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

I have just been informed that because I/my son had severe shoulder dystocia (head come's out, but baby is stuck because the shoulder's don't fit. This can lead to lack of oxgygen etc.) that I should probably have a c-section with this baby. I do have the option of being induced 2 week's early, but there is no guarantee that A) an early induction will work B) that the baby won't be stuck again even if it is early.

I really had my heart set of another vaginal birth and I am all emotional and confused. I know that the I have to do what is best for baby and me, but a c-section was just not something I had ever considered.


Has anyone been through this and how did you decided what to do with your following births?

How did you deal with having the power taken away from you really because even though you have a choice c-section really is the only way to guarantee bub's is safe.

No one else I know has even heard of shoulder dystocia let alone dealt with it.

Hi Seenabeena

Sorry your having to go through this really tough decision. I had severe shoulder dystocia with my DD. I've decided to go with a c-section for many reasons. I'm the same, would have loved to have a vag delivery, and I'm still still a little upset about having the c-section. But here's my reasons....

1)DD has a brachial plexus injury as a result of the shoulder dystocia. Her right arm was completely paralysed at birth and she has had nerve grafts while she has good movement now, she will always have weakness and restricted movement.

2)Induction would be useless as she was already 3 weeks early. She weighed 3.9kg, so not the biggest..

3)I could not find a Ob that would support a vag delivery.

4)My DH is a pretty big bloke with abnormally large shoulders and chest. DD has inherited them from him. Even the midwives at hossy when DD was born couldn't believe the width of her shoulders.

These are just my reasons. It may be different for you. How big was your DS and did he have any injuries?

Also check out the spinning babies website. It has heaps of great info on Shoulder Dystocia and how it is largely a positional problem and will not necessarily occur in your next delivery.

HTH.

Thank you so much for your reply. As much as I don't want anyone else to have to go through this it's nice to know I am not alone. I am so sorry to hear about the injuries your DD has because of it. DS had movement in his left shoulder when he was born, but it was very weak and when he got older he couldn't crawl becase of this so we did physio and it improved, but he still couldn't crawl and just went straight to walking. Because it's his left shoulder and he is right handed it's hard to know for sure how strong/weak it is now. I guess as he get's older we will have a better idea if there is any permanent weakness/damage. DH's dream of producing a star football player have been shattered :lol:


DS was 4.6kg born and with very wide shoulder's so I doubt there will be an OB in Aus. that would allow me to have a vag birth this time around. I am going to go now and check out the website.

Thanks again you have made me feel more 'normal' and accepting about having to have a csectoin.

I also had shoulder dystocia with my recent birth, but I don't believe it was severe. My bub did not have big shoulders and was 7 pound 13, born a week and a half early. If I were to fall pregnant again (not planning on it after the trauma of the last birth) and it was recommended that I have a c section I would jump at it.

I think that you just need to go with whatever offers the best outcome for mum and bubs. It's easy for me to say this though when I'm not actually facing it, I could feel differently if I was.

Hi, I also had SD with my DS although it was not severe and he only really had bruising as a result of it... nothing major so I am sorry to hear that that wasn't the case for you.
With my DD, I only had midwife care and none of them seemed concerned that because I had SD with the first born, that the 2nd would be the same...

Until the last MW I saw when I was over due decided to scare me into thinking that I would probably need to go to a different hospital to have my baby because the hospital I was going to was low risk and I would probably need extra care or possibly a C-section! If I hadn't had bubs by Monday, she recommended that I should go and have an appointment at this other hospital to see what they say....

Thankfully, I didn't need to.. Bubs came that Sunday night/early Monday morning!!!

I did not have any issues with the birth, in fact she came very quickly so I believe that in my situation, I think it was just 'one of those things' with DS and not necessarily the case for subsequent bubs... but that was just my situation anyway, I thought I would share that with you... It is possible!!

