As a midwife for the past 35 years and supporting women using water since 1989 I am well aware of the dramatic changes that are ignited if shoulder dystocia occurs during birth. A calm and relaxed environment alters to a full “all hands on deck” if the babies shoulders fail to rotate.
It is rightly seen as a medical emergency where time is of the essence for the safety and wellbeing of mother and baby. Whilst it is vital that we recognise risk factors and warning signs, many occur without warning and thus the skills of practitioners are vital. Waterbirth adds an extra element to this scenario – on the positive side water encourages freedom of movement, position change and buoyancy which may assist in actions to deal with shoulder dystocia. When the mother moves in the water she alters her hormones (more adrenaline produced in an emergency) movement alters the shape of her pelvic outlet and if standing up has gravity to also assist.
Water, on the other hand, means that a quiet calm relaxed environment, with a “quiet observer” practitioner needs to alter their tone and language during this emergency. I call it changing from Mrs Fluffy Bunny to Mrs Assertive, to ensure engagement with the women and break through the zoning out (deep relaxation) many women experience in water.
Another guiding principle I teach is that if I have never met the mother before, I explain that if I ask her to stand I mean it now not after a 15 minute conversation. As already said time is of the essence in shoulder dystocia. In all the years I have supported women in water I have never had a mother who would not nor could not stand for me.
The leaflet I have designed with Edel Immersys reminds us of the risk factors and warning signs, but I believe as a practising midwife the percentage is important to remember. UK stated figures 0.58 – 0.7% and USA 0.5-1.5%, higher figures in USA have never been fully explored. Type of labour and birth management, known care giver and place of birth are rarely mentioned as a rationale for difference.
So finally, whilst shoulder dystocia is concerning to colleagues one other way to support mothers when this occurs is to teach the 5 steps in the leaflet and as a skills drill as shown below.
Dianne Garland SRN RM ADM PGCEA MSc
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