February 18, 2015
Volume 17, Issue 4
Midwifery Today E-News
“Shoulder Dystocia”
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Want to know more about shoulder dystocia? You need the Shoulder Dystocia Package!

When you order this package you’ll receive The Shoulder Dystocia Handbook, the Shoulder Dystocia and Malpresentations Audio CD and Midwifery Today Issue 103, which has the theme of Shoulder Dystocia. This is a great way to learn more about this important topic and would make a welcomed gift for an aspiring or student midwife. To order

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In This Week’s Issue



Eugene conferenceJoin us in Eugene!

Plan now to attend our conference in Eugene, Oregon, this March. You’ll be able to learn from teachers such as Elizabeth Davis (pictured), Robbie Davis-Floyd, Gail Hart, Fernando Molina, Sister MorningStar and Michel Odent. Choose from a wide variety of classes including full-day classes on Midwifery Skills, Breech Birth and Essential Oils.

Learn more about the Eugene, Oregon, conference.



Quote of the Week

Bad times have a scientific value. These are occasions a good learner would not miss.

Ralph Waldo Emerson


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The Art of Midwifery

During any type of shoulder dystocia, inlet or outlet, an arm behind the back makes it harder than expected to bring the baby out. Whatever your favorite technique is, the technique will be less likely to succeed until you get that arm over the baby’s chest.

Gail Tully
Excerpted from “Arm Behind the Back: A Shoulder Dystocia Complication,” Midwifery Today, Issue 103
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.


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Editor’s Corner

Motherbaby’s Needs

The birth process is an almost perfect design. Midwives and doctors are invaluable, but if we stay out of the way and let the almost perfect process unfold, we do the least damage. Each birth worker needs skills, knowledge and intuition to know how to help and to know when help is really needed.

The new research on the microbiome is giving us more evidence to understand what midwives were called by God to do in the first place. When there is confidence and an absence of fear surrounding birth, only a small percentage of women need interventions. Midwives and doctors can and do save lives, but the medicalization of the process has also taken lives and left many mothers and babies scared of birth and scarred for life. Our work is serious business. We have the lives and lifetime welfare of motherbaby in our hands. It is time to learn all we can about what we need to do and what we need not to do. Midwife Nicky Leap says, “The less we do, the more we give.”

Let’s look at our birth routines and take into account that important first hour, realizing it belongs to the motherbaby. It is their time to be skin-to-skin, to bond and to allow the mother time to give her prize microbes to her new baby. Michel Odent says it so succinctly: “Do not disturb the mother.” We, of course, don’t want to disturb the baby either, both in labor and in that first critical hour after birth.

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Conference Chatter

We are excited to be getting ready for the Eugene, Oregon, conference, which will take place March 18–22, 2015. This is going to be a great event as speakers and registrants join together to learn, share and receive new insights. We always have an amazing time and with this conference’s theme being “Birthing with Love Changes the World,” we will give and gather much love. At this event, we have Gail Hart and Elizabeth Davis doing a half-day session on the topic of shoulder dystocia. With these two talented teachers, you will learn about how to deal with this important and sometimes frightening complication. If you are unable to join this class, you can bring up the subject in the Tricks of the Trade circle, which is always a favorite session.

We have our Bad Wildbad, Germany, conference program ready now. You can see the program here. This beautiful location in the Black Forest, with stunning spas for afterhours soaking, is a perfect place to bring your family to vacation while you attend the conference. Robin Lim will be with us, as well as a whole list of fantastic teachers. Great classes, a beautiful location, wonderful teachers and relaxing spas—what more could you ask for in a working vacation?! Please share this link with your network: http://www.midwiferytoday.com/conferences/Germany2015/

Toward better birth,
— Jan Tritten

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Featured Article

How Being a Homebirth Midwife Enabled Me to Learn about Shoulder Dystocia

Back in 1970, if you wanted to be a midwife, there were very few options for training. There were two nurse-midwifery education programs then, but since I didn’t live in New York City or Jackson, Mississippi, I had no way of knowing about them. I just knew that I wanted to be a midwife. I was lucky to have the opportunity to witness the most gorgeous birth anyone could possibly have, and that birth launched my quest to become a midwife. Those who have read already know that my initial training came from a short seminar from a kind obstetrician whom I met on the caravan I traveled with at the time. That quick course in emergency birth assistance was later supplemented by the relationship that I developed with Dr. John O. Williams, Jr., a local family practice doctor who lived near the place where my friends and I finally settled and where we started the community that we still call The Farm. Sixteen years of being the main access to medical care for the local Amish community had taught Dr. Williams that homebirth was nothing to be afraid of, as long as you were alert to early signs of complication.

This may sound strange to today’s readers, but Dr. Williams taught us that the way to deal with shoulder dystocia was to deliberately fracture the baby’s clavicle. He remarked that this intentional injury could save the baby’s life, that the fracture could quickly heal and that it was an injury that was preferable to a brachial plexus injury, since the latter injury was sometimes a permanent one. I remember wondering if there might be some way to avoid having to take this route with a difficult birth.

