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q for midwives.. have you heard the term


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#1 swimmingalong

Posted 14 March 2012 - 04:32 PM



an older lady I  know used to be a midwife and we got to talking about brow presentations.

She was saying how  in the event that they had a brow presentation they used to put their hands up a woman and in between contractions would jiggle a baby's head around..  they used a technique, it wasn't just random jigging..

This is called "chinning"...

putting it out there as I have never heard the term and she was wondering if this technique is still used..

#2 Arthur or Martha

Posted 16 March 2012 - 04:22 PM

..................

Edited by ambwrose, 07 October 2013 - 04:01 PM.


#3 Alina0210

Posted 16 March 2012 - 04:29 PM

Dont think its done anymore... There is an easier way of going hands and knees and using a rebozo (large peice of fabric) to jiggle the belly to help with positioning....

#4 Monket

Posted 16 March 2012 - 04:33 PM

My OB did this to DS.  Wasn't quite jiggling though, more like a big thump....it hurt like hell!

#5 Mianta

Posted 16 March 2012 - 04:41 PM

Never something I have heard of or been trained to do. Brow presentation is a malpresentation. It isn't a typical posterior position with  flexion. It is a deflexed head wih the brow as the presenting part, increasing the diameter of the presenting part that needs to be delivered, which is alo true of the posterior presentation, but not as much as a brow presentation.

#6 TwiceTheWoman

Posted 16 March 2012 - 06:31 PM

QUOTE (Monket @ 16/03/2012, 05:33 PM) <{POST_SNAPBACK}>
My OB did this to DS.  Wasn't quite jiggling though, more like a big thump....it hurt like hell!

^^^Monket, I have been 38years in "the business" and have no idea what was done to you!

OP, I'm probably old enough to remember various practices to which you may be referring.
The old midwife you were speaking to may have some things mixed up as officially, "chinning" is not practiced anymore, where as providing gentle counter pressure on the chin to encourage flexion - as in the case of brow presentations, is still practiced, however this is not referred to as "chinning".
"Chinning" was applied via the rectum, together with "crowning",  while delivering babies waaaaay back when as it was claimed to "prevent" face presentations.  Old labour ward staff also tried to teach us as student midwives that it also prevented the babies from "sliding back" at the completion of the contraction.  To get a perspective on this, many of these midwives were educated back in the 1930's - before the modern era of drugs and medical machinery and (gasp!) the notion that patients had say in their preferred outcomes.  I have to add that many of the old midwives were amazing with regard to the skills that they taught and were committed to nursing as a career, keeping abreast with modern advances and were as up-to-date as the rest of us.

Bit of background.......
Mid 1970's, unlike days of yore, the majority of women who entered nursing via senior tertiary hospitals, were well educated, having achieved matriculation and or HSC and had considerable knowledge of anatomy & physiology, physics, biochemistry and patient ethics, together with all the vast array of other medical & surgical nursing subjects.  Tertiary hospitals were aware they were educating the modern era of nurses; the education via these educational facilities, was commensurate with university standards of the time.  Nurses had been lobbying since 1933 for university education and tertiary hospitals had to provide the on-going standards by which our colleagues were soon to be graduating.
We were not the nursing graduates to be told to put up or shut up; thus the 1970's were the new era of nurses who aligned with patient advocacy.

Back to the topic at hand......
Many student midwives at the time were absolutely horrified at the practice of chinning (as described above) and complained that this was against the physiological process of childbirth and that the practice was unnecessary.
Chinning, in the opinion of many of us outspoken feminist midwives, had no place in modern labour wards, given that if a woman was allowed to labour as she was most comfortable, she would, in 80% of instances, have a normal delivery. (As I recall, stats were obtained from UK)
So, we introduced change and many midwives refused to do certain procedures, previously claimed to be imperatives and looked to maternal centred labouring instead of medical-centred.
As student midwives, all of us already had at least four years experience working in medical & surgical nursing which was already evidence based practice at the senior tertiary hospitals, but it seemed that midwifery was a tad slower at catching up.

Re: Brow presentation - this is a mal- presentation requiring close monitoring and ideally intervention as early as is practicable.
Different hospitals have different protocols for management, however....
The anterior brow can be held during vag. exam.(VE) when a contraction occurs, to encourage chin flexion during the downward pressure of contraction; this may promote a more preferable outcome (rather than forceps or c/s).
If the previously diagnosed brow presentation remains flexed, the mother can invariably, deliver her baby without medical intervention.

