Management of true shoulder dystocia at attended homebirth.
At attended homebirth, shoulder dystocia poses less of a challenge and has better outcomes compared to hospital birth. If you don't panic, but do call someone into the room to help you with suprapubic pressure if needed and run thru the maneuvers systematically, you will get the baby out by six minutes avoiding damaging long-term consequences. At hospital birth, it is estimated to take a minimum of two minutes to turn the woman onto all fours from the usual position in a hospital bed while connected to a monitor, IV and epidural. An epidural anesthetizes the woman making it impossible to push optimally. Epidural also anesthetizes the baby, making spontaneous breathing less likely and making resuscitation more challenging. Suprapubic pressure is difficult at the height of the hospital bed, so time is lost while the bed is lowered. Vacuum and forceps vaginal deliveries, which are not used at home-birth but accompany about 8% of hospital births, are independent risk factors for true shoulder dystocia.
judyslome@hotmail.com
Judy Slome
JS
Cohain
D004420:Dystocia / Q000451:nursing*; D005260:Female; D006700:Home Childbirth / Q000451:nursing*; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D008880:Midwifery / Q000379:methods*; D009321:Natural Childbirth / Q000451:nursing*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010358:Patient Participation; D056888:Patient Positioning / Q000451:nursing*; D011247:Pregnancy; D012782:Shoulder; D055815:Young Adult