From the Editor: Complications and Fear
Midwifery Today, Issue 137, Spring 2021.
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A midwife is responsible for knowing and recalling all she is able about any complication that may arise. We have lives in our hands, so we want to know as many techniques for any given situation as we can. Most do not happen very frequently. Shoulder dystocia is one of our big ones; learning all we can and reviewing our knowledge base often is very important.
This is why we, at conferences, concentrate on classes that keep midwives up-to-date on all possible complications. This is one reason that we go around the world gleaning the best—and sometimes previously little- or unknown—ideas and techniques. Then we incorporate these ideas and techniques into our next class on that subject.
I have had a few cases of severe shoulder dystocia in my 12 years of active practice. I know that it is really important to mentally review all of the techniques for dislodging those shoulders! One of the worst cases I encountered was my first. It happened on an Easter Sunday. My friend Monika’s husband was a pastor and I teased him that his baby would be born on Easter. It was a beautiful day.
Her first child, a son, was playing outside. The experienced midwife for that birth was unable to come to the birth. (Her ex-husband had been found at the bottom of the Chicago River with a rock tied around his foot—a drug deal gone bad.) She had just heard the bad news as Monika’s birth started. The other apprentice midwife who was with me knew even less than I did. Baby Sara came out, retracted against the perineum, and turned purple without restituting. I knew immediately what it was, being an avid reader. At this point her son came into the room from playing outside. I had to stay calm for him and the family, remembering that calm is very important. I had just read about Ina May Gaskin’s maneuver: turn the woman onto hands and knees for shoulder dystocia. I told Monika to turn onto her hands and knees, which she did just like a trouper. She is German and strong. We avoided scaring her son because we remained calm. Baby Sara came out and Monika eventually became my magnificent midwife partner. We did births together for years.
Fear is our enemy when it comes to complications. Synonyms for fear are panic, horror, terror, trepidation. Obviously, these make it hard to think! What happens when we are afraid is one of three impulses: freeze, fight, or flight. We experience a flood of negative emotions when clear thinking and calm are needed. One of the most important adages is to “Never, never, never give up.” We must get the baby out. This is one of the times we actually “deliver” a baby. Mostly, mom does that. Fear is another issue we tackle at conferences.
To reiterate: have all techniques you have ever learned in your mind, have someone keep time, stay calm, and go to work. Be ready to resuscitate.
It is best to prevent shoulder dystocia, whenever possible. Induction not only interferes with the hormones’ natural actions, but can unnecessarily force the baby’s head into the pelvis. This may be why so many more shoulder dystocias are reported in vaginal births in the hospital. Many midwives reported few shoulder dystocias once they changed past practices to be less interventive. Mothers need to be free to get in whatever birthing position is comfortable. They will most often find the perfect position in which to birth, thus preventing this devastating complication.
I also believe it is essential to have at least two midwives present at a birth, because there are two lives involved. One of my other midwife friends had a situation where she needed to deal with both a mom hemorrhaging and a baby needing resuscitation. We have such a big responsibility to those we serve in birth and to deal with the unexpected that sometimes occur. At times the responsibility can be overwhelming, but if you are called, that is what you do. I am so thankful there are still so many of you amazing midwives who keep up against all odds. Please keep up the good work toward better birth!