Gaskin Maneuver: Essential Techniques in Obstetric Care

What is the Gaskin Maneuver?

The Gaskin maneuver, also called the all-fours method, is a technique used to alleviate shoulder dystocia, a potentially dangerous complication that occurs during the birthing process. It happens when the infant’s head emerges, but the baby’s shoulder gets stuck behind the mother’s pelvic bone. The Gaskin maneuver is an effective technique that involves the repositioning of the laboring mother to her hands and knees, which widens the pelvis, frees the baby’s shoulder from behind the parent’s pelvic bone, and allows more space for the baby to continue with delivery.  The Gaskin maneuver is named after Ina May Gaskin, a certified professional midwife known as the “mother of modern midwifery” who first introduced it.

Importance of the Gaskin Maneuver. 

The Gaskin maneuver is crucial because it provides a non-invasive, effective solution to a potentially life-threatening situation. Shoulder dystocia, if not managed promptly and properly, can lead to severe complications and serious injuries for both the baby from nerve damage (brachial plexus injuries), hypoxia, clavicular or humeral fractures, and, in rare cases, stillbirth; and to the mother from suffering from postpartum hemorrhage, damage to the bladder, and anal sphincter and rectum injuries. By repositioning the mother, the healthcare providers can often resolve this obstetric emergency quickly and safely.

Steps Involved in the Gaskin Maneuver.

Recognition of Shoulder Dystocia:

The first step is for the labor and delivery team to recognize and announce when shoulder dystocia is occurring. In most cases, a doctor or midwife considers shoulder dystocia to be the complication if the baby’s shoulders do not emerge within 1 minute after the infant’s head is delivered. This means the baby’s shoulders remain stuck behind the mother’s pelvic bone during birth. 

Reassurance and Communication:   

The doctor and healthcare team reassures the mother and explains the need to change positions. Clear communication is vital to keep the mother calm and cooperative.

Repositioning:

The mother is helped onto her hands and knees, into an all-fours or table top position.  This may involve turning or rolling from a supine or lithotomy position, which can be challenging during active labor. 

Delivery Attempt:

Once the mother is in the hands-and-knees position, the healthcare provider will attempt to deliver the baby’s shoulders. The repositioning often creates enough space for the shoulders to pass through the birth canal and continue with a safe delivery.  

Effectiveness of the Gaskin Maneuver

Studies have shown that the Gaskin maneuver is highly effective in resolving shoulder dystocia.  Its non-invasive nature reduces the need for more aggressive interventions, lowering the risk of traumatic birth injury to both mother and baby.  The maneuver has become a recommended practice in obstetric care guidelines worldwide.

In a comprehensive review of obstetric techniques, the Gaskin maneuver has been highlighted for its simplicity and effectiveness. Research indicates that when performed correctly, it can significantly reduce the incidence of neonatal brachial plexus injuries, Erb’s Palsy, Hypoxic brain injury, and other birth-related traumas. This non-invasive technique not only ensures the safety of the baby but also reduces the likelihood of postpartum complications for the mother, such as excessive bleeding or severe tearing.

Training and Implementation

For the Gaskin maneuver to be effective, proper training and implementation are crucial.  Healthcare providers, including obstetricians, midwives, and nurses, must be trained in recognizing shoulder dystocia and executing the Gaskin maneuver efficiently. Regular drills and simulations can enhance preparedness and response times during actual deliveries.

Hospitals and birthing centers often incorporate the Gaskin maneuver training into their standard emergency protocols. Simulation-based training allows practitioners to practice the maneuver in a controlled environment, ensuring that they are prepared for real-life scenarios.  Moreover, interdisciplinary training sessions can help foster better teamwork and communication among the delivery team, which is essential during high-stress situations like shoulder dystocia. 

Common Complications Addressed by Gaskin Maneuvers

Nerve Injuries: 

By promptly resolving shoulder dystocia, the risk of brachial plexus injuries, which can lead to long-term nerve damage in the baby, is significantly reduced. This type of injury can result in weakness or paralysis of the arm, which may require extensive physical therapy or surgical intervention.

Fractures:

Properly executed Gaskin Maneuvers minimize the likelihood of fractures to the baby’s clavicle or humerus, which can occur if excessive force is applied during delivery. Such fractures can cause significant pain and require careful management to ensure proper healing.

Maternal Trauma: 

The maneuver reduces the need for episiotomies or instrumental deliveries, thereby decreasing the risk of maternal trauma. Avoiding these interventions can lead to a quicker and less complicated recovery for the mother, allowing her to focus on bonding with her newborn.

Medical Malpractice and Gaskin Maneuvers

Despite their effectiveness, there are instances where the failure to properly execute Gaskin Maneuvers can lead to adverse outcomes. In cases where shoulder dystocia is mismanaged, and the appropriate steps, including the Gaskin Maneuver, are not taken, it may result in severe injuries to the baby or mother. This is where medical malpractice cases come into play.

Implications in Medical Malpractice Cases

When a healthcare provider fails to recognize shoulder dystocia promptly or does not employ the Gaskin Maneuver correctly, resulting in harm, it can be considered medical negligence. Families affected by such negligence may pursue legal action to seek compensation for the injuries sustained during childbirth. 

Common Grounds for Medical Malpractice Claims

Failure to Diagnose:

Not recognizing the signs of shoulder dystocia promptly can lead to delayed intervention, increasing the risk of complications. This oversight can result in prolonged labor and potential harm to both mother and baby.

Inadequate Training: 

Healthcare providers must be adequately trained in Gaskin Maneuvers. Lack of training can result in improper execution, causing harm. Institutions must ensure that their staff are well-versed in this technique and regularly updated on best practices.

Improper Technique: 

Incorrectly performing the maneuver can exacerbate the situation, leading to injuries. In some cases, inappropriate application of force or incorrect positioning can cause more harm than good.

Contact Joseph M. Lichtenstein, Medical Malpractice Attorney

Joseph Lichtenstein was named Medical Malpractice Attorney of the Year for 2019 and 2023 by the Top 100 Registry among other honors. If you believe you have been a victim of medical malpractice related to childbirth contact his office online or give them a call at (888) 529-0120 to take your first step towards the justice and compensation you deserve.