Following on from shoulder dystocia thread - Klaw and other knowledgable people, can you expand on best positions for birth to aviod sd

[barbamama]

Hello, I have been meaning to post this for a while and the post about not being allowed a home birth due to risk of shoulder dystocia has reminded me.

I won't bore you with the details again but I had a previous sd last time (proper one I think, McRoberts manouevure etc - but in my opinion due to mismanagemnet of the labour not baby being too big). Anyway, about to give birth again in a couple of weeks, in a hospital unfortunately because of the sd last time, and I could do with some advice about what to do to minimise it happenning again.

Klaw, you wrote:
"Changing positions can allow the pelvis to open more to let baby out. Upright positions (not sitting) allow the pelvis to open up to 28% more and at the point of delivery the Rhombus of Michaelis moves back giving you 2cm extra room. Optimal foetal Positioning allows your body to do what it instinctively knows how to do and also allows your baby to do what it knows it needs to do.

Labouring with your pelvis in front of your hips and your hips higher than your knees gives your baby the easist path out. If rest is required then lying on your left side and right knee up but foot on the bed will be OK."

I can't quite visualise what you mean by this - how do I have my pelvis in front of my hips?. I definitely don't want to be lying down and feel I should be standing up but I am not sure what I should do at the end to get him out. Also, I can't quite see what/where I should be in the (small) hospital delivery room for optimum foetal positioning. I could lean against the bed but I am tempted to shove it in the corner so they don't make me get on it which caused the problems last time. I am wondering whether to put a sleeping bag on the floor or something and take my ball with me to lean against?

Any advice gratefully received!

[DaisyMOO]

baramama, I can understand how after last time you are worried about another shoulder dystocia, but personally I wouldn't worry too much about being in the 'right' position. The key thing is that pushing the baby out whilst on your back or half-seated reduces the amount of space for your baby to get out! If you go with whatever position you instinctively find yourself in, it will almost certainly be one which allows this extra space, such as on all fours, leaning over something or squatting. Thinking too much about what you are doing can actually have a negative effect and stop you finding the best position spontaneously and potentially slow your contractions down.

I think taking a sleeping bag is an excellent idea, or you could enquire about whether they have mats for you to put down on the floor - many hospitals do.

Hope that makes sense! I'm sure it will go well for you this time - trust your body!

[Klaw]

D'oh, I meant BELLY in front of hips!!!!

So sorry for confusion, must check what I'm writing more vigorously before hitting the post message button!!

Yes, shove the bed to the side, or brief birth partner to do it for you and perhaps stipulate this in your birth plan. Take your ball, for definite as you can do your pelvis tilts, rocks and circles on it. And you can sit on it and lean on bed for support. Also you can kneel and lean over the ball, you'll need cushioning for your knees. I couldn't see how to use the ball in hospital as thought my knees would hurt and because the bed was in the centre of the room, I got on it. hindsight...

But remember to keep hips in front of knees and definitely higher than knees. Gee I wish that this stuff was on the net so that I could just link you to it. It makes so much sense. But Jean Sutton says her granddaughter will hopefully doing it for a project soon.

This is NOT to say that if you don't do this and don't get baby in LOA position before labour starts that you are doomed! This is not the case at all but it seems very logical to me that by trying to make things easier for you and baby will give you a head start!

Have a look at this resource page Scroll down for some labour positions. Note the first standing one?... Jean has issues with squatting because we westerners are not practised in squatting and get too low with our knees not turned out enough. A supported squat so that the belly, pelvis, knee thing can still happen is better.

There's a lot to think about and it might be useful to get Jean's book if you think it makes sense to you and you wish to follow her thoughts. Here is a great page on the Homebirth site which describes things in more detail

As I said before, you mustn't let this take you over, be sensible about your posture and positive in your labour!

You CAN birth your baby!

[Klaw]

Too right DaisyMoo, let the animal take over, close down the rational brain! Is what I was needing to say when I said not to overstress about this!

[lulumama]

all fours , or supported squat ,is the short answer

the Gaskin Manouvre to resolve shoulder dystocia is to get the woman onto all fours...opens up the pelvis more

RCOG say to resolve shoulder dystocia, tehn the mcroberts manouevre should be done..legs up round the ears basically...

[barbamama]

Thanks everyone. That is really good advice. i do have a tendency to over analyse these things and I am feeling a bit paranoid about not being in control again but I do think it will be easier to trust my instincts this time. Last time my insincts were to stay standing up and I would have done if they hadn't pressurised me to get on the bed so I think this time I will really resist any pressure. I was thinking about a supported squat but not sure if this would be to much for dp? Maybe the half squat?

Thanks for the links Klaw - I think I will print out that page and take it with me! I just know I will forget it all but you're right, I need to let instinct take over - not easy for a control freak like me!

[DaisyMOO]

How about practising supported squatting with your husband beforehand and see how it goes and allow him to build up a bit of strength in his arms Or you can have two people supporting you, one on either side - another birth partner, a student midwife or any random stranger you can pull in off the streets

[mears]

barbamama - ask your hosital what equipment they have. We have floor mats, birthing balls, bean bags and birthing pool.

Please don't worry that the midwives will resist your request to avoid using the bed - they will probably be very happy.

I myself get disappointed when women INSIST on using the bed myself. I agree that the design of delivery rooms is poor and then bed is often the main feature. Often you can't push it out the way well because it blocks access to a cupboard or something!

If for some reason you do find yourself on the bed, just avoid the sitting upright position. Go on all fours or even on your side. HTH.

[Mintpurple]

Barbamama

I agree that keeping upright is the key but in my (admittedly quite medicalised) unit, most of the midwives will not use alternative positions but insist on semi-recumbant, due to various excuses such as 'Im too old and fat for that and cant get up from the floor' to 'Im scared Ill drop the baby', to 'I cant see what Im doing).

So, ask if the midwife you are allocated is happy to do standing or alternative delivery positions and if not, ask for a midwife who is, they are usually more than happy to swap around!

Klaw - great links once again, thank you.