I read a lot of midwifery, medical and related journals each month (and then create our annual Gathering in the Knowledge online course to summarise the best and most relevant of those for your practice so that you don’t have to) and one of the things that I most love is coming across a really useful, practice-related paper that I know will be a great basis for discussion.
So when I saw the title, “Shoulder shrug maneuver to facilitate delivery during shoulder dystocia” on a paper in Obstetrics and Gynecology, I went right to it, and was really excited to see that it was Open Access, which means you can also see the full article even if you’re not a subscriber.
In the article, Ronald Sancetta and colleagues describe a technique that they call ‘shrugging’ the shoulder as a way of helping a baby get born. For those of you who aren’t midwives or doctors, when you’re faced with a baby whose head is born but whose shoulders are truly wedged, then you try all sorts of things, and our emergency training courses feature a whole array of manoeuvres. In their article, Sancetta et al (2019) describe three births in which they successfully used their shoulder shrug technique after the McRoberts manoeuvre didn’t work.
Now, I do have a couple of big questions about this. One is that the authors don’t mention asking the women to get on all fours at any point, and I suspect that perhaps this might have worked too, but we’ll never know. It is always important to consider the context of birth-related research and thinking, and this paper is written within the context of US-style, obstetrician-led birth, where women lay on their backs and are ‘delivered’. But even if we don’t advocate the approach overall, individual techniques and manoeuvres that are developed within it may still, on occasion, be useful to know.
One other thing to note is that I am really confident that there will be other midwives and obstetricians who have tried and successfully used something like this before, which is great, and I know it may not be new to you. But the important thing is that, as Sancetta et al (2019) have done, we don’t just talk about the things that have worked for us; we write them down, describe what we’ve done and reflect upon them so that others can try them too, or at least just be aware of them as one more potential tool.
Sancetta et al (2019) have gone one step further and made a video to demonstrate the technique and to show clearly what they are doing and I found this a helpful addition to their article. Yes, that was also created in the US obstetric context, so it has a disembodied woman who is lying on her back and thus her sacrum isn’t free to move. You may like to try turning your laptop upside down or, as I did, putting your phone on the floor and then going round to the other side to watch the video!
There is no suggestion that this is the only or best way to approach shoulder dystocia. This isn’t a ‘one ring to rule them all’ sort of problem. We need a kitbag full of things that we can try, so I’m sharing this as one more tool that we can consider, discuss, reflect upon, analyse and then maybe store away just in case, one day, we encounter a situation for which it is the solution.
This was my ‘study of the month for May 2019 in our free Birth Information Update. If you’d like to get our free monthly update as well as news about my books, events and online courses, you can sign up here.