Re: [ozmidwifery] Manual rotation

[Susan Cudlipp]

Hi Astra I have used this in the past having been shown it by (even) older midwives, but not for many years.  I had mixed success with it, there's no doubt that it can help on occasions, as with all these "old skills" some situations require a bit extra and if a midwife is alone she needs to use all the skills known to her (or him - sorry).  I have not had a situation in which to think of it for a very long time.  OP's mostly rotate after full dilation and when they begin to descend, so trying to rotate them prior to that or when they are still high, seems pointless now.  It seems to me to be part of the old "you are fully now so let's get you pushing" scenario which I no longer practice. Physiological pushing when the woman feels the urge will accomplish rotation in most instances. If a woman is pushing as directed by her own sensations and has a baby in OP it will often take a long time to bring the baby into view because she is pushing him around gently - I rarely see a persistent OP these days, don't know when I last caught or saw a 'face to pubes' bub.   =I witnessed a digital rotation, or manual rotation of the baby of a woman in late first stage of labour, and a cascade of issues followed.= Did this incident cause some adverse outcomes?    Regards, Sue   ----- Original Message ----- From: Astra Joynt To: ozmidwifery@acegraphics.com.au Sent: Tuesday, June 20, 2006 6:31 PM Subject: [ozmidwifery] Manual rotation Hi eveyone, I am a first year Bmid student who has recently joined the list, and have been getting a lot out of reading the posts on various subjects. Now I'm wanting to ask advice on an issue that I have been trying to resolve since early on in my clinical experience. Without going into the whole story, I witnessed a digital rotation, or manual rotation of the baby of a woman in late first stage of labour, and a cascade of issues followed. In debriefing with my lecturers at uni, I was told this is not good or safe practice at any time. I then witnessed the same midwife perform this procedure again a few weeks later. Debriefing with a clinical educater, I was told it is an 'old skill', and certain very experienced midwives still practice it. Then my clinical supervisor refuted this and said it is dangerous and has no place in midwifery practice.This is a very brief summary of these conversations, but I hope you get the gist. Anyway, I was happy with this, until I read in Mayes Midwifery the other day that this procedure can be used to help turn a posterior baby!! I am completely confused! Safe, or not? Evidence based, or not? I would really appreciate any light cast on this subject... and just in case no one knows what I mean by digital rotation (if this is not the common term for it) It is the midwife using her fingers internally to sort of hook the baby's head (cervix fully dilated I guess, or close to it) and turn it into a more optimal position, using her own strength and accompanied by the woman actively pushing. I just want to also say that I know this is not something that should be occuring in any normal straightforward birth, but what other information or experience to you have,                                                              warm regards, Astra No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.9.1/369 - Release Date: 19/06/2006