Using a Bed Sheet to Avoid an Assisted Delivery

To the Editor: A few years ago, I attended the delivery of a primigravida who had received epidural anesthesia who was nearing delivery after 3 hours of pushing. She was exhausted and no longer pushing effectively. As I contemplated an assisted delivery with a vacuum or forceps, a midwife suggested a technique using a bed sheet. With this method, the patient soon delivered a healthy baby without the need for a vacuum nor forceps. I have successfully employed this simple alternative a number of times since.

The procedure is easy to perform. A knot is tied in both ends of a sheet (Figure 1). One end is held by the patient from a dorsal lithotomy or lateral position, and the other by the maternity care provider from the foot of the bed. With contractions, the provider and patient pull against each other (Figure 2).

This procedure is designed to increase expulsive efforts and improve maternal positioning. As the patient pulls on the sheet, she automatically increases intra-abdominal pressure through a Valsalva maneuver. The physical communication through the sheet allows the provider to coach better how long to push, when to breathe and when to relax. Maternal positioning is optimized with an automatic flexing of the maternal head and curving around the baby. This technique may be especially useful for patients who cannot be upright because of an epidural or other reason.

Although use of the sheet technique avoids most risks of assisted delivery, it does carry some risks and contraindications. It requires significant physical exertion by the maternity care provider, which may be unsafe or impossible for some. To overcome this, help could be enlisted or the sheet could be tied to the foot of the bed, although the physical coaching aspect would be lessened. Contraindications to performing the sheet technique include: fetal distress and certain maternal conditions such as hemorrhage, any condition contraindicating a Valsalva maneuver, and any condition preventing grasping of the sheet.

I have not been able to find this technique described in the literature. I hope this letter will inspire usage of the technique and encourage well-designed studies to document its effectiveness.

• Download figure
• Open in new tab

Figure 1.

A knot is tied in both ends of a sheet.

• Download figure
• Open in new tab

Figure 2.

With contractions, the provider and patient pull against each other.