baby out. Tell her you are going to help her and be very clear about what you want her to do.

Changing the mother's position to hands and knees will deliver many babies at this point. If advance of the neck is not seen, slide one hand inside, along the mother's sacrum, and locate the posterior shoulder of the baby. The hand is up inside to the wrist at this point. Traction is made on the arm and shoulder [while] being careful to avoid the axilla, where pressure on the superficial brachial nerve plexus can cause partial or complete paralysis of the arm. If this is not successful, flex the arm with pressure on the antecubital fossa, inside the elbow, and pull it across the chest and out. The most severe shoulder dystocia babies who do not deliver progressively at this point can be worked loose by rotating the now delivered posterior shoulder and arm up under the pubic bone. The other shoulder comes out through the roomy curve of the sacrum.

Marion Toepke McLean
Excerpted from "Managing Shoulder Dystocia," Midwifery Today, Issue 12


Featured Products

Looking for a good appointment book for the new year?

With Woman Appt and Resource Book The With Woman Appointment and Resource Book is just what you need. This handy spiral bound book lets you record 15 months of appointments and is perfect for midwives, doulas, childbirth educators and lactation consultants. You'll appreciate the reference guides and resources, the place for listing client information and the handy pocket in the back that can hold business cards or a gestational wheel. If you're a student it can help you keep track of your prenatals, births and postpartum visits. Not a midwife? With Woman makes a great gift for someone who is. To Order

Sick and tired of seeing birth misrepresented in the media?

Laboring Under an Illusion

Then you need Laboring Under an Illusion: Mass Media Childbirth vs. the Real Thing. Explore media-generated myths about childbirth as you watch over 100 video clips chosen by anthropologist Vicki Elson. This DVD is a thought-provoking tour of diverse attitudes and practices, and an enlightening look at how media influences our attitudes toward birth. Get the DVD.


Cook delicious and wholesome meals for your whole family.

Whole Family Recipes   Whole Family Recipes—For the Childbearing Year & Beyond highlights foods that are especially needed by pregnant women, breastfeeding mothers and their growing children. Taking a non-dogmatic and down-to-earth tone, the book focuses on incorporating vitamin- and mineral-rich foods and good quality fats into the diet. If you're an expectant mom or new parent this book belongs in your kitchen. If you work with pregnant women, have copies in your library to share with your clients. Recipes include Cherry Maple Yogurt, Lake Perch on Greens and Carrot Soup with Curry. To Order

Show your support for midwifery…

…with a Midwifery Today logo shirt! Available in sand, forest, ocean, black and lavender. Order a shirt!

 

What is Midwifery Today magazine?

A 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more. Subscribe. Midwifery Today Magazine

Learn how you can have a safe, gentle birth.

Pregnancy and Childbirth SecretsPregnancy & Childbirth Secrets is packed with information that will guide you throughout your pregnancy and during your first days as a mom. Mothers, childbirth professionals and researchers share their experience and knowledge, giving you the insight you need to have a birth that is safe and rewarding for both you and your baby. To Order


Crowning Earrings

Birth Earrings Make the
Perfect Gift!

 
Your midwife or doula would love the "Crowning" Earrings.

Womb with a View EarringsThe Womb with a View Earrings are prefect for an expectant mom or any birth professional.

Baby Earrings 
Anyone who loves babies
would love the "Baby" Earrings.



Web Site Update

Read this article excerpt from the Autumn 2009 issue of Midwifery Today newly posted to our Web site:

  • Stories of Extraordinary Central American Midwives—by Marie Tyndall
    “There is a truly authentic, mammalian sense of love among midwives in the region, and beyond that, an ardent sense of human rights that is often difficult to come across. I think more than anything it is these two virtues that characterize midwives working throughout Central America. In this short commentary, my hope is to share with you the lives and work of two midwives in the region who exemplify these virtues. Around these parts, they are well-known, loved and respected, and their stories deserve to be told.”

Please support our advertisers!
advertiser

Midwifery Desk Is Your Front Desk.

