Shoulder Dystocia?

Ok so when I had DD I was induced after being hospitalized for two days before hand with suspected leaking waters. After about an hour an a half of pushing they had to do an episiotomy (?) and use the forceps pretty strongly. She had a really bad cone head and a huge mark from the forceps (she has a scar now, small but it is there)

The dr told me afterwards that her shoulder was stuck and that was preventing her coming out. He also said I would have to discuss my options if I had another baby as it was because of my pelvis? DP doesn't remember that... But I think he was too busy checking out his girl lol

My question is this. Has anyone had this in a birth and then had it happen again? Reading online it seems to say there is a risk of it repeating and sometimes a csection is needed? I am terrified it will happen again and I am requesting my birth records to discuss it with my DR this time around but I was hoping to hear anyone else's experiences??

I had this too with DS2! I guess now that I am UTD I need to be thinking about the labor and birth.
I remember there being like a code red where they had all these doctors come running in, pushing my legs back as far as they could and DS popping out seconds after.

I do NOT want another C section after having an emergency one with my first DS. I honestly didn't even think about it happening again!

*hugs* for your first birth.

yes, having experienced shoulder dystocia previously, you are at a greater risk of it occuring again. of course the deciding factor is if it was bub who caused it, or you (your pelvis). Shoulder dystocia is where bubs anteria (top/front) shoulder gets caught on your symphis pubis (the front of your pelvis). sometimes its just caused by bubs position, if bub is large - eg gestastional diabetes, etc.. sometimes it just happens... and sometimes, a small portion of the population have abnormal shaped pelvis's. I would have a good chat with the dr re: this, i'm not 100% sure if they can sus out your pelvis before hand, and maybe get an idea before birth?

My girlfriend had shoulder dystocia with both of her bubs. First one was in hospital, and ob pulled him out and dislocated his little collarbone at the same time. Poor little mite was bruised for weeks. Second bub was a home waterbirth, and she'd told her IM about her previous shoulder dystocia. When bub got stuck, IM literally used 2 fingers to rotate him ever so slightly, and she reckons he just about fell out :) 2nd bub was much bigger than the first as well, 8 pound v 10 pound I believe.

My point is, maybe you could try and find an ob or IM that is well versed in shoulder dystocia, and it shouldn't be a problem for you :)

Read up on the Gaskins maneuver and the McRoberts maneuver. Positioning during birth can help prevent it.

I'm going to play devil's advocate here and suggest that maybe, just maybe, there was no shoulder dystocia at all and this was your Ob's lame ass excuse to needing to hurry up and get bubs out of there instead of giving you more time to push. I say this because you DON'T use forceps to pull out a baby with shoulder dystocia!! When I read that I felt sick thinking about what could have happened to you or to bubs if the reason for forceps was shoulder dystocia! He could have done a lot more damage than leave a small scar (which in itself should not have happened!). The other thing is that bubs had a large cone head. The moulding is indicative of your baby's skull needing to mould to fit through the birth canal and this is entirely normal for this to happen and also the reason why you had such a long pushing stage - again it is absolutely normal for some women to push for that long with absolutely no risk to the baby. For my first birth I was pushing for 1hr20mins and when he was born the moulding on his head was spectacular - it was a sight to behold that's for sure! But, he had a large head. At birth his HC was 35cm, but a week later it was 40 - after all the moulding had gone and he had a beautifully round head.

If it were me in your shoes and the Dr did that to me. I'd be running a mile quite honestly. I would be concerned that he chose to use forceps instead of one of the acceptable manouvers to help bubs out and it would indicate to me that he either does not know how to perform them or that he's just an ass who doesn't give a **** about what happens to his patient. I've had shoulder dystocia with my last two babies - both of them were in a terrible position for birth and both of them were born without the use of forceps. For my last birth the shoulder dystocia was particularly bad because he was born with his head in a deflexed position and his back was along my left side, so his shoulders were in a north/south position. My Dr use the McRoberts maneuver to get him out with no effects on bubs at all.

