Head deeply engaged at Caesarean section – a new technique
I always sweat a bit more doing a Caesarean section for a woman when the baby is really well engaged in the pelvis. Nearing full dilatation it can be difficult to disimpact the head to deliver the baby, and the worry is always that the uterine incision will extend laterally. Often I will ask a midwife to be ready with a pair of sterile gloves to do a vaginal examination under the drapes and push the baby’s head up. On the times I’ve needed this, it seems that the main benefit has been from air getting in below the head and releasing the suction force holding the baby’s head down. So this new technique is actually very simple.
I owe this technique to one of my colleagues, Sarah Luthy. She explained that when the baby’s head is deeply engaged, she uses a feeding tube or small suction catheter between the fingers of the hand that will elevate the head. Then, when her hand passes down into the pelvis, air can rush in below the baby’s head to break the suction. Simple, but very clever!
I tried this technique recently for a patient having an emergency Caesarean at 9cm dilation. The baby was big, and it’s head was deflexed OP at the level of the spines. I put a feeding tube between my fingers and passed my hand down over the baby’s forehead, and sure enough there was a fantastic sucking sound as the suction released and the head popped up. Very satisfying!
Have you got any tips for dealing with this situation? Let me know in the comments below.