so let's say arms come out fine

so let's say arms come out fine good that head up there good alright so we have the head up there and I thought okay this head is not coming I could see you know that um there was no bulging anus and I reached and I realized I was feeling I could I didn't know which side the chin was on there was a doctor who came in the room she just had come in because she wanted to see what we're doing she knew that she didn't have to be there she also knew that um she wanted to learn something and she came in with forceps because they always bring forceps in because the physicians always feel they have to have forceps there and I said I think I need an episiotomy and she came and she she gave me an episiotomy we often will say in shoulder dystocia with the head down baby that the reason to do an episiotomy is not necessarily to make sure that the that there's more space here for the baby but so you can get your hand in and so in this situation I did get my hand in there and I go in and sure enough I can go up and I was thinking I'm just gonna go do a thing that we have often done which is what I'm gonna crank it done which is a Marcel smelly beats for the upright position which is you put your your fingers up here and I'll sit put push on it and force down on and you're holding here haha um and you and forcing um and you got two fingers on the side of the cheek muscles and then that wasn't working but it wasn't really not working but I realized that my finger my hand actually went up past there and I thought oh and I didn't remember that ever happening before when we were doing birth on the back and now I realize that the probably that didn't happen is because we know now from the MRI study that we did in Frankfurt that the um the diameter of the ischial between the ischial spines and between the ischial tuberosities opens uh 0.9 to 1.9 basically 1 to 2 cm more and guess what that's just about how wide our fingers are and so this gets down to my whole thing at the time I was thinking wow and then I realized it would it would fit even farther back but at the time I also was trying to use the other hand because I was still of the thought that you have to put your use your hands like forceps okay I put two hands in I could do that because there was an epidural in it and I went in but I could tell that this one hand just went right past and my whole hand was in there and I just grabbed the baby out and I had and flexed it I think that one wasn't too turned to left occiput uh anterior basically um but what happened was I realized that that I just turned to this woman I said well that's a lot better than the forceps you were thinking about using cause she had she had clapped so hard down on this steel tray and I thought I knew that she had only maybe been to about one or two breaches and that she never used them so I knew that she was not gonna be very um confident and I didn't want to see more damage done and I had already seen damage from one forceps delivery where there was a craniotomy in our in our own hospital and since then I've also heard about another and then there's a third one where forceps were used um and a baby died I have done this probably just about four or five times I'm not sure each time it was totally necessary but I felt it was necessary and it was a very easy thing to do I don't do some of the other maneuvers that David does like the other first maneuver I don't do that one just cause I'm trying to do it and I the second time I did it I was on the other side it's the one that I got the video of where this mother had been on the birth stool I think she got up just a little early and um and then when she fell over on her hands and knees I think it forced the baby up a little bit and that's the first one that I did um I think the baby was up pretty high I think it was up about here and I had to go in quite far and I was trying to so originally I started doing the Marcel smelling beads and then what happened was that's when I discovered that my hand would just go out there and I was just amazed and then I was doing and I had the episiotomy so I have not used an episiotomy since because I suddenly realized that first of all I don't need to use two hands and so when I first started teaching this uh we had a a meeting in Prague we had the ICM in Prague and then there were some meetings afterwards with some positions and then we had the first Amsterdam conference and I presented it there I did a whole presentation about people's hands what I started realizing was I think that William Smelly who created forceps originally so William Smelly I I studied his picture a lot and what I realized was his he's got a very big chubby face just look at this big chubby face can you see this on the oh yeah so I looked at this chin and I went okay we have no photos of him living in the 1700s he had big hands and so I thought okay so he probably wouldn't have been able to go in there the way I went in there and then I looked at William's and Steph's and look at this and so this is the four steps right here and this is the hand and I thought why do they need the four steps certainly one would say oh well but they're still instruments and they can grab they have better and you have two of them and they act like a salad tongs taking the baby out that's why they cause damage because they are very hard steel instruments against the baby's head whereas our hands are very forgiving so what's beautiful about this is that the physicians in Amsterdam at OLBG made a decision to do a study with me because they picked it up in Amsterdam and there are three female physicians in particular and um at Leonie's um unit and they also picked it up on the street one of the members there and so we're doing a study together so so so we put in a um an abstract to Figo and that was already two years ago we've been I've been dealing with a few other studies as you know trying to get the funnel pressure study going but this one is actually I've got my data collected on this now we pretty well got the data from them as well we're just working through ethics and I want them to get there they've got all their database together too so they're great thank you you're welcome