C/S or V/B after shoulder dystocia.

[HotKim]

This is my first post so Hello! to you all and thanks for sharing!


I have three children Miss11, and Masters 4 and 6. My children were all born naturally weighing 3800, 3950 and 4590 grams and I recieved care from midwives for all three. I am an advocate of women being well-informed during pregancy, labour and delivery. My last child (the whopper!) was delivered at a birth clinic and suffered shoulder dystocia during delivery. My midwife was able to deliver him after I went on all fours but he suffered a Brachial Plexus injury and endured 18 months of intensive physio.

I am currently pregnant with another child due in June 08 **YAY!** and while I tried to obtain midwifery care through the local hospital I have been unceremoniously dumped into the care of a doctor considering my previous problem. My doctor (I should say A doctor) has suggested I consider a c-section considering my last child's birth weight and BPI.

I've done a fair bit of research which loosely suggests that macrosomia is key in SD. (There are other factors but I have none of these such as GD, maternal obesity etc) However, what's worried me is the suggestion that having had a previous SD I am now more at risk for another. I have no fear of birthing a large child as I have had no stitches for any.

Considering how lucky we were that Master4 has no residual effects from his BPI and that I know a mother who refused a C/S for her macrosomic baby who then suffered brain damage after V/B I feel between a rock and a hard place.

I was hoping for some inspiration, advice or support from other mums or midwives who have faced the same dilemma.

[BellyBelly]

Shoulder dystocia is an unfortunate positional problem and even babies of 7lbs have been known to get it. Just bad luck. Check out spinningbabies.com which is an optimal fetal positioning site and its a great help/read.

If you read the Cochrane database, there is a study on induction for suspected marosomic babies where mothers had GD - but with or without GD, results showed induction for suspected macrosomic babies resulted in more c/s without improving outcomes including dystocia or other trauma.

Have known mums to go on and have normal births without SD after prior SD experiences.

[Lucy]

My daughter Olivia (7lb6oz) was born naturally with shoulder distocia.

In hindsight it was a positional issue.

I then went on to have my son Charlie vaginally, and then Lexie naturally.

I was encouraged to have a CS for my son, but inisisted against it. I did end up being induced with him, which was a shame for me, but the birth was easy. I gave birth standing with him.

HTH.

I can understand your dilema.

[HotKim]

Kelly, thank you for your input. Unfortunately I 'm finding it hard locating info to help me resolve my dilemma. I have read in other posts, your comments about SD maybe being related to an inactive birth but feel confident that I was very active throughout Master4's labour and delivery. I guess my biggest problem is that there is so much conflicting info on SD that it's hard to feel like I'm making a properly informed decision. Research suggests that anywhere between 48 - 89% of SD occurs in non-macrosomic babies. Not only that 'there is evidence to suggest that delivery of a previous macrosomic baby is quite a reliable sign of pelvic adequacy to deliver a macrosomic infant. However, previous SD constiutes an apparent risk factor, despite a lcak of consistency'. The same report then goes on to say that one should avoid VD in a patient with previous SD as 'these patients carry a 7 to 16 times increased risk of repeated SD and should better avoid VD.'

Gah! It's no wonder I'm confused!!

[HotKim]

So I went to see a physio therapist today and he gave me the name of a site that has the result of actual studies into thousands of medical problems etc.

Here's what I've found,

Gurewitsch ED, Johnson TL, Allen RH.
Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. dgurewi@jhmi.edu

Among risk factors for shoulder dystocia, a prior history of delivery complicated by shoulder dystocia is the single greatest risk factor for shoulder dystocia occurrence, with odds ratios 7 to 10 times that of the general population. Recurrence rates have been reported to be as high as 16%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, intervention efforts directed at the particular subgroup of women with a prior history of shoulder dystocia can concentrate on potentially modifiable risk factors and individualized management strategies that can minimize recurrence and the associated significant morbidities and mortality.

PMID: 17531900 [PubMed - indexed for MEDLINE]


Ginsberg NA, Moisidis C.
Department of Obstetrics and Gynecology, Northwestern University, Illinois, USA
...The mean fetal weights were 3885 g in the recurrent dystocia group and 3702 g in the group without recurrence (P <.03). Gestational age, operative delivery, and gestational diabetes were similar in the two groups. CONCLUSION: Factors that appear to increase the recurrence risk of shoulder dystocia include fetal weight and maternal parity. Prior shoulder dystocia is the single greatest predictive factor.
PMID: 11408863 [PubMed - indexed for MEDLINE]


Lewis DF, Raymond RC, Perkins MB, Brooks GG, Heymann AR.
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport 71130-3932, USA.

OBJECTIVE: Shoulder dystocia continues to be a major complication of obstetrics, and several factors have been identified to help predict its occurrence. A previous shoulder dystocia is one of the risk factors. However, the recurrence rate is unknown. The purpose of this study is to report the recurrence rate of shoulder dystocia. STUDY DESIGN: Our obstetric database was used to identify all vaginal deliveries between January 1983 through December 1992. A subset of vaginal deliveries complicated by shoulder dystocia was selected from this database. These records were reviewed to identify subsequent pregnancies, outcomes, risk factors, and demographic data. RESULTS: During the study period there were 37,465 total vaginal deliveries, with shoulder dystocia complicating 747 (overall rate 2%). Of these 747 cases, 101 patients had 123 subsequent vaginal deliveries, with shoulder dystocia complicating 17 of these pregnancies (13.8% recurrence rate, p < 0.0001). Comparisons were made between those patients with recurrent shoulder dystocia. CONCLUSION: Shoulder dystocia recurred at a rate approximately seven times higher than our primary rate. Whether patients with a history of shoulder dystocia should be offered an elective abdominal delivery requires further investigation.

PMID: 7755040 [PubMed - indexed for MEDLINE]


Awwww, not good!

[BellyBelly]

Its up to you what you want. I just have never known someone to have it twice. They are probably out there but never heard it myself.

Try the Cochrane Database, they are independent study reviewers, not biased.