Let us act as your front desk. We collect your fee and offer your client/mother a payment plan on your behalf. You no longer have to remind or negotiate your fee. We are here to ensure that you have more professional and personal relationships with your client/mothers. To empower the midwife by advocating your pay! www.midwiferydesk.com



Advertising Opportunities

Online Coupon Page

It's not too late to participate in holiday advertising! Use our online holiday coupon page to pass savings on to your customers. Take a peek here. [ Learn more here. ]

Midwifery Today E-News

Do you have a Web site? Does reaching more than 15,000 potential customers sound appealing? Purchasing an ad in Midwifery Today E-News, our biweekly e-mail newsletter, gets your message out and sends customers directly to your Web site. Each issue is archived and continues sending more customers in the future. [ Learn More ]

Advertise at Midwifery Today's Philadelphia, Pennsylvania, Conference

Reach a targeted, enthusiastic market by advertising at Midwifery Today's conference in Philadelphia, Pennsylvania. By advertising at "Trends and Traditions in Midwifery and Birth" in April, 2010, you will reach an audience passionate about birth. [ Space is limited so learn more ]

Contact our Advertising Director at: ads@midwiferytoday.com
View more advertising options at: http://www.midwiferytoday.com/ads/


Question of the Week

Q: Have you ever worked with a client with vulvodynia? How did it affect her pregnancy, labor and birth?

Midwifery Today E-News staff


SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.


ed page graphic

Start or continue your midwifery education!

Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.



Question of the Week Responses

Q: What is your best tip for shoulder dystocia?

Midwifery Today E-News staff

A: One of the things I would like to contribute to the discussion of shoulder dystocia (SD) is the idea that SD is sometimes, often, an arrest of rotation. Help the baby finish the rotation that nature intended.

An arm may have been swept behind the back in labor after the baby had rotated from occiput posterior (OP) to occiput anterior (OA).

Please feel inside for the location of the shoulder girdle. If the shoulders are front to back, the likely [solution is] one of these: standing, Gaskin's followed by Running Start (if needed), McRoberts with suprapubic pressure or rotation by strongly guiding the posterior shoulder from the back towards the chest and into the oblique diameter.

But if the shoulders are in the oblique or transverse, suprapubic will not work. McRoberts may not work. Rotation of the shoulders will help bring them down. Work from behind the shoulders to be protective of the brachial plexus. Never stick a finger tip in the arm pit from the front; never draw the baby out without rotation, to avoid panic-driven pulling. Be calm. You can do this. You must do this.

FlipFLOP is an easy-to-remember series of actions: 1) Flip to hands and knees (Gaskin); 2) lift the leg in a running start position (almost as if for running a race); 3) rotate the posterior shoulder into the oblique diameter; and 4) bring out the posterior arm.

If the mom is on her hands and knees, start with Running Start and go get the arm. This works for most SD.

Occasionally, SD is a matter of size. Bringing out the posterior arm helps here. Rotating and pulling from the posterior axillary crease (PAC Pull) brings out the larger babies. We had a happy outcome with the PAC Pull for our Christmas baby in 2008. She was 11-1/2 lb through a 5 ft 1 in mother. We really underestimated her baby's size!

Occasionally, arms are locked in a rectangle across their chest. Unlock the arms; bring one out if you need to. Keep rotating the baby. Keep the spiral turning. Rotation is protective.

See a detailed description of FlipFLOP, at: http://spinningbabies.com/spinning-babies-and/resolving-shoulder-dystocia

— Gail Tully, CPM

A: In answer to your [question on] shoulder dystocia, the best tip is anticipation—practicing in your mind what you will do and what position you will need to move the laboring mother into. Have a spiritual connection with her; this will enhance her response when you need her to work quickly.

I have used the hands and knees position many times to unlock a shoulder. Even having the mom do a side-step will sometimes allow the baby to slide through. You must remember, though, to always check for a nuchal cord, because of compression.

Bottom line is: anticipate, and don't hesitate.

— Debbi Leonard, CNM


Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.


Think about It

The accountability sometimes feels overwhelming when shoulder dystocia happens out of the hospital. There is no one to call—no doctor on the floor, no neonatal intensive care team to come help with resuscitation, no extra nursing staff to lend assistance. It's just me and a frantic woman trying to push out a stuck baby. We have to get the baby out. We have to keep that baby from dying. Just us. If I don't know what to do and how to do it, that baby will die. I will be accountable.

It scares me that midwives are delivering babies at home who are inexperienced enough to be confident that "birth works" all the time, that all we need is faith and to let nature take its course. What I know for a fact is that I would have three dead babies in my career if I didn't know what to do with shoulder dystocia. I would have dead babies if I confidently assumed that all I'd have to do is get the woman on her hands and knees and the baby would come. These last two kids definitely did not come when mom was moved to hands/knees. McRoberts doesn't always work. Standing doesn't always work. Screw maneuver doesn't always work. Suprapubic pressure doesn't always work. Trying to deliver the posterior arm doesn't always work. Breaking the baby's clavicle isn't always possible. Even cutting a big episiotomy, a favorite technique of the medical profession, probably won't do a thing to help release most babies.

