Tricks of the Trade

Tricks of the Trade – Issue 146

Midwifery Today, Issue 146, Summer 2023.
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Hyperemesis Gravidarum Tips

Giving birth was the only thing that worked.
Rosie Beattie

Colleen Marie

I give promethazine suppositories and advise sips of water, followed by carbs with protein in small frequent intervals.
Sh Anderson

Victoria Wilkins

IV fluids and original Coca-Cola.
Mary Hope Hodson

Eating mandarins or smelling mandarin essential oil (on tissue in pillowcase to sleep).
Jenni Price

Liver support! Dandelion, milk thistle, and nettle. I have had some luck with honey under the tongue at first wave of nausea.
Victoria Sherick Garwood

Progesterone cream worked wonders for me.
Crystalyn Tadano

B vitamins.
Sabrina B. Slonim

Ice lollies.
Elizabeth Ann Perfect

Karen Hurd’s bean protocol.
Laura Dearman

Tricks for Repositioning an Asynclitic Baby

I’ve repositioned the head manually with great success when nothing else worked.
Alli Gober

Abdominal lift and tuck. Pendulous bellies cause asynclitism.
Linda Bennett

Rebozo. Always!
Carol Gautschi

Cat/cow positions and crawling around.
Jennifer Mercier

Knee-chest position.
Gail Johnson

Pulsatilla can sometimes work.
Joanne Dozor

Go up steps, two at a time, if possible. Squat. Get on a birth ball like you are mounting a horse; mom holds onto something, another person holds the ball, and she swings her leg over instead of just sitting down on it. Knee-chest. Lie flat on back with legs hanging over the end of the bed, put a towel roll under hips (also works for posterior). This is uncomfortable but try to get through a few contractions.
Vicki Gilbert Ziemer

Determining Fetal Station

If the head is large and not in proportion with the pelvis, then the caput can be +1 and the widest biparietal diameters can still be above the inlet. Before going in internally, take a few moments between contractions to palpate above the pubic bone. When palpating abdominally to determine if engaged or not, have your hands aim outward, by the time they hit the pubic bone (engaged) or head back toward each other (not engaged). If you think “hmmm, engaged?” go back to the upper pole and make sure the head is not up there instead. Vaginally, the trick is identifying the ischial spines.
Linda Bennett

I was shown that it’s the angle of your fingers in finding the head. With that angling up you can have a head that feels low but is -3 or -2, but as you make your way toward straight but deeper toward the posterior it slowly increases until you are angled downward and right in front of the opening. But we can also use the contraction pattern and see the overlap on the belly to determine so much. Also, seeing from the outside other signs, hormonal and physical, to show descent and change.
Nicole Franklin Morales

The “Pelvic Press”

In cases where the baby doesn’t descend, the helper presses on the iliac crest while the birthing woman pushes. When the top of the pelvic is compressed—even a fraction of a centimeter—the bottom of the bones moves apart to an even greater degree. If the progress of labor is arrested because of failure of the baby to descend, this technique is perfect. Usually, no more than three contractions are needed to get the baby into the inlet or past the ischial spine.

Contraindications: There are some problems with the pelvic press. First, the midwife should make sure the head is properly flexed and positioned in the pelvis. A deflexed head or transverse lie usually won’t work. If the baby does descend while malpositioned, it can make for a long second stage with military presentation or transverse arrest or transverse birth.

Quote of the Quarter

The wisdom and compassion a woman can intuitively experience in childbirth can make her a source of healing and understanding for other women.
—Stephen Gaskin

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