C/S or VD - Advice please

[Captain]

My DH and I have been talking about TTC #2 and it has started me thinking about alot of things with my first birth.
A quick recap, My DD was born at 37 weeks and we went through severe shoulder dystocia (shoulders got stuck) that resulted in injuries to DD. DD was abou 8 pound 10 and she had quite large shoulders. The midwives wanted to measure her shoulder size and compare it with other bubs, but never found the time, I wish we had done it though.
I've been told by some Drs that I should never have a natural birth again and 1 Dr tell me it is possible. Despite what happened, I'm still more fearful of having a CS than attempting a VD again. But my biggest fear is that I will be putting my future bub at risk of the same injuries that DD has

What I would like to know is, has anyone had or know of anyone who has had a natural birth after Shoulder dystocia. What were the outcomes and was it difficult to find an Ob to support this decision?

Sorry if I'm waffling, I have a lot of question on my mind.

[paradise lost]

Hi Captain,

Can i ask what position you were in when the dytocia occurred and what the Obs tried to free your DD and what worked?

What injuries occured, and how?

A lot of questions, sorry, but it'll give us all a clearer picture of what happened which will make a difference to future deliveries etc.

Bx

[BellyBelly]

Tenille,

Shoulder dystocia is a positional thing, it's just bad luck hon. I know people who had it once then never again, in fact not heard of someone having it twice.

I have heard babies of all sizes have this - its not only the bigger babies.

I would make sure you do some optimal fetal positioning in pregnancy and make sure you have an active labour to get that baby moving around. Read New Active Birth by Janet Balaskas. Get off the bed in labour or off your back and move often.

Sounds like you would prefer a vaginal birth over a c/s, and of course, there are lots of things to consider with surgery too, but most of all, it's important to understand the nature of shoulder dystocia and that it's nothing to do with your body being inadequate. It was just bad luck hon.

[paradise lost]

I have heard babies of all sizes have this - its not only the bigger babies.

SO true Kelly, i recently read a study which concluded that induction to avoid dystocia in women with GD is ineffective as even 7lb bubs can get stuck if all the wrong factors add up, just as 12lb bubs can get out fine if all the right factors add up.

B

[{sarah}]

I'm pretty sure Tegan's Lily had this problem but her second, Charlie, was fine.

[Captain]

Thanks for the replies.

I know now that I was not active enough during the labour. I was on my back for the delivery, but when I think about it now I was most comfortable when sitting on the toilet. I delivered her head with no problems not even any tearing. One of the midwives tried to encourage me to move postions but through the pain I really don't think I paid enough attention to what she was telling me.

Hoobley, they tried moving my postition. I ended up with midwives and DH holding my legs up near my head. Not exactly sure what happened in what order but the Dr did an episiotomy, twisted DD and pulled her following shoulder out before the leading shoulder, which was the one that was stuck (does that make sense?)

During the pulling and twisting the nerves in DD neck were torn which paralysed her right arm and made her right eye droopy (the eye has healed completely and the arm still has a way to go) No one can pin point exactly at which point the injury occurred.

I know people who had it once then never again, in fact not heard of someone having it twice.

Kelly this has given me hope that I will be able to have a VD. Can't wait for DH to get home so I can show him, I think he is more nervous about the idea than I am.

[paradise lost]

I was on my back for the delivery, but when I think about it now I was most comfortable when sitting on the toilet

Being on your back can give you as much as 20-22% LESS room inside your pelvis for a baby coming through cmpared to squatting and hands and knees positions - that's alot when you think about it, several centimetres tighter.

You being most comfortable on the loo is a great sign - it means you already know one of the positions your body likes to birth in and can ask for a birthing stool for next time.

they tried moving my postition. I ended up with midwives and DH holding my legs up near my head.

One of the most effective ways to free a dytocia and yet one which seems underused, is the Gaskin manoeuvre, named after the midwife Ina May Gaskin, though she learned it from some indigenous people somewhere. She reports 100% success with it and no baby injuries (some women tore a little). If a dytocia occurs the mother is helped to turn onto her hands and knees. The combination of movement to get there and the opening of the pelvis hands and knees brings unsticks the baby.

The use of traction on the head to free the following shoulder does risk injuries as you describe (though full recovery is both possible and common, even if it does take a little time ), another method is to break the collarbone of the stuck arm to narrow the shoulders. Most Obs go for the first method because it *might* result in injury whereas the second obviously will.

I too, in the pain, needed a crowbar to get me to move, but next time i'm going to make myself a sign that says "MOVE!" and put it right where i can see it!

There was probably a positional factor too, so your baby was coming at a slightly bad angle perhaps, Spinning Babies website has masses of information on Optimal Foetal Positioning and New Active Birth and most things Sheila Kitzinger has written can tell you more about the "birth dance" - moves you can do and positions you can assume which will keep you comfortable and open your pelvis to let baby down and through and out into your waiting arms.

If you'd told me you were delivering on hands and knees, the obs had you crawl and deep-squat and when all that didn't work the lodged collar bone was broken AND the head traction/turning used, i'd be more cautious about saying this, but given the situation you describe i honestly cannot see a SINGLE reason why you should expect a dystocia in ANY subsequent deliveries. Besides which (probably because the experience is traumatic and leaves people asking questions which give the answers they need to have an easier time with the next birth) like Kelly, i have never heard of anyone having 2 dytocias. You sound like you already know alot more about it all than you did last time. Knowledge is power.

Bx

[Captain]

Thanks Hoobley

You're right, knowledge is power. I already feel I will be in a lot more control over what happens this time round. I just need to convince DH of that. He's still worried about what might happen. But since I'm not pg yet I have a lot of time to talk him round
I'll be checking out the websites too. Thanks for the advice.