The reverse Gaskin manuever

I thought this was an incredible video of a shoulder dystocia at a home birth:

Watch it all the way to the end. You need to hear the birth weight! And, that the mom didn’t even need stitches!

This is a great example of the McRoberts maneuver, (with violins!) which is a technique of positioning a delivering woman’s legs way flexed up towards her ears. There are also some other cool aspects of the video. She was pushing on hands and knees. So, even though I have read “But, why don’t they just try the Gaskin maneuver?” often in the Monday morning quarterbacking on the birth webs more often than “Why didn’t they try the McRoberts maneuver?”, the Gaskin maneuver wasn’t going to work for this woman, because she was already doing it herself.

In the hospital setting, I think the McRoberts maneuver, and then some suprapubic pressure would be the first course of action with a shoulder dystocia. I am not sure if the Gaskin maneuver is commonly used in the hospital setting. I am pretty sure you can’t put one of those simulation dummies with a shoulder dystocia in the Gaskin position, can you? I have a friend who is a midwife, and she said she and her partner put a woman standing up with one foot on a chair, Captain Morgan style, and it changed the dimensions of her pelvis in a way that helped her deliver the shoulders of the baby.

In the video, the baby is born in the amniotic sac, which is also called being born in the caul. Cool! I have never seen that. My membranes were artificially ruptured about 18 minutes before I delivered the second time. I wonder what would have happened if they weren’t? Her face is so chubby, and gets pretty purple. I don’t know if they edited the amount of time the head was out. I am guessing they did, because it wasn’t a dramatic amount of time on the video, maybe one minute, and that includes flipping her on her back.

I love the supporting cast in this video. The dad is so matter-of-fact. So unruffled. The midwives are so calm, too. Even the narrator is subdued. I try not to watch the dramatic birth shows, but I can only imagine the tone of the narration would be a little different, and they would probably put some dramatic music in the background. The only thing that gets them excited is the gender.

I wonder why the baby was so big? The mom certainly didn’t seem to be obese. Obesity is often associated with macrosomia, but plenty of obese moms deliver normally sized babies, and few have a problem with shoulder dystocia. In any case, it didn’t seem to be the case, if my non-licensed BMI judging via short YouTube video can be trusted. I wonder if she had any other kids, and what their birthweights were? I wonder if she had been diagnosed with gestational diabetes?

Speaking of birth shows, did I ever mention I was on one? I was a midwife student in a few of episodes of House of Babies. Like, for a few seconds in two of the episodes or so.

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16 Comments

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16 responses to “The reverse Gaskin manuever

  1. I have always been intrigued by babies born in the caul…even more so since my last was born in the caul as well. What an amazing video!

  2. Evie

    Do we know if midwives generally catch babes with higher birthweights? And if so is this because midwives are OK with going to 41+7 or farther?

    I would think that an unwritten policy of induction or cesarean by 40 weeks would yield thinner babies since (correct me if I’m wrong here) in the last weeks before delivery there’s a lot of body-fat storage going on.

  3. mommymichael

    House of Babies is what got me started on my road to a home birth!!

  4. The Gaskin maneuver wasn’t working (possibly) because the midwife was trying to deliver the posterior shoulder first, instead of the anterior shoulder. Did you notice that? Mom was on hands and knees, and the midwife was pushing down on the baby, instead of pulling up. I know it can feel very backwards, when mom pushing on hands on knees, because your hands do what they “normally” do in a lithotomy position birth.

    • MomTFH

      Thanks so much for this! (Glad to see you here, too.)

      The midwife I mentioned in the post who told me about the foot on the chair maneuver also told me about trying to deliver the anterior shoulder first. She also said she thought that prevented tears.

      I am one who needs extra coaching when it comes to visualizing things 3D. I had to watch the video a third time before I realized the baby wasn’t sunny side up (duh! mom was on hands an knees!) I hope that thinking extra carefully about such things will help me think in the round when I’m the one trying to deliver the anterior shoulder if the mom is upside down.

  5. You know, some women just have big babies. And it could just be that position accounted for the distocia, and not the baby’s size. I think we tend to think that obese babies make huge babies and that fat women have gd etc etc and all of THAT makes distocia happen. It’s certainly more likely with large babies but not certainly not a given by any means.

