Answer: Since I only deliver babies on the floor, a hard surface, if the baby’s head is out, but the shoulders are too big to slip under the pubic bone, I pull mom down into a lying down position. Then I tell her to pull both her thighs upwards and outward as far as they can go. While in this position, I ask her to push really hard while I carefully press down on the baby’s head to release the shoulder that is stuck under the pubic bone. Doctors and trained midwives also get mom flat on her back with her knees pulled back as far as they can go while they press down on the baby’s head to free that shoulder from under the pubic bone.
I’ve tried Ina May’s hands and knees position, what she calls the Gaskin Maneuver, but it doesn’t work nearly as well as this position, in my opinion! It was taught to me by a local Las Vegas Obstetrician many years ago.
In water it is really difficult to get that shoulder to release because the head has to be able to drop down with the help of gravity and the water prevents that from happening like it does in an air birth.
Shoulder dystocia happens in about 1 in every 200 births.
Shoulder dystocia is a medical emergency. When the baby is stuck, they cannot breathe and the umbilical cord may be squeezed. They will need help to be born quickly so they can get enough oxygen. It can also cause a fracture of the baby’s collarbone or upper arm, nerve damage affecting the shoulders, arms, hands or fingers, brain damage or speech disability. Sadly, there is a risk that lack of oxygen during birth can lead to brain damage or even death.
As seen in the following picture, when I encounter a shoulder dystocia, as I said, I get mom in a strict flat on her back position on the floor (has to be a hard surface, not a soft bed and definitely not in water), pull her knees up as far as they will go, and while I am pressing down (carefully) on the baby’s head, my assistant puts fundal (top of the uterus) pressure in a downward direction. I have gotten many “stuck” babies out this way without any harm coming to them.
Doctors are telling mothers not to push when there is a shoulder dystocia, but they tell a nurse to put fundal pressure (on top of the uterus) and another nurse to put supra-pubic pressure by the pubic bone (like in this picture) and PUSH the baby out. Why can’t the mother push then? Such contradictions. I always have the mother push as hard as she can when her baby is stuck. If the baby doesn’t come with her pushes, we help by doing what the nurses are told to do in the hospitals. Mothers helping push are completely necessary!