Brow presentations can go several ways.
1. Midwife can promote flexion of the baby's head to encourage vertex (crown) presentation by brow pressure via VE during a contraction.
(I have done this many, many, times with natural delivery outcomes).
Outcome is either normal delivery or forceps, or rarely, c/s.
2. Brow presentation may extend into full face presentation.  Intervention required depends on level of descent at diagnosis.
-  If the mandible is posterior, again, midwife can promote flexion of the baby's head to encourage vertex (crown) presentationand hopefully help to release the head from behind the pubic bone.  Mother then goes on to deliver either deliver normally, with the assistance of forceps or a c/s - depending on dyad assessment.
If the baby presents as a face presentation with the mandible posterior, when high in the pelvis; this will most often require a c/s.
- If the mandible is anterior - again, the midwife can apply gentle pressure to the jaw during contraction, to encourage head flexion thus minimising diameter outcomes while the foetus negotiates it's way down the pelvis.
- If mandible anterior presentation on perineum, chin release is sought from behind pubic bone and held with the following contraction, encouraging the baby's head to flex as it descends down the birth canal while midwife sweeps back perineum over the back of the baby's head.

I do hope this all makes sense and helps you in finding out about things.
I have worked in many different hospitals and have seen many, many positive outcomes with midwifery intervention for brow presentations.

Edited by TwiceTheWoman, 16 March 2012 - 09:15 PM.


#7 Marchioness Flea

Posted 16 March 2012 - 06:34 PM

God I love this forum, you can learn so damn much!

#8 weepingangel

Posted 16 March 2012 - 06:39 PM

QUOTE
God I love this forum, you can learn so damn much!


YES!

Great informative post TwicetheWoman. Thank you

#9 TwiceTheWoman

Posted 16 March 2012 - 09:16 PM

Thank you ppt!

P.S. To manoeuvre a mal-presenting baby towards normal delivery, then have the mother reach down to lift out her own baby, is pure, pure, bliss!

#10 Mianta

Posted 16 March 2012 - 10:02 PM

Wow, Twice The Woman, I hope you work in midwifery education. If you don't, you really should. As a relatively new midwife (3 years post grad) I am still learning and found your post a fascinating read, especially considering that I am working in delivery suite currently.

#11 Mianta

Posted 16 March 2012 - 10:33 PM

QUOTE (fertile woman @ 16/03/2012, 10:25 PM) <{POST_SNAPBACK}>
"Chinning" was applied via the rectum, together with "crowning", while delivering babies"


Twice the Woman - this is how I understood "chinning" to be too, although I thought it was to somehow reduce perineal tearing.  I've only ever heard one midwife speak of it.

Oh, I now understand what you mean, however, I have never heard the term "chinning" , not at uni or at work, ever. Am going to talk to my educator and some of the older midwives about it now, very fascinating!

#12 ChickenortheEgg?

Posted 16 March 2012 - 10:57 PM

QUOTE (fertile woman @ 16/03/2012, 11:19 PM) <{POST_SNAPBACK}>
biggrin.gif

These skills are getting so lost unfortunately.  I had a brow baby who turned to a face.  She had been laying in face presentation position as twin two (extended rather than flexed) due to lack of room for a couple of months prior to birth.  I wish I'd had the foresight to know that she would have presented through my pelvis the same way.  She still sleeps in the same position at 20 months old.  It looks painful!




My DS, 24 months, sleeps the same way!! We co-sleep and it leave us with no room. lol

#13 Soontobegran

Posted 16 March 2012 - 11:16 PM

A slightly different experience of 'Chinning' for me. What was called 'Chinning' for us  wasn't done via the rectum it was done by using your forefinger to locate the chin through the skin of the perineum between the anus and the vagina and maintaining a hold on the chin as the woman pushed.
I am old enough to remember it being done by some doctors to stop the head from deflexing and save the perineum from tearing. I was horrified to see some students copying this and it was outlawed by our place by late 70's.
Oh my goodness it was cruel!

Edited by soontobegran, 16 March 2012 - 11:21 PM.


#14 swimmingalong

Posted 17 March 2012 - 02:25 PM

Thank you all for the fascinating reading..

My 3rd baby - dh was pressured to pressure me into a cs for a brow presentation and the 2nd was stillborn, dh maintains to this day that it was 'necessary'.. now I do know in my heart that this simply isn't true, something else 'could' have been done and you have all just confirmed it.

There was nothing wrong with baby #3 or the pregnancy but the brow presentation was put out as the 'reason' for the cs, oh'and the previous stillborn'.

#15 TwiceTheWoman

Posted 17 March 2012 - 03:01 PM

Swimmingalong, I am so sorry to hear of your sadness, but nothing has been confirmed here.  A few comments in a forum does not confirm or deny anything at all for individual circumstances.
(The topic was asking about comments with reference to chinning and brow presentation which I felt the need to comment, were different situations in my experience)  
Some babies who present as brow will get "stuck" and require a c/s as flexion may not be possible and there may also be several other factors involved as well with the medical team's decision.
As heartbreaking as it is, I'm sure your medial team would have made the best decisions with the facts presented to them at the time.
This is simply a forum of discussion, and I wouldn't want you to misconstrue it otherwise.

