Birthing on all fours

  1. What is your opinion on this position for delivery?

    I had a patient who was about to deliver and who could not turn around or even onto her side. The Dr. could not get there in time and I really found it difficult for me to deliver a baby in this position. I was so disoriented of where I was supposed to be guiding this baby to get the anterior shoulder out. Fortunately the dr made in time to at least finish talking me through it (the head was out) but even he said he finds the position difficult to deliver in.

    I also had a nurse comment that any baby she has seen delivered in this position has diffficulty with transitioning to extrauterine life.

    So what are your thoughts and experiences with having a mom deliver on all fours?
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  2. 7 Comments

  3. by   dawngloves
    I can't imagine how it would contribute to TTN. How did your little person do?
  4. by   SmilingBluEyes
    The only link I could see is if the baby "came down the pipe" too fast and was somehow "shellshocked" after birth. All fours delivery (AKA "Gaskin maneuver/positioning") Can be very beneficial, particularly for OP babies. I have women who have no epidural and want to relieve back pain or have OP babies, get on all fours whenever I can.
  5. by   mitchsmom
    So what are your thoughts and experiences with having a mom deliver on all fours?
    I haven't caught a baby in this position but I'd rather have to do it than go to c/s for failure to progress. I have found exams harder that way and I'd imagine catching would be tickier but I guess I just see it as something else to learn. If it's best for baby or mom then I'll do it.

    My only thing that I've seen in my short time so far, is that by the time we get to the point of suggesting all-fours, many women are past the point of being cooperative (too tired, just "over it", unable to think well in late labor, etc.) with the idea and don't want to try it. I would like to see ideas on this aspect if any of you have a particular way of helping pts through this?
  6. by   eden
    Well this mom was cruising so the failure to progress was not a problem. We were switching positions frequently to relieve her urge to push prematurely and the all fours was just the postion she ended up in when baby was crowning, so it was really accidental.

    The baby was definatly shell shocked from the entry.

    I like the position for labouring, it does work beautifully for those OP babies, I just never thought I would have to make a catch in that position

    Mitchsmom when I want a mom on all fours to get to progress again, I find that if I explain to them that this position will help relieve back pain/get baby to turn and descend they are more willing to try. When many of my mom's are just getting to the end and they have a specific goal in mind delivery/avoiding a section ect I think it also help them to cooperate when they know it may speed things along. I also bargain with my mom's just to get them to try ing and tell them idf it is not comfortable we can try another position ( mind you this doesn't always work but you may be in luck).
    Last edit by eden on Mar 10, '07
  7. by   SmilingBluEyes
    Its not hard to "catch" a baby in this position, at least, no more difficult than it is in the traditional lithotomy position so many are in in the hospital. With experience, it's not hard at all. But most places (hospitals specifically) will not allow, or at least discourage it, for often what they will cite as safety reasons. In the hands of an experienced practioner, such as a CNM, it's really a piece of cake. But for you and me, nurses not specifically trained nor expected to actually deliver babies, it can be harder, because of lack of experience doing this.
  8. by   eden
    Oh I totally agree, it seems to be no problem for the midwives and I am sure if I had done it before I would not have found it quite so awkward (that combined with the fact that this was only the second delivery I have done). Even delivering sidelying would be easier for me because of easier acess.

    Our hospital allows it and most Drs will allow it but I find that an overwhelming majority still end up delivering in the traditional lithotomy position.

    Anyway it's interesting to have other people's points of view.
    Last edit by eden on Dec 29, '06 : Reason: fixing a typo
  9. by   SmilingBluEyes
    I agree, and learn a lot here myself, Eden.

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