In the midst of a profusion of shoulder dystocia papers and publications, there is a notable absence of discussions regarding what is arguably the most effective, and least damaging, maneuver to relieve shoulder dystocia.
Years ago, I worked in a hospital-owned and administrated Certified Nurse-Midwifery group. Practice meetings occurred, periodically, to discuss administrative concerns and other pertinent issues regarding patient care in our clinic. One particular meeting was assembled to meet and welcome a new hospital CEO who was making rounds on the various clinics and departments. Executives had a tendency to come and go in this hospital so these meetings were not a new experience for our group. I have no clear memory of other meetings that I attended, but this one stands out.
During the course of a vaginal birth, a baby's shoulder can get caught on the mother's pubic bone, preventing the body of the baby to proceed down the birth canal for delivery. When this occurs, it is the result of shoulder dystocia.
All events that are associated with a shoulder dystocia must be carefully recorded in the medical record. Appropriate documentation allows an accurate record of what happened during the delivery, especially for attorneys and experts to review retrospecitvely, but also for reviewing your own experience.
With the possible exception of airline pilots, air-traffic controllers, parents of newborns and owls, registered nurses working night shifts and advanced practice providers with demanding on-call responsibilities, tend to experience unprecedented levels of sleep deprivation from their career choices.
The American Medical Association is having another moment, recently pushing back over proposed legislation which would expand the scope of practice for "non-physicians". When physicians' perch at the top of the vertical health care hierarchy began to wobble, the American Medical Association, in its physician advocacy role, went on the attack.
Campaigns against midwifery, starting at the beginning of the 19th century, set the table for strained relationships between physicians and midwives, which persist to the present time. Anti-midwifery sentiments, enhanced by the attitudes of J. Whitridge Williams and Joseph Bolivar DeLee*, ushered in the age of obstetrics and scientific medicine which were considered the only modern and realistic choice for safe and healthy childbirth in America.[1]
Myth of the Ordinary Midwife Part 1
In deposition for a professional negligence lawsuit against a Certified Nurse-Midwife (CNM), the examining attorney’s opening question to the midwifery expert witness was this:
Attorney: Do you know what the learning and skill is expected of an ordinary midwife, yes or no?
Expert: Sir, I don’t know what an ordinary midwife is.