Please consider getting a second opinion or changing care providers. There is more chance of the shoulder dystocia happening the first time because bubs was in a bad position as opposed to anything being wrong with your pelvis. This is also your second birth and a completely new baby, so the chance of it happening again is quite small really and certainly nothing to warrant an automatic c/s for. Put it this way, you could be choosing to have major abdominal surgery that comes with its own risks and healing issues to prevent something which may not happen again.

So ask as many questions as you can, check out spinning babies and work on optimal fetal positioning and give both of you the best chance of it not happening again. Even looking into getting the pink kit to help you understand your pelvis.

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I'm going to play devil's advocate here and suggest that maybe, just maybe, there was no shoulder dystocia at all and this was your Ob's lame ass excuse to needing to hurry up and get bubs out of there instead of giving you more time to push. I say this because you DON'T use forceps to pull out a baby with shoulder dystocia!! When I read that I felt sick thinking about what could have happened to you or to bubs if the reason for forceps was shoulder dystocia! He could have done a lot more damage than leave a small scar (which in itself should not have happened!). The other thing is that bubs had a large cone head. The moulding is indicative of your baby's skull needing to mould to fit through the birth canal and this is entirely normal for this to happen and also the reason why you had such a long pushing stage - again it is absolutely normal for some women to push for that long with absolutely no risk to the baby. For my first birth I was pushing for 1hr20mins and when he was born the moulding on his head was spectacular - it was a sight to behold that's for sure! But, he had a large head. At birth his HC was 35cm, but a week later it was 40 - after all the moulding had gone and he had a beautifully round head.

If it were me in your shoes and the Dr did that to me. I'd be running a mile quite honestly. I would be concerned that he chose to use forceps instead of one of the acceptable manouvers to help bubs out and it would indicate to me that he either does not know how to perform them or that he's just an ass who doesn't give a **** about what happens to his patient. I've had shoulder dystocia with my last two babies - both of them were in a terrible position for birth and both of them were born without the use of forceps. For my last birth the shoulder dystocia was particularly bad because he was born with his head in a deflexed position and his back was along my left side, so his shoulders were in a north/south position. My Dr use the McRoberts maneuver to get him out with no effects on bubs at all.

Please consider getting a second opinion or changing care providers. There is more chance of the shoulder dystocia happening the first time because bubs was in a bad position as opposed to anything being wrong with your pelvis. This is also your second birth and a completely new baby, so the chance of it happening again is quite small really and certainly nothing to warrant an automatic c/s for. Put it this way, you could be choosing to have major abdominal surgery that comes with its own risks and healing issues to prevent something which may not happen again.

So ask as many questions as you can, check out spinning babies and work on optimal fetal positioning and give both of you the best chance of it not happening again. Even looking into getting the pink kit to help you understand your pelvis.

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BUT the use of forceps can put you at higher risk of getting shoulder dystocia. as can being too hands on. when bubs come down the birth canal they are constantly rotating and moving to get into optimal position. once bubs head is out they restotute (where they turn from facing mums bub to facing mums side) this gets the shoulder out from behind the bone (in a normal uncomplicated birth). if you pull bub too soon or don't give bub a chance to do this, they have a higher chance to being stuck. So maybe it was the other way around. maybe the forceps didn't give bub a chance to get in the correct position and then thus got stuck. (we can then argue that the ob said it was her pelvis so as not to blame his use of the instrument...but there is no point blaming at this time, its the time to see what we can do to help her avoid it again in the future).

also just want to put it out there...don't want to cause a debate or accuse anyone or defend the 'bad guys' but shoulder dystocia is a terrifying thing. you basically have mins to get that baby out before it becomes severly oxygen deprived which results in severe brain damage or death. so as a care provider, the priority is getting that baby out, and sometimes its not without pain on the mother (eg.. episiotomy) and even bub (eg.. breaking a bone, bones heal. death doesnt.)

sorry...I just had to say that because it really is one of the most scary things in the world.