    I’m obese, have never had gd and my largest baby was only 6lbs 6oz. I think genetics have more to do with the size of the baby than anything else, except in cases of diabetes, which would be a non-natural cause of growth and outside of normal parameters.

    • MomTFH

      Yes, I agree. Obesity is just a minor risk factor, not a guarantee of gestational diabetes, a macrosomic baby, or a problem with shoulder dystocia. That’s why I was wondering if she had any previous babies and what their birthweights were.

  6. catinthehatandthings1to4

    I started my last pregnancy at a healthy weight (about 12 lbs below the top normal for my height), and gave birth to an 11 lb baby at 40w4d. I took my glucose challenge and passed with a level of 96 at 1 hour. My diet was excellent, especially in the last few weeks because I was trying to prevent a large baby after my 10 lb 2 ozer 18 months earlier. My two earlier kids were 8 lbs 2 oz and 7 lbs 12 oz.

    For me, the biggest difference was that with the smaller kids, I ate normally but with the larger kids I followed the Brewer Diet. I also had absolutely gigantic placentas at birth. I found a study or two seeming to indicate that in animals, placental overgrowth preceded fetal overgrowth and the Brewer Diet supposedly works by creating the best environment for the placenta to grow. Even by 18 weeks with my 11 lber I was already measuring 4cm ahead on fundal height measures and dates were confirmed by early ultrasound at 6 weeks.

    I am currently pregnant again, avoided the Brewer Diet and my fundal height measurements are dead on for gestation. I’m 25cm exactly at 25 weeks. It’s all very anectodal and may not be related at all, but I promise you I’m not going to be protein loading in any subsequent pregnancy.

  7. I saw this video floating around but I never ended up watching it. I don’t think it was “real time.” I’m pretty sure it was heavily edited for time.

    I can see why hospitals require patients to shut off cameras in the event of SD. It’s hard to judge how much traction is actually used.

    My husband and I both started rolling after the husband’s “May I cut the cord, please?” It sounded like, “Could you pass the salt, please?”

    I think your mission should be to start a chain of Captain Morgan sponsored birth centers in your region. Step 1: Get “Captain Morgan Maneuver” into common usage, both in practice and in terminology. Step 2: Procure funding. Step 3: Open birth centers. Step 4: Total world domination.

  8. Some midwives think it’s the actual TURNING of the mother that is so helpful in the Gaskin Maneuver, more than the actual hands and knees position. Turning alters the relative aspects of the pelvis to itself internally (if you know what I mean, I didn’t say that very well) and often creates just enough room to help baby resolve whatever’s going on. So doing the Captain Morgan thing might achieve a similar goal.

    I think it’s a little of both……hands and knees gets that weight off the tailbone and opens up the space more. It also lets mom arch her back, which can create more space as well. But I also think that simply moving the mom and altering the relative internal dimensions of the pelvis often resolves things. If a woman has a SD in hands-and-knees, some midwives roll her to being on her back, just for that reason. It’s the movement that matters, not the specific position you go to.

    There’s also what I call the “anti-McRoberts” maneuver. I read about this somewhere but cannot now find the reference for it, alas. Apparently one old move for SD in the hospital setting was to scoot mom to the edge of the bed, elevate her behind on a bedpan or something, and dangle her legs over the edge in the extreme. This arches her back very strongly and creates extra room in the back, and helps rotate the pubic arch.

    If the baby’s shoulders are truly stuck at the pubic arch, I’m not sure this would help as much as McRoberts, but if the problem is that the shoulders are not done rotating yet, I think it might give extra room for that. A lot of women (including me) have a very strong urge to arch the back right at the very last minutes of pushing, just when we are told to curl up into a C. I think that urge to arch somehow opens up a lot of extra space and we should respect it.

    Or it may simply be that, like the Gaskin maneuver, arching alters the relative dimensions of the internal pelvis and thus allows more space for baby to work its way out. It may not be the specific MOVE you make so much as the fact that you get the mother’s pelvis MOVING and rotating.

    I think any asymmetric positions are especially good for SD. Lift one side of the pelvis higher than the other and you are altering those relative internal dimensions again.

    And I definitely think we have to add the Captain Morgan Maneuver to the birth lexicon!

  9. Pingback: The Captain Morgan maneuver « Mom’s Tinfoil Hat

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