I had been attending births for a little more than six years when some members of my community and I made our first trip to Guatemala to do relief work after a massive earthquake had ravaged the country some months earlier. It was there that I met the local district midwife, Etta Willis, whose job it was to supervise the traditional comadronas (midwives who attended virtually all of the births for the highland Mayan women). It was Etta who told me that the comadronas had a better way of dealing with shoulder dystocia than the methods she had been taught in midwifery school. All you had to do was help the mother into a hands and knees position and the previously stuck baby would be born. (Please note that I later learned that sometimes it’s necessary to rotate the baby’s posterior shoulder into the oblique position, but the hands and knees position makes this easier to accomplish than when the mother stays on her back.)

Ina May Gaskin
Excerpted from “How Being a Homebirth Midwife Enabled Me to Learn about Shoulder Dystocia,” Midwifery Today, Issue 103
View table of contents / Order the back issue


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Website Update

Read this article excerpt from the Winter 2014 issue of Midwifery Today magazine, now on our website:

  • Preeclampsia and Nutritional Priorities—by Michel Odent

    Excerpt: “What about Homo sapiens, the member of the chimpanzee family with an enormous highly developed brain? The spectacular brain growth spurt during the second half of fetal life is a specifically human trait. A conflict between the demands of the fetus and what the mother can provide without creating her own imbalances leads us to consider first the needs of the developing brain.”


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Birth Q&A

Q: Please tell us about a shoulder dystocia you experienced and how you resolved it.

— Midwifery Today

A: The Gaskin maneuver always works for me. I had to repeat it twice on an 11 lb baby with its hand on its back, but it worked. I have had lots of shoulder dystocias. I had a student who needed to learn about them I guess. In the three years she was with me, we must have had 20, and I’m not talking about just sticky shoulders.

— Deb Phillips

A: First, I usually try McRoberts as I have dislodged ordinary shoulder dystocias like that most easily; this is most effective when mom is flat on her back with pillows under her bum (I have seen it done in hospital very ineffectively without this). Talk to baby and tell her what you are doing. Gaskin helps but it depends on how stuck the baby is! Movement is key. Depending on which side seems to need more room, I have the mom lunge into a chair or get into the running start position. It is often quite intuitive after assessment because I am praying under my breath while I’m trying to solve the problem. Sometimes I think of things that are not in the books or I have never heard of! I always pray “clean hands and pure heart” on my way to every birth so I can be heard and hear clearly from my God. Never pull on heads!

— Carol Gautschi

A: I’ve had a few shoulder dystocias over the years, but only 2 gray hair-inducing kinds. Most women I assist are not on their backs, which always helps to avoid a shoulder dystocia. One I had took 20 minutes with a 12 lb baby. It was the mom’s ninth. I tried everything: hands and knees, McRoberts, squatting. McRoberts finally worked with mom not pushing and someone giving supra pubic pressure in the direction I was trying to turn the shoulders. The baby needed resuscitation and we transported by ambulance. The baby breathed spontaneously when the ambulance was t-boned in an intersection halfway to the hospital, which was located 45 minutes away. My daughter was bagging the baby when they got hit and that’s when the baby started crying. I think it scared the crap out of her and scared her into breathing. She’s 18 now and doing just fine. They discharged her the next day. The other was a 13 lb 8 oz baby girl. Same thing happened with her. We tried it all then did the same thing with McRoberts and supra pubic pressure in the direction we were trying to turn the baby. She came out and only needed some rubbing. All of us in the room needed to be resuscitated when we saw how big the kid was. No tears—not even a skid mark.

— Mary Bernabe

A: I had just gotten back from a Midwifery Today conference where I attended a shoulder dystocia workshop. The doctor wanted to do a c-section because the mother was 42 weeks and a few days; they thought the baby was too big and they told her she might have a dystocia. I went over all the maneuvers in my sleep with my hands. During labor, the mother was in the tub on hands and knees. She was rather big and the water was not deep enough to have her turn or maneuver without the baby’s head coming in and out to the air. I had the mom carefully stand and climb out of the pool without dipping the head back in the water. Then I tried having her crawl, then I used McRoberts, then back to hands-and-knees, lunging into the sofa in between. Head discoloration was looking bad and no external tricks were doing anything. I went in for the one arm, but I couldn’t slip my hands in, so I went in for the other. It was tight in there and I felt like I was wrestling with the angel of death. Being careful to go with the direction of baby’s body, I swiped one arm against the chest, but still the head wouldn’t come out so I went for the other arm as well. Mom did tear and baby took a while to come around. For a few days, her one arm was looser, but thank goodness she was soon firmly grabbing with both hands and absolutely perfect.

— Marva Zohar

A: I have the mom get on her hands and knees, then I deliver the posterior shoulder first and have mom squat next if needed.

— Gail Johnson


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