HTH, Good luck with everything! :D

Hi Seenabeena,I had my 4th bub in 2006 and he was stuck in the birthing canal due to shoulder dystocia and it was frightening and very painful birth, poor DH was tearing his hair out. Bubs weight was average 3.6kg not a big bub,just very broad in the shoulders. Then in December 2007, I had my 5th bub,which was born through c-section, weighed 3.7kg ,after long detailed discussions with my OB, she recommended a c-section as the Doctors new how hard the previous birth was and that it put myself and our baby at risk. I admitt, I was scared and asked alot of questions and bugged the hell out of my friends who had been through a c-section and we all came to the same conclusion,as long as the baby and I got through the birth unscaved thats all that mattered, and even though it was my first c-section,I got though it ok,but the recovery afterwards is much slower than the vaginal birth,but if I had to do it all over again, lol....(that would make 6 bubs!) I would do what is the safest option for both of us. Don`t feel bad about having a c-section,sometimes it just can`t be helped.Best of luck.:hug:

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

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

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.

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.

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

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.

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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.

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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!

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

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.........

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!

Thank you Julie. I feel really lucky and proud of my 3 births: they were all blissful.....

All these posts are just brilliant. Ahhhhh so nice to be able to have the amazing people we have on BB...

my daughter had SD at birth and ended up have a brachial plexus injury to her left arm, she was 4.2kgs. i wanted nothing more than to have a vaginal birth again and was determind i was going to get it, but once i got to around 37 weeks pregnant with DS doctors started saying that they thought he was going to be the same size as DD if not bigger, and highly recommened a c/s i told them all my feelings and that i wanted nothing more than to try for a v/delivery..they respected that but what really hit home for me was when she said "its totally up to you noone can make the desicion for you, but in the end you have to think about if you were to have a vag/delivery and things were to go wrong again could i live with myself?" well that got me thinking...then she told me to go home and talk it out with DF write down a list of pros and cons of a vag/delivery and a c/s.

in the end i chose to go with the c/s it definatly was a hard decision but i just felt that no i wouldnt forgive myself if DS was injured if i went for a natural birth. did i make the right decison? i will never know all that really matters to me is that my baby boy got here safely!

goodluck with everything

I'll preface this by saying that I have absolutely no medical background and have not given birth (either vaginally or by c/s), so I have absolutley no basis to back this up, but I have to say I agree with Blanche.

I know it goes against the thread of other advice, but I'd just like to caution you to think about how you will feel if you do birth vaginally and the SD happens again and bubs is injured.

Having said that, by all means research, talk it over with as many people as you can and make an informed choice as to what is right for you.

Hi Ladies,

This sounds like a very difficult situation and I cant relate to this experience. But what I can relate to is c/s. I had planned a natural vaginal delivery with MIDWIVES only (my mother) in a birthing centre. Unfortunately I had to have an emergency c/s as I was only 2cm dilated and bubs hb dropped dangerously low and did not rise after contraction had eased. I think what alot of people forget is that c/s are major abdominal surgery, they are painful, risky and the recovery time is long and hard. I was isolated in my home for 6weeks because I could not drive. My DS was drowsy for days due to the drugs and my milk took longer than expected to produce because I was not able to allow my natural hormones to do their job at the right time. C/S can be necessary and often save lives, but...they should be for emergencies only and even then, there are many unecessary emergencies that present themselves conveniently with OB's. Since you do not have an emergency on your hands I would advice talking to a midwife or a doula about birthing options, as OB's are very good at preempting medical emergencies when there may never be one.

I too have some aprehension about my future births, since I did not experience a successful vaginal birth the first time. But I am very lucky to have supportive midwives around me who continually remind me that every birth is different and help me build confidence in my abilities to birth naturally. I am planning on having a VBAC for my next birth and I would very much like to homebirth.

C/S is not always the safer option especially if you continue to progress with a normal and healthy pregnancy. Natural vaginal delivery is a safe and NORMAL way for a mother to birth her child. Midwives and doula's can provide you with a myriad of information about labouring and birthing positions and will help you find the confidence within yourself to birth your child safely and normally. Im not sure of there is a support group for vaginal delivery after SD but if there is...join it. And please dont limit yourself to talking to OB's only, they are trained to look at birth as a medical procedure and may only offer you advice that includes medical intervention and sometimes (I wont say 'all' becuase I know there are some wonderful OB's out there) harbour unecessary fears in women about birth, taking their confidence away (im not referring to your situation at all when I say 'unecessary'...just in general)

I wish you all the luck in the world.

Seenabeena, I had a shoulder dystocia with my first child in July 2008, which resulted in erb's palsy. I'm now pregnant with my second, due in June 2009 and I'm trying to explore my options. What did you end up going for - c-section, induced or waiting til due date? I'd be keen to hear your story. Thanks x