Friday, September 12, 2014

Shoulder Dystocia

Shoulder dystocia occurs after the baby's head had been birthed, when the shoulder is pinned behind the pubic bone and unable to pass underneath.  After the head is out, the body is normally born within the next one or two contractions.  Try to remember that if the head is able to pass through, SO CAN THE SHOULDERS.  The head is much larger than the shoulders, and all that is usually required is for the mother to change positions so as to encourage rotation of the shoulders.

My personal preference is the squatting position.  According to Janet Balaskas, "When the mother squats, the sacrum is free to move, allowing the interior-anterior diameter of the pelvic outlet to widen by as much as 30 percent more than it would if the mother's weight were resting directly on it - that is, if she were semireclining.  The sacrococcygeal joint, the joint between the sacrum and the coccyx or tailbone, also softens in pregnancy; it is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges.  Of course, this is impossible if the mother is sitting on her coccyx" (1).

In other words, as the tailbone moves back, there is more room near the pubic bone for the baby to pass through.  If for some reason this position is not possible or does not work (which I doubt), the next position I would try is hands-and-knees.  The shoulder is often dislodged simply by assuming this position.  If not, a helper can try what is called the screw maneuver.  That is, if the mother is not opposed to this intervention.  In this maneuver, the helper simply puts two fingers under the baby's armpit and rotates the baby counterclockwise, or left, until the shoulder is dislodged (2).

My own personal opinion is that the body is perfectly able to birth the baby in the squatting position, which is preferable to intervention whenever possible.

(1)  Balaskas, Janet.  (1992).  Active Birth:  The New Approach to Giving Birth Naturally.  Boston:  The Harvard Common Press, p. 15.
(2)  Davis, Elizabeth.  (1987).  Heart and Hands:  A Midwife's Guide to Pregnancy and Birth.  Berkeley:  Celestrial Arts, p. 111.

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