Edited by TwiceTheWoman, 17 March 2012 - 03:21 PM.


#16 TwiceTheWoman

Posted 17 March 2012 - 03:18 PM

STBG is spot on when she says "It (chinning) was too cruel!  
It's one of those weird practices that you would never want revived.
We were also told that chinning would help prevent perineal tearing but this was absolutely not the case - in fact, quite the reverse.*shudder*



#17 seepi

Posted 17 March 2012 - 03:34 PM

Fascinating stuff.

My first came out all bruised up one side of her face head and top of her nose with a serious black eye. It seemed to me as if she had been pushing her head out with one side of her forehead and the one eye. (as if you were wearing a hat at a jaunty angle right down over one eye - that circle of her head/face was all bruised - she had a little haematoma on her head as well.)

Is that a brow presentation?

Noone ever told me what was going on. 2.5 hours of pushing did leave her bruised up though.

#18 Soontobegran

Posted 17 March 2012 - 04:59 PM

DP

Edited by soontobegran, 17 March 2012 - 05:02 PM.


#19 Soontobegran

Posted 17 March 2012 - 05:01 PM

Just want to stress to some that a baby can't deliver in a brow position, it may deflex and become a face presentation or flex and become vertex. If the presentation can not be manoevered (and many can't) then the mode of delivery will be a C/S.
The diameter of the brow presenting is too wide for the pelvis .
Swimmingalong, I am so sorry about you situation but it is very common that no amount of manoevering or pushing will get your little baby to move it's head into a favourable position for delivery.
I don't want you to be misled by what has been said here into thinking that something can be done all the time because I would say a C/S is very often the outcome of a persistant brow presentation.

#20 Alacritous~Andy

Posted 17 March 2012 - 09:04 PM

Fascinating thread.  I am continually amazing by the knowledge and patience and  compassion shown on these boards. wub.gif

#21 mama123

Posted 20 March 2012 - 10:01 PM

This was done to me with my first child.
I was induced and had an epidural. Pushed for 3.5hrs and had to labour on my side with one leg up in the air! It was the only way bub would move down. My midwife was excellent (my 6th one). She showed the OB whilst she did it. I was none the wiser.

Will never touch an epidural (or any pain relief) again!

#22 Soontobegran

Posted 21 March 2012 - 08:37 AM

QUOTE (mama123 @ 20/03/2012, 11:01 PM) <{POST_SNAPBACK}>
This was done to me with my first child.
I was induced and had an epidural. Pushed for 3.5hrs and had to labour on my side with one leg up in the air! It was the only way bub would move down. My midwife was excellent (my 6th one). She showed the OB whilst she did it. I was none the wiser.

Will never touch an epidural (or any pain relief) again!


Can I ask how you knew they were 'chinning' your baby down? Did they tell you that is what they were doing?

#23 =R2=

Posted 21 March 2012 - 07:49 PM

I've never heard of chinning and all the brow presentations I've come across have ended up in theatre.

I was looking after a VBAC woman once and she had a c/section for her first baby for brow presentation. Once she got to 8cm with her second labour I diagnosed another brow presentation and had to call the OB in to reasses and sure enough her second baby was brow again so off she went to theatre. She must have had an odd shaped pelvis.





#24 mama123

Posted 22 March 2012 - 06:58 AM

QUOTE
Can I ask how you knew they were 'chinning' your baby down? Did they tell you that is what they were doing?


They never told me they were going to do anything at all, I guess so I wouldn't tense up? They never used the term 'chinning' as such but when the midwife was showing the OB and talking her through it, I could hear what they were saying. Things like 'working the chin down gradually'.....The OB was saying she had never seen it done before. They took their time. When they left the room I asked hubby what they were doing and he said she had her finger up my butt......sorry that sounds a little TMI when I put it like that but quite relevant! original.gif

QUOTE
It's one of those weird practices that you would never want revived.


Why is that? I assume it must hurt? Or is it considered to be bad for the baby?

QUOTE
We were also told that chinning would help prevent perineal tearing but this was absolutely not the case - in fact, quite the reverse.*shudder*


I still needed an episiotomy. The midwife said I was going to tear badly if I didn't, judging by the look on her face, I took her word for it!

He shot right out after that. I was happy because we avoided forceps. He had a very long cone shaped head biggrin.gif

Edited by mama123, 22 March 2012 - 06:59 AM.


#25 new~mum~reenie

Posted 22 March 2012 - 09:59 AM

Apparently the first bit of footage the doctor is 'chinning' the baby, according to one poster below.

Is this what you are talking about?

http://midwifethinking.com/2010/08/07/birt...ys-perspective/




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