The sheer mechanics of birth
are mind-boggling. It makes that old bit about the camel
through the eye of a needle seem like child's play. And
yet somehow it works � most of the time. Dystocia, when
the baby's shoulders get stuck within the mother's pelvis
during delivery, isn't common, but can be permanently
debilitating. Severe dystocia can cause brachial plexus
palsy (BPP), a condition where the nerves leading to the
baby's arm are damaged, which then causes infant paralysis.
When it comes to the important business of getting infants
with dystocia unstuck, new research has shown that fetal
manipulation is a far cry better than episiotomy.
The findings were the result of
a retrospective study by researchers who wanted to know
which intervention, episiotomy, fetal manipulation or
both, resulted in the healthiest mothers and babies.
The study, published in the September issue of the American
Journal of Obstetrics and Gynecology, examined 127
cases of severe shoulder dystocia. Episiotomy was used
in 22 cases, fetal manipulation in 57 instances and
both interventions were tried in 48 cases. Infant health
was measured by levels of BPP and neonatal depression,
while maternal well-being was gauged by incidences of
anal sphincter trauma in the mothers. BPP rates in the
episiotomy-only group were the highest at 59.1%. Babies
delivered using fetal manipulation alone suffered from
BPP 35% of the time and 58% of babies delivered using
both methods were affected by BPP. There was no difference
in the neonatal depression rate between the three groups,
which shows that avoiding an episiotomy does not jeopardize
the baby's health. However, the mothers who had episiotomies
suffered significantly more anal sphincter trauma.
"Episiotomy will only eliminate
soft tissue barriers to delivery, whereas rotating the
infant will realign its shoulders to fit within the
mother's pelvis. It is the bony pelvis that is widely
acknowledged as the main cause for the infant getting
caught in the birth canal," summed up lead author Dr
Edith Gurewitsch of the Johns Hopkins University in
Baltimore, MD. It seems that a bit of a twist for baby
goes further in ensuring a healthy outcome for both
mother and child.
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