Question
“I have a question to ask you as this issue came up during the birth of my first baby. When my daughter was being born, the midwife realized that she had a nuchal hand, which means that she was holding her hand up by her face. Since the birth, I have been searching the Internet for more information about nuchal hands and while I have found it mentioned a bit here and there, there doesn’t seem to be a whole lot of information on it. Did the nuchal hand contribute to my second degree tearing? Was it the cause of such a long early (prodromal) labor, because my baby couldn’t get into a good position for birth? If I have a second baby, is it likely they will have a nuchal hand too? Is there anything I could have done during pregnancy or birth to help avoid it? I thought that with your amazing research skills, you might be able to locate more information about this issue. I would be really interested to see any research and/or studies that have been done on the topic of nuchal hands.” – Criselda
Answer
Additional Resources
- Compound presentations
- Nuchal hand
- Diagnosis
- Management during labor
- Risks
- Can it be prevented?
- Study on compound presentations
Thank you so much for covering this topic — I may have had a compound birth with both hands, and I thought I would share in case it helps others to know about this (I also have some questions). I was laboring at home with a home-birth midwife for about 32 hours before transferring to the hospital due to an inability to pass urine at what my midwife said was 8.5 cm. I ended up opting for an epidural, as I really needed sleep and I wanted to have energy to push. However, the first (and then second) epidural wore off on my right flank within about 30 minutes. I was finally at 9.5 cm and told I could start pushing after around 38 hours of labor. The pushing only took about 15 minutes, and while I was stretching well, I still tore upwards around the clitoris (which is more rare, I hear). My home-birth midwife, who was photographing the birth, said that it looked like both of my girl’s hands were up by my her face, kinda crossing each other at her chin, and that her elbow passing out was what caused the upward tear on her exit. This was not captured in the notes by the hospital staff though — those involved in handling my daughter’s exit either didn’t notice, or it’s possible that my home-birth midwife was incorrect in her observation. I’m curious how common that is… to have different providers have a different take on such a thing as compound hands? I’m also saddened to hear that so little research has been done on this issue, and I’m curious about double-compound hand presentations, and if that might have been why my labor was so long. I hope to deliver my next child at home (as I had intended to with my first baby), and I don’t want to be afraid of this happening again. Thank you for covering this issue, as this is the most helpful thing I’ve found online about the matter.
Elisabeth, thank you for sharing your story. It sounds like you had quite an eventful birth. I am not sure how common it would be to have different providers observe two different things. Although during a birth where there is a lot going on and multiple people focusing on different things I could see that something could not be caught, especially if they aren’t looking for it. I am happy to add double-compound hand presentations to my Q&A list and see what research I can find on it. I will keep you posted!