Feb 2, 2013

Hands tapped by Prof - TWICE!!

All alone guarding the fort - the whole full board recognizing the full labor ward.

My wardmates left to attend teaching and presenting for our monthly Census. 

Out of the flash, Prof appeared.
I presented the whole ward of patients by referring to the maternity board.
Alerted by a staff nurse after noted a suspicious fetal tracing, we made our way to that patient. 
The fetal tracing was indeed suspicious, bordering on pathological. 
A quick review revealed the mother had indeed entered 2nd stage of labor. 
I scrubbed up and attempted to guard the perineal with my right hand as the baby's head is crowning.
Prof tapped my hand. 
"Hands poised!" he said. 
I removed my hand. 
The lady kept bearing down and the baby's head kept coming down. 
I moved my hand back to the similar place, stuck tightly with the perineal body.
My Prof tapped me again - TWICE!!

"Hands poised, young man" he exalted, again.
Therefore, first time in my working history (was not that long to begin with), I stood at the end of the bed, overlooking the delivery of a baby without any perineal guarding.
And her perineal only have a short second degree tear.
Tiu. It was sublime. For that moment in time.
Was it luck? Was it a coincidence?
Is 'hands poised' another fancy English term by Prof T?
I decided to look it up academically (basically just googled it - lah).

I don't even know wtf is the meaning of poised.
Here's what I got from Reducing Genital Tract Trauma at Birth 
 The first was a study from Great Britain that assessed the role of hand maneuvers for the actual birth in a large, randomized controlled trial.[4] In this study (called the HOOP trial, for "hands on or poised"), some 5,471 women were randomized to either "hands on" (one hand flexing the baby's head and the other hand guarding the perineum) or "hands poised" (both hands off, but ready to apply light pressure to the advancing head in the case of rapid expulsion) at delivery of the baby. Both approaches are taught in British midwifery education programs for management of birth, and both are practiced in the United Kingdom. 
Midwife compliance with the experimental allocation was 84% overall, 95% in the "hands on" group and 70% with "hands poised." After each birth, trauma to all sites in the genital tract was systematically assessed and recorded by the attending midwife. This was the first large clinical study to provide a detailed and complete picture of the total array of genital tract trauma sustained by women having normal, spontaneous vaginal births. 
Results of the HOOP trial showed that trauma is indeed a very common experience of low-risk childbearing women: 68% had major or minor trauma to the perineum, 61% had vaginal lacerations, and 11% had episiotomies. The trauma profiles of women in the "hands on" versus "hands poised" groups were virtually identical (recall that the techniques were used at expulsion of the baby, and not earlier in the labor). However, marginally fewer women in the "hands on" group reported perineal pain at the 10th postpartum day (31% versus 34% for the "hands poised" group). 
This represents a 3% absolute difference (95% confidence interval, 0.5% to 5.0%; statistically significant because the confidence interval for the risk difference does not overlap 0). While this difference is small, it is of interest to U.S. midwives because "hands on" for management of the actual delivery is the practice norm in this country.
And all this time, for the people, mostly HOs or nurses who conducted the delivery, ending with obstetric anal sphincter injury, the superiors would just screw them up nicely for not guarding the perineal properly and send them to some classes.

When all they need is to stand up (after reading this post) and reply "Hands poised".

P.S. it appear like I am rather stupid, not knowing all this all this time. 

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