Shoulder Distocia

Hi I Was wondering if anyone had any feed back ond Shoulder Distocia (where the baby's collar bone can become fractured/broken during labour)?
My son suffered this condition during his birth and now that I am pregnant with my 2nd child my doctor is advising me to have a c/s as a repeat of this condition can be as high as 50%. From the llittle that I know Distocia isn't an adequate indicator for c/s. I wish to avoid c/s and Distocia if possible so would appreciate hearing from anyone who has experienced this. Thanks, Vanessa

Well i was told should dystocia was when the shoulder got stuck?? Anyways i had this with DD, her shoulders got stuck in my pelvis. I was also advised to have a c/s, which i am a bit against. So i am going to go through am OB for next bub and ask to be induced at around 38 weeks, so bubby is smaller and i will get another chance at another normal birth. I layed down for most of my labour with DD which is the worst position so next time i'll be up right and even give a go at birthing while standing and slightly squated as i heard this is the best position. I am not ruling out a c/s altogether. But i want to give a natural labour another go. If i could do it last time, then I sure as hell can do it again!

Hi Vanessa,

I can think of one BB member who had this problem during their first labour and was induced with the second because of it, but didn't have any problems at all. I hope that she will see your post and share her experience with you shortly.......

Ina May Gaskin (american midwife) has invented a manouvre which releases the vast majority of stuck shoulders. If the shoulders are jammed, turn onto your hands and knees - this widens your pelvis by up to 30% and makes a massive difference to the room bubs has to slide past the bones. With some babies the collar bones may still have to be broken but this is VERY rare. Ina May once delivered a 12lb baby from a first time mum with this manouvre and she didn;t even TEAR. It is not easy to flip onto your knees when the baby's head is out so you need assistance, but it is easier than having the head pushed back/having the collar ones broken. A pelvic press can also be used (this is where two assistants lean on the upper bones of the pelvis to widen the lower bones - think of the pelvic joint like a pair of scissors, narrowing the top widens the bottom) but this is not usually as effective as the Gaskin manouvre.

Talk to your ob about alternatives - a c/s is pretty major compared to flipping onto your knees....

Hana

I had shoulder distocia with my daughter. Olivia was only 7lb2oz, so I am pretty sure that the reason she got so stuck was because of position. I had been standing all labour (7 hours) and then all of a sudden I was 9cm dilated and everyone had a panic and got me on the bed in a reclining position and basically she got stuck becasue I was in the wrong position.

My OB (in Darwin), when I got pg again, straight way said that for my second birth that he would closely monitor the size of the baby and we would most likely go for an induction as that way the labour could be managed and if #2 got stuck again we would all be prepared. He indicated that my pelvis was small (even though I have wide hips? Go figure?)

Anyway, then I moved when I was 6 months pg, to Adelaide and the Darwin OB had to "handover" my care to a new OB in Adelaide. My old OB was old and experienced and felt that in the hands of a young OB a CS would be "safest". But I REALLY DIDN'T want a CS because of the recovery. (Imagine.........major abdominal surgery and its recovery with an 18 month old toddler and a newborn? Nightmare!!)

SO, when my new OB saw me, I was lucky that he was happy to take on my thoughts and really considered what I wanted. He did offer me a CS. And he also sent me for a guesstimate scan to try & see how big the baby # 2 was.......everyone kept telling me he was HUGE. I ate like a pig through my pregnancy but I still lost weight, and so I was all baby IYKWIM?

Anyway, the scan predicted an 11lber!!!!!

I was still adamant that I did not want a CS, and that I would prefer to be induced with my OB there so that if Charlie did get stuck, we could manage it together. And my OB agreed to this no problem.

As it was, I was induced with the drip (cytocin?SP?), my waters broke straight away, I went to 7 cm dialted in the first hour, then went into transition and vomited everything up, then started to push whilst still on the birthing/fit ball. My OB tried to get me on the bed (more convenient for him) but I screamed the hospital down to object to this, and got into the shower instead! After about 20 mins in the shower (I was pushing, but standing up) the midwife gently moved me into the main room of the delivery suite, told me to stand on a mat, she held one hand, Andrew (DH) held the other (I nearly broke both their hands!) & I carried on standing. For the last few pushes I went into a legs bent position, but not full on squatting, IYKWIM? And Charlie was delivered. Honestly, I found, in that position that it was "easy"! He slid out like a bar of soap! No tearing at all. He was 6lb 13oz, so a little bit smaller than Olivia.

My recovery was almost instant. I did lay on the bed to have my OB deliver the placenta at the same time as putting Charlie to the boob. That was at 5pm, and by 7pm I was outside taking a walk round the grounds making phone calls!!!

I am convinced that the speed and the position made it all possible. I had no drugs or anything........not becasue I have anything against them at all, but I didn't know how long my labour would be, so I kept thinking "I'll save the gas for when it gets REALLY bad", & didn't end up having time!

Induction worked really well for me. Because of Olivia, I wanted to be really organised and have her well fixed up with babysitters etc, so having an appointment for an induction made it possible for us to arrange all her care with my SIL, which took a load of my mind and made me relax more.

I think that if you talk to your OB and discuss that you really want to go for a vaginal delivery, he should defiantely support you.

Shoulder distocia is, in my experience, all about position, and confidence!

Very best of luck..............

Any other queries, let me know?

Hi Girls thank you so much for all the info, you're brilliant!!

During my labour with Rohan (11lbs 20zs birthweight, 5.040kg), yep a woppa by anyones standards I spent much of the time lying on my back. This was mostly because I gained 32kgs during my pregnancy (normal weight 56 kgs) and the only position I felt comfortable in. Because of the weight gain (I ate sensibly and exercised, and I didn't have Gest. Diabetes) I was unable to squat in delivery as I felt it very hard on my knees and legs and just couldn't support my own weight, even with help. So I think that this was a major contributing factor to the whole distocia thing.
This prgnancy I have changed doctors and am going to an OB also. The weight gain in my first pregnancy remains inexplicabl but I am working hard to be completely in control of the decisions being made in relation to the management of this prgnancy. My original doctors ignored the weight gain I had with Rohan and I am convinced the labour would have been amuch more positive experience had I have been listened to.

During the labour I had amidwife that believed in a natural delivery, without drugs and who had never had any children of her own. So, you can imagine how unimpressed I was to deliver such a large bub after having been denied pain relief for much of the labour, although i was begging for it.
I was left to push for a further 2 hours after the distocia became apparent and then I was finally given an epidural. As luck would have it though, my Anaesthetist took off to a rugby match and couldn't be raised when I needed a top up and it was discoverd that I had leakage around the epidural site. Suspicious that it may have been CSF I wasn't alowed a tpo up untill they could raise another Anaesthetis. ( it doesn't pay to deliver on Boxing day girls!!) ](*,)

Eventually I was topped up, given an episiotomy that must have broken all records and Rohan was delivered using the largest forceps possible. During his delivery he sustained a broken collarbone, severe facial bruising and bloodshot eyes from the trauma. Topping it all off he also had to recover from group B strep.

So girls you can see why I want to avoid this happening again. From your comments I am convinced that had someone suggested a better delivery osition much off this could have ben avoided.

Oh and apparently Shoulder distocis is not linked with the size of the bub.

Thanks for empowering me,
=D>
Vanessa + Rohan3 1/2 ( My shining Star)[/code]