[mama123]

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!

[soontobegran]

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?

[=R2=]

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.

[mama123]

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!

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?

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

This post has been edited by mama123: 22/03/2012, 06:59 AM

[new~mum~reenie]

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/

[MrsRB]

^^^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.

Thank you! What an informative and well-written post!

[soontobegran]

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!



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



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

Chinning is extremely painful and can badly bruise the perineum.

If he had a long cone shaped head he probably wasn't presenting by the brow but more likely to be a posterior position or just in the vertex for sometime.
Glad all worked out well!

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/

No NMR, the doctor is not 'chinning' he is allowing the head to descend whilst with his lower hand gently placed between the vagina and anus to keep the head flexed.
This is not a horrible delivery, he has ensured an intact perineum by taking the time to stretch her up and allowed the head to progress with minimal handling and controlled pushing.
Chinning in our terms is when the fingers grab the chin with their fingers. This baby in the footages chin was tucked so far under you would not be able to locate it with your fingers.

[new~mum~reenie]

Yeh, I thought it wasn't as you described - just tried to find some footage of it....

Chinning in our terms is when the fingers grab the chin with their fingers. This baby in the footages chin was tucked so far under you would not be able to locate it with your fingers.

I assume that was through the vagina (ie, not through the anus)
Sorry if that seems a silly question, but I'm curious...

[mama123]

If he had a long cone shaped head he probably wasn't presenting by the brow but more likely to be a posterior position or just in the vertex for sometime.

Yeah, the midwife said it was because he was in there for a long time.
She said she was getting the baby into position.

[soontobegran]

Yeh, I thought it wasn't as you described - just tried to find some footage of it....



I assume that was through the vagina (ie, not through the anus)
Sorry if that seems a silly question, but I'm curious...

NMR, it seems that 'chinning' means different things to different places because I think someone mentioned putting fingers into the rectum but that is not how 'we knew it'
It is hard to describe and that video you showed has the woman so heavily draped it was hard to see all her perineum but if you look to see where the Obstetricians lower hand is instead of it lying there flat, chinning involves digging the fingers in just in front of the anus on the perineum until you can feel the mandible then holding the chin as the woman pushes.
In theory it was 'supposed ' to stop the head deflexing which does both increase the diameter and increase the chance of tearing but it really is so not necessary to do this to guard the perineum.

There were all sorts of horrible ways we used to assess the station of the head. One was called post anal palpation where you dug your fingers in behind the anus to locate the head as you can also feel it there. This was also an extremely painful thing to do and so unnecessary as you can see it happening...you don't have to feel it.
This was also (thankfully) something they stopped teaching students shortly after I had finished my training.