Leading Independent NewsPaper
for the Obstetrician/Gynecologist
Vol. 32, No. 22 Published November 15, 1997
Midwife Presents Solutions toBY SHEILA STAVISH
Arrested Second-Stage Labor
San Francisco Bureau
VA N C 0 U V E R - For arrested secondstage labor, there are several simple maneuvers that can be very effective, said Caroline Buttner, director of midaifery at Rochester (N.Y) General Hospital and a member of the state's Midwifery Board.
She gave three examples at the annual meeting of District 11 of the American College of Obstetricians and Gynecologists.
Hydrotherapy. "Virtually every lowrisk patient of ours gets [in] a shower or rub to help the pelvis relax," explained Ms. Buttner, who is a certified nurse-midwife.
What warm water can accomplish was illustrated by the case of a 25-year-old gravida I with arrested second-stage labor. After an hour in the tub, the woman was fully dilated and ready to push.
The Towel Trick. Another way to relax the perineum and to create a pelvic curve that the fetal head can more easily negotiate involves playing tug-of-war with a knotted towel which helps create a pelvic curve to help fetal head progress.
The patient sits up on the bed with her knees maximally adducted and pulls as hard as she can on one end of the towel. The clinician, standing to the side of the bed, yanks on the other end. An alternative, which is easier on the clinician's back, is to use a sheet tied around his or her waist.
The first time she administered the towel trick, Ms. Burtner said, her exhortations to the patient to "pull, pull, pull" brought many mystified staff members to the doorway.
There is no risk of overstraining the pelvic muscles with this maneuver if the patient is limited to just three or four pulls.
Early on after nurse-midwives had been introduced into the department, the usefulness of midwife-style techniques like these impressed physicians and led to a n eventual turnaround in their attitudes toward the midwife profession.
In one case, an attending physician with surgical patients stacked up and a staued-out 25-year-old gravida 2, para I took Ms. Buttner up on her offer to help him out. The patient, who had been pushing for 30 minutes and had descended to +3, responded so well to the towel pull that the baby was delivered with the next contraction, to the relief of the mother and her harried physician.
Position Changes. A few examples of position changes are having the patient put one leg up, or sit on the toilet and push, or drape herself over an oversized hall normally used in back therapy The toilet is a natural place to bear down, Ms. Buttner said, and the birthing rooms' large bathrooms are designed to facilitate that use.
Since Rochester General incorporated midwifery principles into its obstetric care, records show an average decrease in the duration of second-stage labor, an increase in the proportion of vaginal births, and a reduction in the number of episiotomies, Ms. Burtner said.
Contributing to the shortening of labor is the practice of not giving epidurals early in the process, which delays progression.
The psychological support and physical relaxation that patients derive from midwifery techniques reduces discomfort, lessening the need for chemical analgesics, she said.