Hi Astra
Thanks for the further details
In this case I would suggest (not having been in the room at the time) that
there was obviously unwarranted interference and the midwife would seem to
have compounded the problem of OP instead of helping.
If the woman was a primip, 'pushing back the lip" rarely works well. I have
sometimes done this with multips who have a stretchy cervix, if they are
getting tired and wanting to 'get on with it' and have felt the baby descend
and rotate quite magically, but to do both procedures under the
circumstances you describe sounds quite mad - what was she trying to prove??
If the woman was making good progress as you describe the best thing would
have been to leave the membranes intact - this allows better rotation of the
head in any case - and WAIT. Pushing 'cause you are now 10 cms' is very old
and not good practice (as I said before) and I have often seen where someone
has apparently pushed a lip back only to find it had returned after the poor
woman has pushed valiantly against her own instincts (being directed to do
so) and yes, they do get exhausted!
Waiting for physiological urges to push gently gently will accomplish far
better results as the baby will be being rotated slowly as he is descending.
A stubborn lip of cervix - as sometimes happens with OP's - is best dealt
with by encouraging the woman to breathe through, perhaps in left lateral or
hands/knees position until the head reaches the pelvic floor and she will
naturally push strongly once the lip has gone.
Funnily enough this was similar to what happened to me with my 2nd bub (1st
VBAC) My midwife colleague was so keen to deliver my baby having been with
me all night, that she held the lip up 'got me pushing' and determined to
stay on duty until I had birthed! I remember wishing she would get the hell
away and go home, but like a good girl I tried to do what she wanted -
second midwife was trying to persuade her to let me be but she was very
determined! I don't think she tried to rotate the bub (who was by then OT)
but had her fingers in my poor peri the whole time! ( something I have
NEVER done since!!) I pushed for 1 1/2 hours with the doctors clanging the
forceps outside the door (great VBAC practice huh!!) He eventually emerged
after a LARGE epis and I was so exhausted that I couldn't even register the
fact that it was over - snored loudly while being sutured.
I still wish she had gone home and left me to the oncoming shift, I know I
would have birthed much better if he had been left to descend and finish
rotating in his (and my) own good time.
Thanks for sharing your experience - learn from everyone but decide for
yourself :-)
Sue
----- Original Message -----
From: <[EMAIL PROTECTED]>
To: <ozmidwifery@acegraphics.com.au>
Sent: Wednesday, June 28, 2006 8:11 AM
Subject: Re: [ozmidwifery] Manual rotation
Quoting Susan Cudlipp <[EMAIL PROTECTED]>:
Did this incident cause some adverse outcomes?
Regards, Sue
Thanks for everyone's reply's.. Yes, this particular time, the outcome was
forceps and a third degree tear which obviously not a direct result of the
manouvre, but from the maternal exhaustion which ensued. In this case I
think,
it wasn't just the procedure, but the reasons for, and manner in which it
was
done. The midwife suggested it to the woman as a means of speeding up her
labour (even though she was nine cm and had only been in the hospital for
two
hours!!), and had already performed an ARM for the same reason. She
suggested
that she could push the cervix back that last cm and rotate the baby, to
save
the baby doing so, and thereby reducing the overall time of the labour!! I
couldn't believe what I was hearing! The woman agreed (???!!!) and this went
ahead, with the woman instructed to push afterwards as she was apparantly
now
10 cms. When no head appeared in due time, the woman was checked again and
it
was discovered that the cervix had gone back to 9cm.(suprise suprise) This
scenario was repeated several times, with the woman encouraged to actively
push
in between. She eventually was so exhausted that the same midwife determined
that forceps would be required... etc etc.Why not leave well enough alone in
the first place? Anyway, the question I really wanted answered was that of
safety. Obviously this was not a good illustration of appropriate of
necessary
use of this kind of technique, but my dilemma is that I have been told on
the
one hand that this kind of thing is dangerous and unnecessary, and then I
read
about it in Mayes, and several of you have replied that it is something you
would do on occasion. I guess this is something I need to look into further.
Thanks for all your help, regards, Astra.
----- 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
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