Q: Is it possible to "diagnose" a nuchal hand before birth (other than with an ultrasound in labor)? Is there anything one can do to help keep the mother from tearing when there is a nuchal hand? Any other useful information on the topic of nuchal hand/arm is welcome.
-Ulrike
If you see a hand come with the head, or feel a hand when you feel for the cord, simply give the hand or fingers a little pinch and the baby will usually retract it.
-RH
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Palpation may reveal a nuchal hand. A slow, guided delivery is important. I have seen a birth with nuchal hand happen without a tear. Hot compresses to stretch the perineum were used. Downward guidance was used to keep the woman from tearing upward.
-Beth
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Generally, if the pregnant woman is not obese, one can feel the hand up by the baby's face by palpating the mother's abdomen. If a pregnant mother has noticed her baby has hiccups, then probably her baby has been sucking his thumb, and that situation more times than not produces a nuchal hand at birth.
If you have a labor that is long or stalled with a large collar type of a cervix, this is usually either a cord that is holding the baby up or a nuchal hand.
Nuchal hands can keep a woman from going into labor, so if she is overdue by two weeks, check to see if you can palpate a hand from the outside and move it out of the way. On delivery, sometimes the hand can be pushed back up into the birth canal or extended out against the head of the baby. These procedures are only valid if you are expecting to deal with a nuchal hand; most of the time they are a surprise. As far as preventing the perineum from tearing, the key of course is always controlled crowning, without or without a nuchal hand.
-Cathy O'Bryant CPM
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I typically have four-hour births but my third lasted 15 hours. I pushed for what seemed like forever. I pushed down and the baby would float back up. The apprentice said she thought the cord was over and around the baby's head but the FHTs were fine so we kept going. I got very tired and I wanted to sleep. At 10 hours my midwife suggested I take some herbs and honey to give me some energy.
The birth video is truly amazing. I have always birthed with my sac complete but my midwife suggested breaking it. I was adamant that I wanted it to happen naturally. In the video you can see the head crowning with water bubbles on the crown and the baby's hand on the head. At that point the water breaks and the baby slips out, hand, head and arm together. I didn't tear, and the baby and I were both fine.
I suppose the reason for the length of the birth was the floating baby. The head could not get a good suction in the pelvic cavity because the hand was in the way.
-Valerie Monterrey
Reprinted from Midwifery Today E-News (Vol 1 Issue 52, Dec 24, 1999)
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