Manual Delivery Without Need for Episiotomy

A study has shown that in rare but serious cases where an infant's shoulders get stuck in the birth canal after the head emerges, it might be best for mother and baby if doctors use their hands to manipulate the baby's position in order to ease delivery, instead of cutting a wider opening called an episiotomy.

Researchers compared the outcomes of stuck shoulder births at Johns Hopkins (Baltimore, MD, USA) and evaluated records from legal cases nationwide in which babies sustained permanent brachial plexus damage. They compared outcomes for both baby and mother when doctors used either episiotomies without manual techniques or manual techniques without episiotomy to finish delivering the baby. Of 40 cases, 24 babies had permanent brachial plexus damage, 12 had poor Apgar scores at birth, and 20 of the mothers had severe perineal injuries involving the anal sphincter muscle. Of the 38 cases where manual techniques were used, 15 babies had permanent brachial plexus damage and six had poor Apgar scores, but only one mother had a severe perineal injury.

"If manual techniques alone can be used to deliver the baby, the mother can be spared a significant perineal injury, and there might even be fewer complications for the infant after delivery,” said lead author Edith Gurewitsch, M.D., assistant professor of gynecology/obstetrics at Johns Hopkins.




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