They cut me first, after getting me to put my knees to my chest to see of that would help? Then after a few minutes he asked if I would allow the forceps as she was stuck. They had me in stirrups by then and he wrapped towels around the end of the forceps and (I think braced his foot on the bed) he was pulling so hard that I was being pulled off the bed. I was very drugged up so I didn't even register at time how freaked out everyone seemed? DP is pretty traumatized by it all, when he rang people to tell them she was here he just kept repeating "they cut Jess like a chicken"

I had been on my back for a while after an epidural as well which I think doesn't help positioning does it?

Hopefully the hospital notes will make it a bit clearer? I don't want a c section if I don't have to, but I don't want to go through that ever again. I know I have ages but this is keeping me up at night stressing!

*hugs* I'm really sorry to hear about your previous experience. Maybe it is worth getting your old notes and talking with someone and going through them so you know exactly what happened and might help you understand better and then know if there is a chance it might happen again.

*hugs*

I rang and spoke to a midwife at the hospital today. She was awesome. Have me all the details to request my notes and also had a chat about my birth and she made me feel so much better.

I am going to have a chat with my Dr next week and then consider sitting down with a midwife from the hospital to go through what happened last time and make a plan for this time to avoid a c section. Hooray!!

Thanks for your advice ladies! I was getting so worked up and panicky. Google is not my friend.

Yes my 2nd baby had shoulder dystocia but with the mcroberts manoeuvre and a very skilled midwife who stuck her arm up there :o I was able to push her out with no intervention.... other than her arm :o

I haven't read much about the risks for when I have another baby but my DD was 10lb 6oz which is 4.7kg!!!! She was a whopper!!!! I reckon it was due to her size... not my pelvis.

My first girl was posterior and 8pd1oz but no shoulder dystocia first time.

Meercat, that is horrific :hug:

:hug: Meercat I'm so sorry to hear of your experience :( you had a terrible ordeal.

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I had this too with DS2! I guess now that I am UTD I need to be thinking about the labor and birth.
I remember there being like a code red where they had all these doctors come running in, pushing my legs back as far as they could and DS popping out seconds after.

I do NOT want another C section after having an emergency one with my first DS. I honestly didn't even think about it happening again!

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I had all of those ppl in my room to after someone hit the emergency button. That was a bit scary...

My goodness Meercat! :hug:

but hang on, I thought shoulder dystocia was when the shoulders get stuck after the head is born? And if shoulders were stuck, how would the forceps work?

My DD apparently had shoulder dystocia - I'm not sure what the OB did to help her out, but there were no instruments and it only took a second. :dunno: I'm sure everyone's case is different, of course. Interestingly (?) my son was born with forceps - they were just in a hurry to get him out :doh:

I really hope you are better cared for this time :hug:

Madb - that is what has really been bothering me... What I remember, what DP remembers and what I was told don't really add up you know? And in my purple book it says "attempted forceps delivery" what does that even mean?!

There was never any emergency button pushed or anything so there is a huge chance I was all whacked out on the scooby snacks and have filled in the blanks with whatever I can remember lol.

I guess it also highlights how little I was prepared for DD's birth, and how in shock I was after because I am only know really questioning it because I will have to do it all again.

I got my medical notes and took a long time trying to work out in my head everything that happened. My breakthroughs came through firstly meeting with a hospital midwife to debrief the birth, reading through my notes and talking to DH and finally when i sat down with a private midwife and went thorugh my notes. The meeting with the private midwife was where i found the greatest clarification.

During my 2nd pregnancy, issues from my first birth arose and after working through them i feel so much lighter. I had done alot of thinking earlier, but i think time and facing birth again helped me to dissect and bring out all my concerns and then be able to work through them and come to greater acceptance. Not acceptance of the things that had happened unneccessarily, but acceptance that i was ok and that i could go on and be healthy and happy.

take care

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I guess it also highlights how little I was prepared for DD's birth, and how in shock I was after because I am only know really questioning it because I will have to do it all again.

