My first experience with shoulder dystocia was thankfully informed by something I read in the newsletter/magazine that The Farm was publishing at the time (1976). In the article, Ina May explained what is now known as the Gaskin Maneuver. (You can read about the history of the Gaskin Maneuver in this issue of Midwifery Today.)
I was at my 15th birth and the senior midwife had just learned that her ex-husband, the father of her child, had been murdered. The other midwife and I obviously freed her from her duties at this birth. The labor had been progressing normally, so we felt confident in handling things without her. The woman, who was to become my dear midwife partner later in life, was in active labor. It was Easter Sunday and we had been teasing her during prenatal visits that the baby would come on Easter since her husband was a Lutheran minister. Indeed, Sara did come on Easter. When we got to the house, the mom, being the strong German woman she was, started making tea for all of us when she was 10 centimeters dilated! She began pushing, and my partner, who had done 20 births and was to be the second midwife, was catching.
When Sara’s head came out, it retracted, turned purple and did not restitute. Though only my 15th birth, I had already studied everything I could find on birth (as most aspiring midwives do). I knew what was happening from the classic description of the infernal struggle in Williams Obstetrics. My partner, who was actually a nurse, worked on the very stuck shoulders, but got nowhere. I remembered reading about the Gaskin Maneuver, so I told mom, “Turn over onto your hands and knees.” She did that without hesitation, and out came a stunned little girl. In the middle of all of this, the couple’s first son, who was about 4 years old, came into the room for the first time. This is where and when I learned the fine art of seeming calm. I was talking to him in an inviting way while dealing with a shoulder dystocia! Judy Edmunds, a midwife author who has written many articles for Midwifery Today, calls this “being a duck”—appearing smooth and calm on top of the waters while your little feet are paddling ever so fast and furiously in the waters below!
If you attend births long enough, you will encounter shoulder dystocia. Midwifery Today made a YouTube video from some footage of a conference where I talked at the Tricks of the Trade circle about shoulder dystocia. I said, “Never, never, never give up.” A Facebook friend had watched that video and later encountered a really tough shoulder dystocia. She tried to get the shoulders free, did several maneuvers to no avail and then was going to call 911 when she remembered the YouTube video and to never, never, never give up. She continued working on the shoulders and freed the baby! She wrote me the sweetest note saying that she feels having watched that video saved this baby’s life. I was so, so touched—those are the kinds of stories that keep me motivated to continue informing birth practitioners of the best midwifery knowledge from around the world.
Another shoulder dystocia I encountered was with my mentor Marion Toepke McLean, who has written for Midwifery Today since its first issue. We were at a birth and a 12 pound plus baby got really stuck. As I watched and helped Marion I thought, “I hope that never happens to me—I couldn’t have done that.” Well, guess what happened at the next birth: I was with another midwife partner when the shoulders stuck. The other midwife couldn’t get the baby out because she had a really bad injury to her hand and arm. She stepped aside and said, “I can’t get it.” You talk about pressure. I did what I had seen Marion do. I remembered Marion telling us to go in along the mom’s backbone to free shoulders because there is way more room to get your hand in that way. Often you cannot get your hand in any other way. Those stuck shoulders really fill up the birth canal! Thankfully, this did the trick and the baby was born.
Gail Tully, Carol Gautschi and I were talking about “The 14 Ways to Resolve Shoulder Dystocia”—the blurb from one of our conference classes taught by Gail Hart. In our discussion, I remembered a trick of the trade from Africa where African midwives move the head (which has been born) up and down to resolve shoulder dystocia. That made 15 ways to resolve this problem, and I am sure you have other methods in your bag of tricks. Please let us know about them so we can share them! A trick today can save a life tomorrow. Both Gail Hart and Gail Tully teach amazing shoulder dystocia classes at Midwifery Today conferences.
A blessing about practicing midwifery in today’s world rather than in the ’70s and ’80s is the access to resources available—besides Midwifery Today magazine and conferences, a midwife can learn from YouTube videos, DVDs and Facebook discussions, and there are many more books and midwifery schools available. When you face intense situations such as shoulder dystocia, hemorrhage or the need to resuscitate a baby, you can be well educated and ready for whatever complications come your way. One very important aspect of being a midwife, doula or childbirth educator is to stay humble and continue to be a learner. This work is too intense not to. You will be rewarded with the fact that birth works almost all the time. You are called to facilitate the process through your relationship with the family, especially motherbaby.
You can learn more about shoulder dystocia with these products from Midwifery Today:
Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977–1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences
around the world! [ PHOTO BY ANDREA NOLL ]
1947 Born in Los Angeles, California. 1965 Graduated from Placer High School in Auburn, California. 1966 Trained for one year as a psychiatric technician. Courses included
basic nursing, pharmacology, microbiology, anatomy and physiology, psychology. 1966–1971 Worked at DeWitt State Hospital in Auburn, California
as a psychiatric technician. 1968 Graduated from Sierra College with an Associate of Arts degree. 1970 Graduated with honors from Sacramento State College with a
Bachelor of Arts degree in Social Science. 1971 Earned Lifetime California teaching credential with fifth-year
program from Sacramento State College. 1972 First daughter born in a hospital. It changed my
life forever. It was an unsatisfactory birth experience, but I had a wonderful
postpartum experience with 2-1/2 years of breastfeeding. 1976 Second daughter born. She was born at home
with a doctor who talked me into a homebirth. The difference between the
two births sent me on a path to do something to help women have positive
birth experiences. 1976 Began training as a midwife. Because I was raising young children
and running a business, and because there were no CNM schools in my area,
becoming a CNM was not within my reach. 1977 Began attending births with the Birth Co-op in Eugene while
organizing courses in our community taught by CNMs, physicians, nutritionists,
etc. 1978 Began a midwifery practice, New Life Care, with a partner,
Chris Howard, and apprentice Monika Dunsmore. 1979 Son born at home. 1980 Did a one-year program with Marion Toepke McLean, CNM. Four of us completed the program, which was modeled after CNM curriculum at that time. She took a year off from her practice to teach us and to go to our births with us. 1982 First group of midwives certified by the Oregon Midwives Council.
Our board was composed of CNMs and physicians. 1986 Slowed down practice and started Midwifery Today magazine.