Gaskin described a maneuver for the resolution of shoulder dystocia that involves placing the gravid mother on her hands and knees.
Shoulder dystocia is a specific case of obstructed labour whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis. The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The aetiology of injury to the fetus is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. Shoulder dystocia is seldom predictable. This is a condition in which the head is born but the anterior shoulder cannot pass under the pubic arch. It can be defined as difficulty in the birth of the shoulders, or impaction of the shoulders. The vast majority of shoulder dystocias are resolvable by effective maneuvering. In 1976, Ina May Gaskin described a maneuver for the resolution of shoulder dystocia that involves placing the gravid mother on her hands and knees. (Bruner, 1998) used this procedure in 82 deliveries complicated by shoulder dystocia and was able to resolve it in 68 cases (82%) with this maneuver alone. While it is incumbent upon all obstetricians to know about the Zavanelli maneuver and how to perform it when a difficult shoulder dystocia occurs, its significant potential for fetal and maternal injury must relegate it to the status of a last ditch procedure. (1) Shoulder dystocia cannot be predicted with any degree of accuracy and (2) Shoulder dystocia cannot be prevented by any specific strategies or maneuvers. (1) The baby's body does not emerge with standard moderate traction and maternal pushing after delivery of the fetal head. While it is incumbent upon all obstetricians to know about the Zavanelli maneuver and how to perform it when a difficult shoulder dystocia occurs, its significant potential for fetal and maternal injury must relegate it to the status of a last ditch procedure. Signs and symptoms [edit]. One characteristic of a minority of shoulder dystocia deliveries is the turtle sign, which involves the appearance and retraction of the fetal head (analogous to a turtle withdrawing into its shell), and the erythematous (red), puffy face indicative of facial flushing. The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The aetiology of injury to the fetus is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. When a shoulder dystocia is recognized, it is generally agreed McRoberts maneuver and suprapubic pressure should be implemented rapidly and simultaneously. These by themselves will resolve more than half of all shoulder dystocias. If the shoulder dystocia persists, other maneuvers can be performed in any order. While it is incumbent upon all obstetricians to know about the Zavanelli maneuver and how to perform it when a difficult shoulder dystocia occurs, its significant potential for fetal and maternal injury must relegate it to the status of a last ditch procedure. Shoulder dystocia is a bony impaction, so episiotomy alone will not release the shoulder. Because most cases of shoulder dystocia can be relieved with the McRoberts maneuver and suprapubic pressure, many women can be spared a surgical incision. Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. 1 McRoberts maneuver; The McRoberts maneuver is employed in case of shoulder dystocia during childbirth and involves hyperflexing the mother's legs tightly to her abdomen. 2  This widens the pelvis, and flattens the spine in the lower back (lumbar spine). The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The aetiology of injury to the fetus is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. The Gaskin Maneuver, also called all fours, is a technique to reduce shoulder dystocia. Gaskin introduced it in the U.S. in 1976 after learning it from a Belizean woman who had, in turn, learned the maneuver in Guatemala, where it originated. In this maneuver, the mother supports herself on her hands and knees to resolve shoulder dystocia. Ina May Gaskin at Nambassa 3 day Music & Alternatives festival, New Zealand 1981. Ina May Gaskin, CPM, (born March 8th, 1940) has been described as the mother of authentic midwifery .. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. Shoulder dystocia is an obstetric emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal. The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The aetiology of injury to the fetus is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury.
https://en.wikipedia.org/wiki/Shoulder_dystocia http://www.caroldenny.com/index.php?option=com_content&view=article&id=129:shoulder-dystocia&catid=65:special-circumstances-and-complications&Itemid=78 http://shoulderdystociainfo.com/resolvedwithoutfetal.htm http://shoulderdystociainfo.com/resolvedwithoutfetal.htm https://en.wikipedia.org/wiki/Shoulder_dystocia http://shoulderdystociainfo.com/resolvedwithoutfetal.htm http://www.aafp.org/afp/2004/0401/p1707.html https://en.wikipedia.org/wiki/Shoulder_dystocia https://en.wikipedia.org/wiki/Ina_May_Gaskin https://en.wikipedia.org/wiki/Shoulder_dystocia
what is gaskin maneuver shoulder dystocia