Shoulder dystocia 1st time ~ what to do this time?

[paradise lost]

SD is almost always a positional issue rather than an inherant problem with mum's pelvis or due to big baby/wide shoulders. Babies are born weighing >4kg every day and don't get stuck and babies weighing <3kg are born and do get stuck.

If baby was not posterior or in another irregular presenting position, you were not induced, had been active during your early labour, were pushing in hands and knees, on a birthing stool or in a supported squat and had not had an epidural then you might want to consider a section, since you gave the baby every chance to be in a good position and offered as wide a gap as possible for bubs to come through.

If you had been laid on your back for much of early labour and/or were pushing in a reclined or semi-reclined position, had had an epidural, or were being induced or augmented then it's likely the intervention contributed to the dystocia and avoiding these factors would make it very unlikely to happen again.

Bx

[Snoopea]

With my first daughter i also had sholder dystocia it was a horrible birth, my son was born 2.5 years later by vaginal birth and he flew out, they had a doctor on standby just incase, but he wasn't needed. My son was also 9oz bigger than my daughter. Every birth will be different and just because you had it with number 1 doesn't mean it will happen again. Please do what you feel is best for you and bubs.
Hope this helps with your decision.
Snoopea

[seenabeena]

Wow hearing all your stories is FABULOUS!!! Thank you so much. It's great to know that some of you had SD and still had a vag birth for the next bub's, but now I am even more confused. I will be taking a huge list of questions' with me to the OB. Of course I will have a c-section if it's absolutly necessary and he believe's that it will happen again, but if there's is a chance that a vag birth will be fine then I will jump at it.

Again THANK-YOU for sharing your experiences it's really is helpful to have so much information and knowledge when making these sort's of decissions.

[Julie Doula]

Hi SB,

I agree that a previous SD does not necessarily mean you will have issues with this birth. But if you choose to go for a vaginal birth, you want to go into it with eyes wide open, really do your research. Spinning Babies is a great place to start. Also, the hands and knees possie for pushing and birthing is the best for SD, or if there is any concern re. SD. This article talks about the Gaskin Manouvre - flipping onto hands and knees. One of Sheila Kitsinger's daughters did this spontaneously in her birth pool when she was birthing her large baby. Birthing in water can be a great help, with the ease of movement that comes with that. The reduced gravity makes it easier for the mum to move around and for the baby to rotate.

In this article a midwife talks about shoulder dystocia and 'bed dystocia' - the difference active and instinctive positions can make.

I would say, that an environment of fear and tension combined with a need to keep the woman on the bed "in case we need to do something" is not conducive to a safer birth process. It is important that you believe in your body's capabilities (that is a challenge after a really scary birth that has knocked your confidence) and that you choose careproviders who have confidence in you and are not scared by the SD risk. You might want to look into having a doula for your own encouragement and support, and for working through the understandable fears and traumas from the last birth. Also, a conversation with an independent midwife can be quite illuminating - while you may not be considering a homebirth, asking a midwife "so how would you avoid/manage an SD - if I were your client, what would you advise?" can yield much helpful info. You can also hire an indy midwife to support you in hospital in the doula role. if she is able to help you remain calm, confident, relaxed, upright, mobile and trsuting your instincts she could be well worth the money.

All the very best.

[Schmickers]

I'd like to heartily second what Hoobley and Julie said.

[seenabeena]

You ladies are so clued up it is fabulous. Are you doula's and midwifes?

With Kael I had to be induced as my waters broke on his due date, but nothing happened. I didn't have diabetes and wasn't overweight. The beginning of the birth I was very active, but near the end they recommended an epidural which I now wish I hadn't had because it made little if any difference to the amount of pain I felt plus I was limited to laying on the bed. I would never ever have or recommend an epidural.

When Kael was stuck they tried the Mc Robert's position and eventually they used their hands to pull him out. I am going to the OB with a bunch of questions thanks to all your information because from what I have read and please tell me if I am misunderstanding, but I feel that if I don't have an epidural am (hopefully) not induced again and can be active there is a good chance I can do this without a csection. My confidence is not a problem as I have always thought that if I can do it once I can do it again. So would it be fare to suggest this to the OB? If he decline's would you recommend I try another OB?

Sorry for bombarding you all with so many questoins, but a c-section is something I do not want to do unless it's totally necessary.

[Julie Doula]

I feel that if I don't have an epidural am (hopefully) not induced again and can be active there is a good chance I can do this without a csection.

Absolutely. Go with that confidence, and wisely choose a careprovider who also has confidence in you. Definitely change cps if your Ob is doubtful. Even look at hiring a midwife who is confident over an Ob who is not. I think the encouragement and support of a doula who believes in your capabilities could make a big difference too.

This next birth could be so different:

- no induction, labour starts naturally
- no epidural
- staying upright and moving
- water for labour and possibly to birth in
- active possies, including all-fours, for pushing and birth
- different place of birth, a place that supports gentle birth such as a birth centre, maybe even a homebirth?
- difference care-provider, not one who sees c/s as the answer to everything, but one who understands and supports gentle birth & knows why it is safer
- new knowledge, new skills, perhaps the support of a doula to guide you on your journey of discovery, perhaps The Pink Kit may also be a big help.

There are many variables that could make all the difference for you this time.

Keep researching, knowledge is power!