There is an interesting research paper ( a retrospective study of shoulder
dystocia) that among other things suggests the incidence of mild/moderate
shoulder dystocia increased during the 80's and early 90's in the UK (and
hence a rise in brachial plexus injuries) due to women moving to beds to
give birth. When they did this, midwives had to resort to pulling on the
head to release the shoulders and over time it became convention and
practice. McNabb's paper, by inference, suggests this is not necessary when
women give birth in upright postures. The reference is:

Mortimore VR. McNabb M. A six-year retrospective analysis of shoulder
dystocia and delivery of the shoulders. Midwifery. 14(3):162-73, 1998 Sep.
(54 ref)   Abstract | Complete Reference

Denis Walsh
Lecturer in Midwifery
De Montfort University
Leicester, UK

----- Original Message -----
From: "Anne Schnedl" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, May 19, 2000 10:59 PM
Subject: Re: Fw: obstetric brachial plexus injuries


> Hi all!
>
> I'm coming out of lurk-dom to let you know that the O'Leary's (I presume
father and son - doctor and lawyer, respectively) have a web site:
>
>  http://www.shoulderdystocia.com
>
> It's directed at parents/laypeople, primarily.
>
> Anne Schnedl, CNM.
>
> [log in to unmask] wrote:
>
> > As a new member of the research mailbase, I am very interested in your
comments.  Having been a nurse-midwife for 26 years in the US, I am very
interested in the questions you raise.  Last year I had the opportunity to
observe for two days at the John Radcliffe hospital in Oxford.  I was very
pleased to see that the midwife waited for another contraction after birth
to attempt to deliver the shoulders.  Most physicians in the US try to
deliver the shoulders immediately after the head is delivered (unfortunately
many midwives do as well because they are working in that "culture").  When
one does this, one does not have the uterus working with the provider to
deliver the shoulders and body resulting in much struggle and pulling.  One
"hurry everything up" physician I used to work with swore that he had a
shoulder dystocia a week!  and on small babies!  Unfortunately, it is a
difficult issue to research because of its infrequent occurrence.  In my
experience, I strongly belie!
>  ve!
> !
> >   t!
> > !
> > hat anything that contributes to poor contractions in the second stage,
contributes to should dystocia.  I highly recommend encouraging women with
large babies to be up or side lying thru most of second stage.
Caldyro-Barcia documented shorter but more intense contractions when mothers
were side-lying.  I am sure that epidural contributes to this problem.  Do
you have access to Medline or Pubmed?  also, you can reach the Center for
Disease Control at CDC.gov.  Let me know if you do not have access to those
sites and I will see what info I can get for you.
> >
> > In the US, it is often see as a status issue to have a physician even
though the care is very different.
> >
> > Also, Helen Varney Burst is very interested and has presented on the
topic.  Have  you seen "Shoulder Dystocia and Birth Injury: Prevention and
Treatment" by James O'Leary? 1992 by McGraw-Hill.
> >
> > Good luck,  Judy
>
>



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