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Shoulder Dystocia - a midwifery action wheel

Abstract:

A recent experience with the unthinkable, that a baby could die, and that I might not be able to help the mother birth her baby because its shoulders were stuck, is the subject of this analysis. This has been my most challenging encounter with shoulder dystocia, and its impact has had a significant influence on me, as a midwife and on how I view my midwifery practice. As a corollary of this experience, a thorough investigation into this phenomenon became imperative, so that I could put reality into perspective, and make some sense of the unpredictable nightmare that is shoulder dystocia. I am now able to put the incident into a framework that will not influence my practice in an irrational and paranoid manner, but add to my quest for ongoing growth of practice wisdom. This article describes the midwifery management of shoulder dystocia by the presentation of an action model that I have developed in the form of a wheel. My specific focus is the needs of midwives who are practising in the home or in birthing facilities without access to immediate medical emergency services.

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mnemonics, positional changes, rotational manoeuvres, shoulder dystocia