March 2, 2016
Volume 18, Issue 5
Midwifery Today E-News
“Shoulder Dystocia”
Print Page

In This Week’s Issue

Learn about shoulder dystocia

e-bookOur e-book, Shoulder Dystocia, features top-notch information from the brightest minds in natural childbirth. When you buy this book, you’ll be able to read articles such as “Shoulder Dystocia: The Basics” by Gail Tully, “Preventing Shoulder Dystocia” by Michel Odent and “How Being a Homebirth Midwife Enabled Me to Learn about Shoulder Dystocia” by Ina May Gaskin.

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Quote of the Week

Growth is painful. Change is painful. But nothing is as painful as staying stuck somewhere you don’t belong.

Mandy Hale

The Art of Midwifery

By bringing the arm around to the baby’s chest, the midwife reduces the baby’s diameter. The midwife may need to continue to bring the arm out to make the baby’s girth small enough for an android pelvis’s outlet. Midwives have many successful techniques for freeing stuck shoulders, but let’s keep in mind that the arm on the chest side of the baby will help make all our treasured techniques successful.

Gail Tully
Excerpted from “Arm behind the Back: A Shoulder Dystocia Complication,” Midwifery Today, Issue 103
View table of contents / Order the back issue

Midwifery Today Conferences

Are you ready for Uncommon Complications?

Mary Cooper and Fernando Molina will present ways to help you be more prepared for uncommon complications such as unusual bleeding, thrombocytopenia, meconium, neonatal jaundice, hematoma formation, signs of embolism and more. Learn how to manage these while keeping the family and yourself calm. Bring your questions and cases to study.

Learn more about the Harrisburg, Pennsylvania, conference.

Fiji conferenceJoin Suzanne Thomson and Carol Gautschi as they share their knowledge of breech birth

Suzanne and Carol will start the class with a discussion of how to turn a breech baby and what to do if the baby won’t turn. Palpation skills, estimating fetal weight, amniotic fluid, and how to communicate with the baby will also be covered. Frank, footling and complete breech will be discussed, as well as cord prolapse, fetal heart tones, intrauterine growth restriction (IUGR) and other complications of breech presentation.

This full-day Breech Skills workshop is part of our conference in Suva, Fiji, 20–24 June 2016..

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Editor’s Corner

Shoulder Dystocia

This can be one of the most devastating complications. Ina May Gaskin has given the world one of the most helpful techniques to resolve this. She gleaned her technique from midwives in Guatemala. It is now called the Gaskin Maneuver, and it involves turning over to hands and knees. I used this on one of the first births I attended and I do believe it was a lifesaver. The senior midwife had just learned that her ex-husband had been killed and I was there with another student midwife who couldn’t get the obviously stuck baby out. The baby’s head didn’t rotate, it turned purple and it retracted against the perineum. I said, “Monika, turn over to your hands and knees.” She did and out came the baby. The “baby” is now married with her own daughter and she is still a good friend of mine!

Gail Tully has also contributed solutions to this tough complication. She uses a mnemonic based on the Gaskin Maneuver to prompt recall of a list of techniques to resolve most shoulder dystocia types. She shows how understanding pelvic layers can match techniques for rotation and reducing the breadth of the shoulder girdle.

Resolving shoulder dystocia is a subject you want to keep studying and practicing until what you do is part of your muscle memory. Someone’s life may depend on your quick action and knowledge. The overriding principal is to never, never, never give up.

— 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

Your Birthing Toolbox

Do you have the tools to resolve shoulder dystocia in your birthing toolbox? If not, a Midwifery Today conference is a great place learn about procedures to resolve shoulder dystocia. Classes are presented at each conference in order to refresh your knowledge and experience regarding this challenging complication. Midwifery Today recognizes the need for the skills of dystocia resolution to be consistently offered at each event. The more you review the information, the more it will become part of your knowledge base on exactly what to do. This in turn will help you react quickly and with care, should mother and baby run into this hurdle.

The shoulder dystocia class at the conference in Harrisburg will be led by Gail Hart on Friday, April 8, at 1:30 pm. Not able to make it to the Harrisburg conference? No worries! Shoulder dystocia will be taught in Fiji and Strasbourg later in the year as well. Don’t let shoulder dystocia be the wrench in the cogs of labor. Register for a conference and continue to build your skills in natural childbirth.

— Oriona Turner, conference coordinator

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Featured Article

FlipFLOP: Four Steps to Remember

FlipFLOP is a memory tool listing four successful techniques to free a baby from shoulder dystocia, an emergency caused by one or both shoulders caught by the pelvis after the birth of baby’s head. In FlipFLOP, two well-known midwifery techniques combine with two effective obstetrical techniques for a step-by-step solution suited to helping an active birthing woman. In FlipFLOP, the four steps spell out the word flop like this:
  1. Flip the mom over with the Gaskin Maneuver
  2. Lift the Leg
  3. Rotate baby to the Oblique
  4. Bring out the Posterior arm

The F in FLOP
From Central American midwives, Ina May Gaskin learned that with shoulder dystocia, it is best to turn the mother over onto hands and knees. The success of this maneuver (and our love for the messenger) is revealed by the fact that this technique was named after Ina May and is now commonly called the Gaskin Maneuver. It is often the turning over onto hands and knees that frees the baby.

When a woman has been on hands and knees for the birth of the head, she has made the largest diameter for the pelvis, but a baby may still get stuck. Hands and knees won’t prevent every shoulder dystocia. The midwife needs to know that flipping the mother over to hands and knees, whether independently or with help, is the point of doing Gaskin’s—not being in that position already. If the mother is already on hands and knees with a shoulder dystocia, she can simply go on to the next technique in FlipFLOP: lifting her leg.

The L in FLOP
Lifting the leg puts the knee to the mother’s armpit and the foot flat on the floor (or mattress). This posture pulls open half the pelvis on the same side as the lifted leg. The mother looks like she may be in the starting position to run a race, so we call it Running Start.

The O in FLOP
Rotating the shoulder girdle of the baby into the oblique diameter of the pelvis was popularized by the insight of Woods in 1943. Later, Rubin reversed the direction of the dial, so to speak, to adduct the shoulders, thus reducing the diameter of the baby. I’ll discuss a hand placement that protects the baby’s bones from breakage.

The P in FLOP
Bringing out the posterior arm is an old technique that has recently gained much praise. With one arm out, the baby’s diameter is 20% smaller, and if the baby is still tightly impacted in the pelvic outlet, the baby’s anterior shoulder can be rotated 180 degrees and the other arm can then be brought out safely by the same technique.

Each of these techniques may succeed independently. But in this order, the least invasive actions, the Gaskin Maneuver and Running Start, put the mother in the most optimal position for steps 3 and 4, should they be needed.

Gail Tully
Excerpted from “FlipFLOP: Four Steps to Remember,” Midwifery Today, Issue 103
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Featured Products

Read about shoulder dystocia management, techniques and experiences

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Midwifery Today Back Issues have the information you need!

MT online store From second stage and prematurity to birth change and natural remedies, back issues of Midwifery Today print magazine are packed with informative articles that will help you improve your practice. You’ll also find inspiring birth stories, birth news, poetry and stunning black and white photography. Choose from these available back issues.

Prepare your body for birth

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Website Update

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  • The Newly Born: Gazing and Human Development—by Sister MorningStar

    Excerpt: There is a sacredness and long-lasting physical, psychological and spiritual eventuality to newborn gazing. By spiritual, I mean the will or spirit of the human creature. How do we protect the moment of birth in relation to gazing, in relation to the undisturbed, uninterrupted search of newborn eyes for maternal eyes?

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