I attended the first British Intrapartum Care Society meeting yesterday. It was a great success and congratulations to all the organisers.
Full dilation CS (FDCS) is a subject very close to my heart. The talk on this left us with more questions than answers and I feel that these need to be addressed.
One of the hardest tasks performed by an obstetrician is to have to tell parents that there was nothing wrong with their baby, but they just couldn’t get the baby out safely even at a CS after a long labour.
The idea of Fetal Pillow was conceived after such an incident many years back. Fetal Pillow has now gained mainstream status in UK and Australia (more than 40%) of all hospitals using it and the numbers are growing. It was cleared by FDA last year after all the available clinical data was presented to them along with stringent mechanical safety testing.
Q. Should we be reducing the second stage CS and not doing “any”?
A. A laudable aim and no doubt should be attempted and already being tried by many others. Using rotational forceps might help but we will always have full dilation CS.
Q. Use of forceps is much higher north of Birmingham. Does that mean there are no FDCS in that area?
A. In fact there are more users of FP north of Birmingham than south of it despite significantly higher use of rotational forceps in some of the hospitals.
Q. Can we push from below with the palm rather than fingers and also rotate the head at the same time?
A. No. For those of us who have had to do this will know that it is impossible to push using palm due to lack of space and awkward direction of push that is required. To be able to rotate the fetal head along with this is an impossible task.
Q. Can we teach rotational forceps in a 3 hr session every six months as suggested by the speaker?
A. No. Firstly there are not enough teachers to go around and the risks involved are high so this is unlikely to ever happen.
Q. Can Fetal Pillow elevate a 3.5kg baby along with IU pressures of second stage labour?
A. Yes. This is a question that used to be asked 7yrs back so it is a bit of a surprise that after almost 15,000 FP uses and lots and lots of clinical data that this should even come up again. To elaborate on this, intra uterine pressures in second stage of labour along with maternal effort are around 140mmHg. For the FDA we carried out mechanical test on FP and subjected it to pressures of 3000mmHg (more than 20 times the IUPs) and could inflate the device easily and elevate a dummy fetal head successfully using a 60cc syringe.
Q. Is reverse breech a better way to deliver a deeply impacted head?
A. No. The best way to manage this problem is to PREVENT the difficulty arising from a deeply impacted head by using FP. Reverse breech is an extremely difficult procedure to perform and the rarity of this condition makes it difficult if not impossible to teach to the trainees and in any case most senior haven’t done it either.
Dr R Varma
Consultant Obstetrician & Gynaecologist
About the author
Dr Varma is a consultant Obstetrician & Gynaecologist with 35 years’ experience in the field of O&G. He is the inventor of fetal pillow and a part time Medical Director of Safe Obstetric Systems. He is still in active clinical practice in the field of Urogynaecology.