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It's often the way. But you have time now to look into it.

My suggestion is that you get on to a trusted health carer or an independent midwife to access and go through all your files from last time and figure this out. I'm no expert, but my impression is that you were not cared for well, at all.

And, the disjointed nature of care - I mean different people pre/during/post, as is standard for most mothers, unfortunately - means you have to go on a sort of forensic scavenger hunt to actually try and piece it together. Having someone there to help you make sense of it could be really helpful. And I really think that understanding what happened last time will be helpful in looking forward to this time.

I sincerely hope that you have a much better experience this time. The foundation of a good experience, in my opinion (and in my experience), is receiving good care. :hug:

Small Pelvis? Here's The Truth About Cephalopelvic Disproportion (CPD)

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Often CPD is implied rather than diagnosed. In cases where labour has failed to progress or the baby has become distressed, medical staff commonly assume that this is due to physical inadequacies in the mother rather than look towards circumstances of the mother’s care. These problems frequently occur when CPD is not suspected and there are many other causes such as fear and uncertainty, difficulty adjusting to a medical environment, lack of emotional support and non-continuity of carer.

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Big Baby? Then You Must Read This Article...

A friend of mines first naby had shoulder distocia. It was quite a close call. The baby was 4.5 kg. her second came out petfectly fine at 4.7kg and she just had a homebirth for her third baby. That baby weighed in at just under 5kg. you are at higher risk than someone who hasnt experienced it, but that certainly doesnt mean it will happen. As others have pointed out, there's lots of ways to help prevent it.

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Size really has nothing to do with it. I know many women who have birthed 10-11lbers without a tear! Its all about position and the way the care unfolds.

Many women are led to believe by their carers that their gestational diabetes babies will be born HUGE. But studies show inducing these babies doesn't even reduce the occurrence of SD.

Induction of Labour - The Hidden Dangers of Labour Induction

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Induction For Gestational Diabetes

Even where there is a medical condition involved, for example, Gestational Diabetes, it is worth studying and asking your Obstetrician and / or Midwife to see if induction is going to offer more risks than benefits. The American College of Obstetricians and Gynecologists has published a study, which you can read here (which you might wish to print and show your Obstetrician), which concludes:

Based on data from observational studies, labour induction for suspected fetal macrosomia (large baby) results in an increased caesarean delivery rate without improving perinatal outcomes.

They state:

Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labour had a lower incidence of cesarean delivery and higher rates of spontaneous vaginal delivery. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomised studies.

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My friend is proof of that, kelly. Shes also not a big lady and came out of her second two births without so much as a graze either. (was cut first time)

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And this is why you don't use forceps with shoulder dystocia;

*warning - this link may be extremely distressing* http://www.mirror.co.uk/news/world-n...-during-839613

This is absolutely horrific. I cannot even begin to imagine how traumatised that would have left every single person in that room who saw that, let alone the mother and father of the poor babe. The story is extremely graphic so please do not read it if you think it would upset you.

Oh Trillian that is just awful :( you would think after six hours they would realize the poor baby was not budging?!?

Afm. I met with my Dr and discussed what I remember. He says it sounds more like the Dr who delivered DD just preferred to use the forceps and he will go through my birth records with me and my midwife to make sure but he believes I won't need a c section. Let's just hope he isn't on holidays when I deliver again! :)

I also had a friend who had an awful first birth after an induction give birth again. She went into labour naturally and had an entirely different experience. I will be avoiding an induction like the plague this time.

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I will be avoiding an induction like the plague this time.

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That's what I figured, too.
Also - the care you receive makes an ENORMOUS difference to how you labour and how you feel about it all. It's hard to get that across till you've experienced different kinds of care.

Meercat, would you consider getting yourself a Doula to help you this time? I think for you situation a doula could help you immensely during the birth and help you avoid what happened last time.

This is a brilliant article on shoulder dystocia. Highly recommend everyone read it.

Shoulder Dystocia: the real story | Midwife Thinking