Obstetrician Hand Pressures During Mock Deliveries

During the delivery of a fetus, an obstetrician assists by applying gentle axial downward traction on the head until the shoulders clear the pubic bone followed by catching and supporting the delivered infant body. If the shoulders become lodged behind the maternal pelvis (shoulder dystocia), the physician may be required to perform additional maneuvers to free the shoulders (1,2). Of significant concern is the potential for injury of the fetus during this process. It is believed that hyperextension, misalignment of forces on the head, or excessive applied forces can result in injuries to the brachial plexus nerves running through the neck and shoulder resulting in temporary or permanent Erb’s of Klumpke’s palsies for the infant. It is important to recognize there are delivery forces that originate with uterine contractions and maternal val salvo. To better understand the forces exerted during delivery in order to prevent these injuries, our long-term research goal is to create a tool that can accurately quantify these forces to improve understanding of them and to create training tools for medical trainees. The research goal of this project was to examine what hand pressures are typical during this traction phase in a normal delivery and where they are applied on the hand of the obstetrician. A secondary research question was whether there are any differences between fully trained obstetricians and residents in these pressures.