R.A.F.S. Rectal Adjustment of the Fetal Shoulder [DRAFT]
Shoulder dystocia is one of the most concerning
complications of birth where the shoulders do not follow the birth of the
baby’s head. Many midwives fear it. It happens .5-1% of the time depending on the
reference you read. Therefore, a true shoulder dystocia happens about once
every 100 to 200 births. This is the rate I have experienced.
In 1994, I experienced my first true shoulder dystocia. It
was a long active labor following 3 days of prodromal labor. All of us were
very tired. After the baby’s head was born, it began to darken from the blood
traveling to the brain, unable to return to the heart. I recognized the
problem. I was attempting all the maneuvers I was taught. But you cannot
accomplish them if you cannot reach the shoulder. Mom had been supine to begin
with because she was so tired. Once we got her on hands and knees, I could
reach a little farther, but not enough still. It is so scary to feel the
seemingly endless neck! I was praying my brains out!
Thankfully, in the midst of my fumbling attempts, God gave the
Motherwit, my fingers slid into her anus. Thank God! The shoulder was right
there within easy reach. I pushed it to the side with the flat of my two
fingers and was able to reach the baby’s armpit with my other hand and wiggle
her free. It had been about 3 minutes but it felt like much longer. She needed
nothing more than a little stimulation and she was pink and happy.
Here is why it works. The anus and the rectum are between
the baby and the spine.
[Insert graphic showing relationship of anus to spine]
The head is not in the way at all so there is no danger to
the baby’s neck. In the diagram you see the location of the rectum. I had often
wondered what was trapping the posterior shoulder. The tailbone could not do it
and the sacral promontory is too high to be the problem. I hypothesize that
because many Americans have stool filling the colon and rectum, the consistency of
modeling clay, it fills the space that baby needs to turn its body. Of course,
the head will push some out. But the stool that is higher remains, constraining
the uterus from behind and limiting the baby’s spiraling movement.
[Insert graphic]
I wonder if the dystocia rate was less back in the day when
enemas were a routine procedure in childbirth. Not that I think any routines
should be imposed. But I will recommend a warm water enema to a client who is
short or short-waisted with a large baby.
[Insert graphic]
All the cases of true shoulder dystocia in my practice that
have happened since have been quickly resolved using what I now call RAFS;
Rectal Adjustment of the Fetal Shoulder. I still try other maneuvers first. I
have the mom shimmy and rotate her hips first. Runners stance and squatting may
dislodge the baby, in which case, it wasn’t a true dystocia. But if baby’s head
begins to darken much, I use RAFS. I am no longer afraid of Shoulder Dystocia.
I hope you will add it to your arsenal.
