Gaskin Maneuver for Shoulder Dystocia

The Gaskin Maneuver

All-fours maneuver for reducing shoulder dystocia during labor.
Bruner JP; Drummond SB; Meenan AL; Gaskin IM
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232-2519, USA.
J Reprod Med, 43(5):439-43 1998 May
OBJECTIVE: To report on a large amount of clinical experience with shoulder dystocia managed primarily with the all-fours maneuver.

STUDY DESIGN: The all-fours maneuver consists of moving the laboring patient to her hands and knees. Eighty-two consecutive cases of shoulder dystocia managed with this technique were reported to a registry through January 1996.

RESULTS: The incidence of shoulder dystocia was 1.8%, and half of the newborns weighed > or = 4,000 g. Sixty-eight women (83%) delivered without the need for any additional maneuvers. The mean diagnosis-to-delivery interval was 2.3 +/- 1.0 (SD) minutes (range, 1-6). No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low APGAR scores (neonatal morbidity, 4.9%). All morbidity occurred in cases with a birth weight > 4,500 g (P = .0009).

CONCLUSION: The all-fours maneuver appears to be a rapid, safe and effective technique for reducing shoulder dystocia in laboring women.

NOTE: According to this study, only HALF the infants whose shoulders lodged in the birth canal would be considered “macrosomic”, i.e., weighing 4000 g. or more. That means that half of the babies were also NOT macrosomic, and they still had shoulder dystocia. This statistic is borne out in other studies. Big babies and small babies are almost equally likely to be delayed at birth by shoulder dystocia. Thank God for Ina May Gaskin’s work in this field!! It is not something to be feared, nor will dieting during pregnancy prevent it. If you do not have an epidural during labor, the all-fours position is quite easy to achieve.

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