I teach the new labor and delivery nurses, and have taught numerous classes for physicians, midwives and doulas. My instructions have been enthusiastically accepted and incorporated into practice in my current world of obstetrics. Why does the medical community not make this information available for all pregnant women? Therefore it is essential that the attempt be made through safe and effective maternal positioning in order to create a path to a more expedient, less painful and more satisfying delivery for every woman and fetus. Malpositioned infants are associated with labor abnormalities that may lead to adverse maternal and neonatal consequences. Malpresentation, especially that of OP, occiput posterior (looking at the stars, sunny side up), pose challenges in every aspect of intrapartum (during labor) care. Maternal positioning has been shown to improve the incidence of all of these except that of “multiple gestation.” Per ACOG, American College of Obstetricians and Gynecologists, the most common indications for primary cesarean delivery in order of frequency is labor dystocia (a stall or cease in the dilitation of the cervix or the descent of the fetus), abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation and suspected fetal macrosomia. Since 1997, the cesarean section rate in the U.S, per the CDC and NCHS, has increased 41%. Why is the correct position for birth important? The woman might feel pain on one side of her body or back. Leopold’s maneuver will palpate the infant in a non-straight up and down position. Many women have back labor with an occiput posterior infant.Īsynclitic: Vertex (head) of infant is not flexed and is often off to the maternal left or right. Leopold’s maneuver will palpate small parts of infant on maternal belly. OP (Occiput Posterior): infant’s spine will be against maternal spine, face looking up towards maternal belly button. Leopold’s maneuver will palpate infant’s back on maternal right just right of center. ROA (Right Occiput Anterior): infant spine on maternal right but looking towards the maternal spine. Leopold’s maneuver will palpate the infant back on maternal right side. When you look up at the maternal uterus, the heavy side will be on maternal right. ROT (Right Occiput Transverse): Infant’s spine is on the maternal right and the infant looking at the maternal left. The acronyms of the malpositioned infants are as follows: I am of the opinion that the relaxation of the lower uterine muscles will assist in the rotation of the infant into the head down or vertex position but you will have to visit other respectable websites such as Spinning Babies, in order to learn how to turn a breech. This website does not refer to the breech infant in respect to any aspect of Gilligan’s Guide. What do I mean when I say malpresentation? If we as caregivers, would put more emphasis on the Passenger, at term and in labor, the cesarean rate would fall.” -Ann Gilligan, RN Power (contractions), Passenger (infant), and Passage (pelvis), and Psyche (mental state). Remember, in relation to labor and delivery, there are four things that need to be addressed. We discuss dilitation, effacement and station, but ignore position. “One of the most important aspects of a laboring primigravida (a woman who is pregnant for the first time) is the position of her infant in utero. Carol Phillips Jean Sutton, PNM Gail Tully, CPM Rebecca Dekker, RN, PhD Penny Simkin, PT Jean Sutton, NM and Lisa Cook, RN, for their teachings. Special thanks to my thousands of clients who demonstrated great power and strength through their birth journeys, and Dr. If you are a member of the birth community Physician, Nurse, CNM or doula, I would love to teach you personally, the anatomy and physiology behind Gilligan’s Guide. I am very proud of how the guide has come together with the help of all of my educational opportunities and my many mentors. Gilligan’s Guide will be provided to you on our first visit, accompanied by a full demonstration and explanations of each position and their benefits. I am also recommending that you use a doptone or an external fetal monitor to monitor the infant’s heart rate when doing any type of maternal positioning. Since I am a Registered Nurse, safety is always the first thing on my mind. Please, always consult your provider before using the Guide. It is safe, simple and efficient for everyone to use. We refer to this as “Maternal Positioning for Optimal Fetal Positioning”. Gilligan’s Guide is an algorithm (a graphic chart that is easy to follow) which assists the pregnant person’s body to rotate their unborn infant into the optimal or best position for birth.
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