United Brachial Plexus Network, Inc.

Hello,
I am new to the forum, with a child who has LOBPI. I dont wish to say too much for legal reasons but I was hoping someone could perhaps enlighten me about the ins and outs of this McRoberts maneouvre during delivery. My Dr is claiming to have done an "informal" version of it and seems to feel that was sufficient enough ( even though my child is injured! ). Has anyone heard of this before? It sounds a little ridiculous to me, as I would think you either do it or you dont as simple as that.

I'm no expert, but don't know what the "informal" version is. I too went into litigation with the hospital and staff who delivered my son LOBPI. The McRobert's manuver was used in my case, but the arbitrator ruled that it wasn't sufficent enough.The McRobert's Maneuver is a simple and effective means to increase the "size" of the pelvic bones to allow delivery of a baby that gets stuck after delivery of the head (called a shoulder dystocia). It involves taking the legs and flexing them up towards the mother's head, so that the knees touch the abdomen or chest. It usually involves one helper on each leg.

It is usually the first of a number of steps taken when the baby's head delivers but the shoulders do not rapidly follow. It is quite safe and often extremely helpful. Since my son was 10 lbs 5 ounces it didn't help at all. He was my second born my first was 8 lbs 12 ounces and I had problems delivering her so... I think that had a lot of signifigance in helping our case.

Welcome,
McRoberts is one of the most basic maneuvers and usually the first of several that are supposed to be done to dislodge the impacted shoulder(s). I too have never heard of an "informal" McRoberts. I agree with you that its ridiculous - you either do it right the first time or you didn't do what you should have known what to do. If that's all the OB did to dislodge your child, then it sounds like the doctor was not very competent at what he/she does at all. Good luck with your lawsuit. If you have other questions, ask away. I'm sure I speak for most when I say, we'll do our best to help you if we can.

Hi,
Thanks for your responses, much appreciated.
Well it seems that my legs were back ( no different than my other two babies so not right at my chest ) and that was good enough or part thereof of a McRoberts?? I dont think so but an expert seems to agree with him which is even scarier! And one push and baby was out albeit injured but out so wasnt that tough in their eyes. It wasnt as simple as that and I only had one assistant aswell. They make me so mad that they think they can justify it so easily. I will fight them on it thats for sure, not good enough an explanation for me!

The question you should be asking is did the doctor have his hands on your baby's head. Did he have to use force to pull the baby out or was it just from pushing. Was there a diagnosed dystocia, in other words did the head come out and then did the shoulder get stuck? Did the baby's head turtle (descend back into the birth canal) because of the stuck shoulder. Did they apply force to the abdomen(uterus)-fundal pressure?

If the doctor did not have his/her hands on the baby's head, you may have a very difficult time in court.

If the birth was uneventful and you only had to push once to birth your child, I will pray that your child only has a stretch injury and will show recovery soon.

The important thing to remember is the amount of force the doctor may have applied to your baby's head. An informal McRoberts (or whatever they want to call it) wouldn't be the root cause of an injury, rather the force applied to "extract" the baby.

Good luck!

-richinma

The Dr used vacuum extraction to deliver her so yes his hands were technically on her head. He used so much force that he actually braced himself against the bed to pull the baby out ( much like a tug-o-war according to my husband ). It was a stretch injury and her nerves recovered but her shoulder joint is irreperable. I had vacuum for all 3 of my babies and each one was more difficult than the last yet I had the same Dr who I beleived could successfully manage my delivery based on each previous event and any emergencies that should occur.

I post this just as information. I was not there at the delivery. That being said, I am a L&D nurse who also has a child w/ a BPI injury from birth.

I have never heard "informal" being used with McRobert's but I am guessing that your doctor was saying you were probably (or someone was helping you) hold your legs back during delivery. The "informal" part to me would make me believe that it was the typical lithotomy position of convenience for the doctor and not McRobert's. With McRobert's the mother's legs with bent knees are truly flexed back towards their chest. This is different than the patient or family holding the mother's legs during pushing that is typically seen. Does this make sense? Many times, although not always, suprapubic pressure is also done by a staff member (nurse, doctor, midwife) over the pubic bone. No pressure should be done on the top of the uterus which is called fundal pressure. Here's a way to picture it, get on the bed on your back, grab behind your knees and hold your legs up like you are pushing a baby out. This would be like an "informal" McRobert's I am guessing he is referring to. Now have somebody push your feet towards your head so your knees are up by your chest (flexed) and out toward the side a bit. This is McRobert's. Notice the difference?

He had to brace himself against the bed to pull the baby out (much like a tug-o-war)??? How horrific! Yes, his hands were on her.

Good luck.

Tanya in NY
Amber's Mom, ROBPI, 4 years old

Your delivery sounds like mine. I agree with Tanya about the "INFORMAL" part.

A Delivery like that is horrific....my doctor was on a rolling stool at the end of the bed with her legs propped up on the end, kinda using it as leverage. When Brandon finally arrived.....she flew 5-6 feel across the floor and hit the wall with so much force that she dented the wall with her head......Ha, HA, she absolutely deserved that one...I hope she still has a headache !!! LOL !!! Still a little bitter I guess !!! GAYLE

Tanya, how you have described the informal is just it. It was the lithomy position, no different than the position I was in for the other two and there was no record of shoulder dystocia on their files from birth. The descent for the other two was slow and required vacuum also but with this one it was different and I dont feel it was handled any differently except for there being more force and more panic! So I dont know where I stand on this informal position and how much it gives them an "out" in the situation but from my stance I only had one assistant and the correct maneouvre/s could not be carried out. I was holding my own legs and trust me I am not that flexible anymore! The nurse could not have held both feet and applied pubic pressure at the same time unless she had more arms so I just dont know how they can justify it.

Anyway, I really do appreciate all the feedback. My husband and I have read your comments with great interest and we are thankful for any information or to learn of others similar experiences.

Gayle I dont blame you for still feeling bitter, your story of events just blew us away!