ICOE Guru’s Chops
Trainer Thanee

“Perilous Rotational Manoeuvre for Shoulder Dystocia”

Excited and anxious, I started my journey to a LEDC country in South Asia, liberated in 1971 and the 8th most populous country in the world. The responsibility of an International ICOE Course director includes being a team leader to plan and arrange travel with accommodation for my team, in order to smoothly conduct the course in a foreign land on a limited budget. From the beginning, the odds were against our team due to sudden cancellation of our direct flight. Fortunately, we managed to reach our destination via alternative flights (at extra costs and much delay), after fighting with taxi drivers to catch the unbooked flight on time. We arrived groggy, and much the worse for wear.

Yet, we immediately sprang to action to arrange our stations and began the pre- skills test OSCE circuit. I was in-charge of the shoulder dystocia skills test and met my challenge when a middle-aged local O&G specialist approached as an anxious participant. She managed to correctly perform the McRoberts and Rubin I manoeuvres, but stumbled when asked to perform the rotational manoeuvre to deliver the baby’s shoulders. I was shocked to observe that she rotated the (mannequin) fetal head directly clockwise, a full 360 degrees! She was also unfamiliar with the technique to deliver baby’s posterior arm in shoulder dystocia.

This experience showed that theoretical knowledge doesn’t always confer practical competency. Simulation training helps in developing our skills to efficiently manage ostetric emergency, enabling us to provide safe child birth practices for our patients.