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

[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!

[paradise lost]

I just wanted to add, because it's a fear many women have after it's happened once, that despite what Obs insist, over 90% of women whose waters have broken will go into labour WITHOUT augmentation within 72 hours (NOT will have given birth, will have begun labour!). So if your waters happen to break early again (they probably won't!) it is safe to wait - by all means be monitored, by all means let them check you for fever and follow your instincts on how things are "going" but don't be bullied into an induction you don't want or need.

Top tips for broken waters/no contractions:

Attend to physical problems which might be stalling you - if you are hungry - eat, if you are thirsty - drink, if you are tired - rest. The body and baby will want the best circumstances, these could be positional (will get to that in a sec) but they can also be physical in terms of your body knowing what you're facing will be too much unless you eat/drink/sleep.

Attend to emotional problems which might be stalling you. Get DH or your Doula or Mum or good friend and explore any nagging things you have going. If you have a lot of fears talking them through and formulating an action plan can really make a difference - early adrenalin from fear inhibits labour, so it's a great time for a vent, a cry or a hug - whatever helps you get to a calm place emotionally. You might find if this happens you'll have fears based on the previous delvery - that is GREAT - it's an opportunity to review everything you've learned since and all your action plans this time.

Sometimes baby won't begin labour in earnest until a good position has been achieved in your pelvis. Appreciate that for bubs it can be much harder to move without the cushion of waters, and you might need to help. Walk slowly up and down stairs to bring bubs head into contact with your cervix - this aids the release of oxytocin which kicks labour off and "rocks" your pelvis which can help baby wriggle about. Crawl about on the floor (gardening knee pads are a welcome prop for this!), this allows gravity AND your rocking pelvis to draw baby into an anterior presentation.

Remember to rest frequently - the idea is to remain active without exhausting yourself.

Do not allow ANYONE to put anything (speculum, fingers, hand, ANYTHING) inside your vagina. It won't tell them anything they need to know (women don't suddenly crown with no contractions) and will introduce and increase the risk of infection each and every time it is done.

In hospital do not accept augmentation - it leads to epidural for SO many women as it is so painful and if baby is malpositioned it will probably cause more problems than it will prevent. Bear in mind that you may need to have antibiotics if you get a fever - that is fine. Once 72 hours have passed with you active and using your techniques THEN and only then is it time to discuss further options with the Ob.

Bx

[Lucy]

I have posted about this before, but will post again.

My first, Olivia, was born naturally, and we went through shoulder distocia. She wasn't large: only 7lb 4oz. She was overdue by 10 days. (I was lucky: I had a fantastic OB & midwife adn despite the SD it was an amazing birth)

Then I was pregnant with my son, Charlie. My original OB was happy to support another natural vaginal birth, but then we moved interstate and I started from scratch with a new OB. Who was a little more keen on the CS option. However, I stuck to my guns and just kept saying "But I do not want a CS", so we compromised on an induction at 38 weeks, as Charlie was guestimated to be HUGE.

I was induced with Cahrlie (syntocin drip), had a 3 hour labour, and Charlie was born at 6lb 13oz, and flew out like a bar of soap........I gave birth standing up in a squatting position. It was brilliant.

Then with my 3rd pregnancy, there was no question of anything else but a natural vaginal birth.....Lexie was nearly born in the car at 7lb 7oz: labour was less than an hour and again I gave birth standing up.

HTH.........

[Julie Doula]

Great story, Lucy!

Yep, 6lbs130z is really HUGE, right?

I love how you had one baby smaller, then one baby larger, than the baby who had SD.

Awesome!