[Couder's maneuver. Knowledge and practices in a French university maternity hospital]

Abstract

Background: During childbirth, the performance of a systematic Couder's maneuver could be linked to a reduction in the risk of perineal tear.

Objective: To know the practices and knowledge of childbirth professionals regarding the Couder's maneuver. To measure the effect of a training program for juniors.

Materials and methods: Single-center questionnaire survey of senior and junior obstetricians and midwives. Before-and-after study in juniors to evaluate maneuver training.

Results: One hundred and twenty-five caregivers responded to the questionnaire: (19 physicians and 46 senior midwives; 21 residents and 39 midwifery students). Only one third of the respondents said they practiced the Couder's maneuver "always or almost always" (41/125, 32.8%) and less than one third felt "very comfortable" with the maneuver (34/125, 27.2%), with large differences according to profession and senior vs junior status. Being a doctor (vs midwife) was significantly related to systematic or frequent practice of the maneuver (70.0 vs 15.3%, ORMH=42.7 [9.4; 192.3]) as was being a senior (vs junior) (46.2 vs 18.3%, ORMH=15.9 [3.5; 72.9]). Less than half of the seniors surveyed had received education in maneuvering. Of those who did not practice the maneuver, the majority did not consider its systematic practice to be useful (19/26, 73.1%), and one third considered it potentially harmful (8/26, 30.8%). Theoretical and practical training of the juniors significantly improved their knowledge.

Conclusion: There are great differences in the practice of the Couder's maneuver. It deserves to be better known, practiced and evaluated.

Keywords: Couder's maneuver; Dystocie des épaules; Déchirure périnéale; Formation obstétricale; Manœuvre de Couder; Obstetrical training; Perineal tear; Shoulder dystocia.