11/16/2023
What would happen if those who deliver babies in hospitals trusted the process more and "managed" less?
If you work in a hospital as a midwife or obstetrician, you may be expected to ‘get the baby out’ within 60 seconds of the birth of the head. There can be an expectation that the baby be born within the space of one contraction.
I have personally been mentored by private midwives and have only watched physiological births at home to learn how to sit with birth, so for a long time I assumed that everyone just waited for the second contraction for the shoulders to be born… turns out, many midwives and obstetricians will put their hands on the babies head to try and put traction/pressure on the babies head to bring the shoulders out within the same contraction.
One of the concerns is that if the shoulders aren’t born soon after the head, that they must be stuck and that the baby is experiencing a shoulder dystocia…but that can’t be true, because most of the births I attend follow a two-step method where we just wait for the second contraction for the shoulders and all those babies didn’t have a shoulder dystocia
There is research on this (of course) and Zhang et al in 2017 did a randomised controlled clinical trial to compare a one-step method with a two-step method.
The control group had the one-step method where the clinician used their hands to speed up the birth of the shoulders, the study group had a two-step approach where the clinician just allowed the baby to be born over 2 contractions
The two-step group had ZERO incidence of shoulder dystocia and no increase in neonatal asphyxia compared to the one-step group. The one step group had 4 shoulder dystocia incidents.
The two-step approach allows physiological birth to unfold, acknowledges the cardinal movements of the baby through the pelvis and allows the time for the shoulders to get into position before they are born to allow for a less complicated birth.
By speeding up and trying to manually manipulate the baby out if it’s mother we interrupt the babies manoeuvres through the pelvis and potentially create incidences of shoulder dystocia.