As far as I'm concerned, the key to delivering a baby with shoulder dystocia is to keep one's mind clear enough from panic and fear that you can direct the woman into various positions, try multiple techniques and never quit until that baby comes out. If you don't know the techniques, you have to learn them and review them often. A severe shoulder dystocia may not happen until a practitioner has delivered hundreds of babies. You can never get cocky and think you have the right technique or position to prevent shoulders from sticking. Sticky shoulders aren't all that uncommon—they'll come with just a trick or two. Real shoulder dystocia is different and deadly. Every midwife who delivers enough babies will get caught someday. I know of midwives who stopped doing midwifery after experiencing true shoulder dystocia. The fear and sense of helplessness became unshakable and polluted their ability to see birth as a normal process. The accountability became too much to cope with.

I cope with the aftermath of shoulder dystocia by trying hard to keep my boundaries clear. I didn't cause it to happen. I just happened to be the one there who had to deal with it. I do the best I can at any moment in time, which is all any of us can do. I know the various techniques and I use them all until the baby comes, and then I make sure I know how to resuscitate that baby. It's the birth that woman got; it's the birth that I got. Bad things happen sometimes and we have to live with them and move on, knowing that we do not have supernatural powers, that we're only human with limited ability to control life and death.

Gretchen Brauer-Rieke
Excerpted from "Shoulder Dystocia: The Event that Wraps a Midwife's Heart in Cold Terror," The Shoulder Dystocia Handbook


Get the whole story!
Subscribe to Midwifery Today magazine!



Letters

The Mid-Atlantic Conference on Birth and Primal Health
Las Palmas de Gran Canaria, February 26–28, 2010

From the conference Web site:

What is the future of a world born by caesarean? This is the question we need to ask now that, thanks in particular to the work of Michael Stark, the c-section has become easier, faster, and safer than ever before. In this conference we will not only focus on technical advances, though…. We will also constantly make reference to recent scientific advances which suggest we should apply new criteria in order to evaluate practices within midwifery and obstetrics. For example, thanks to a large amount of data provided by developing disciplines as diverse as ethology, bacteriology, epidemiology and hormonology, it has recently been possible to confirm scientifically that…a human newborn baby needs his or her mother. After thousands of years of beliefs and rituals which have disturbed or prevented first mother-newborn interaction, modern science now has the power to reverse our deep-rooted conditioning.

We welcome all of you, participants from the five continents. We want to thank Prof. Garcia Hernandez and our friends in Las Palmas for suggesting the Canary Islands Convention Centre as a venue for this conference held under the auspices of the Goddess of Love…the Goddess born from the foam of the waves.

Dr. Michel Odent, President, and Heloisa Lessa, Executive Secretary

For more information and to register: http://www.wombecology.com/conference


Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.


Classified Advertising

Tell our readers about your business. Just $35/issue ($125 for four) gives you 30 words to promote your products or services. http://www.midwiferytoday.com/ads/enews.asp or ads@midwiferytoday.com


Remember to share this newsletter

You may forward it to as many friends and colleagues as you wish—it's free!

Want to stop receiving E-News or change your e-mail address? Or would you like to subscribe? Then please visit our easy-to-use subscription management page.

On this page you will be able to:

  • start receiving any of our e-mail newsletters
  • stop receiving any of our e-mail newsletters
  • change the version (text or HTML) that you receive
  • change the e-mail address to which newsletters are delivered

If you have difficulty, please send a complete description of the problem, including any error messages, to our newsletter.


Learn even more about birth!

Midwifery Today Magazine—mention code 940 when you subscribe.

 1-Year Subscription2-Year Subscription
United States$55$105
Canada / Mexico$65$125
All other countries$75$145

E-mail inquiries@midwiferytoday.com or call 1-800-743-0974 to learn how to order.

Or subscribe online.


How to order our products mentioned in this issue:

Secure online shopping

We accept Visa and MasterCard at the Midwifery Today Storefront.

Order by postal mail

We accept Visa; MasterCard; and check or money order in U.S. funds.

Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA

Order by phone or fax

We accept Visa and MasterCard.

Phone (U.S. and Canada; orders only):  1-800-743-0974

Phone (worldwide):  +1 541-344-7438

Fax:  +1 541-344-1422


E-News subscription questions or problems

Editorial submissions, questions or comments for E-News

Editorial for print magazine

Conference

Advertising

For all other matters

All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.


Midwifery Today E-News is published electronically every other Wednesday. We invite your questions, comments and submissions. We'd love to hear from you! Write to us at: mtensubmit@midwiferytoday.com. Please send submissions in the body of your message and not as attachments.


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 or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. 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.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

© 2009 Midwifery Today, Inc. All Rights Reserved.


Midwifery Today: Each One Teach One!