Being advised against home birth due to risk of shoulder dystocia

(86 Posts)

Hi I'm 36 weeks pregnant with DC2. DS was born via forceps delivery and his shoulder got stuck briefly - it was released with the mcroberts manoeuvre and supre pubic pressure (sp?) within a matter of a few minutes at most. I had wanted a home birth with him but was transferred to hospital due to his high birth rate, pushed for 2 hours then was taken to surgery for epidural, episiotomy and forceps delivery.

I believe the shoulder dystocia was caused by the following

*high bmi (30 when falling pregnant)
*large baby 9lb 7oz
*being forced to labour on my back despite instinct telling me to turn on all fours
*forceps delivery

this time around
*my bmi was 25 when falling pregnant
*according to growth scan today baby is average size for dates (I am aware this isn't necessarily accurate)
*part of the reason I would like a home birth is do I'm free to move around/avoid time constraints and can push in my own time and whatever position feels natural

I have seen a doctor (presumably obstetrician) today who basically told me to think of my baby, once head is out we've got 9 minutes to deliver or your baby is dead and I should have him/her in hospital.

Understandably I'm very upset, I don't want anyone to think I'm not putting my baby first but feel my needs are important too. I've never left DS for more than a couple of hours and thought that by having a home birth I'd have him close by and therefore feel more relaxed and confident in labour. , I'm also feeling in my gut that the chances of it happening again are reduced by mine and baby's size and would be reduced further by having an active and relaxed birth environment that I don't feel I could get in a hospital.

Does anyone have any light to shed? Am I high risk? Is there really a huge advantage to being in hospital if SD was to happen again? I live 15-30 mins away if that makes a difference

Thumbwitch Fri 21-Sep-12 23:46:50

Nicecup, it may not be too late to hire a Doula for the birth if you are concerned that you are unable to stand up for yourself and you do go ahead with the hospital route. They will advocate for you when you are unable to do so, and if your partner isn't any use. You need to have someone there who will speak for you.

foronethreadonly Fri 21-Sep-12 23:57:43

My sisters younger child had shoulder dystopia.
He's 13 now, has a partly functioning right arm, it was damaged during delivery, and has global development delay due to lack of oxygen at birth.
He also happens to be autistic.

The risks to the child are real IMe.
He was a real struggle to turn, apparently.
I would go for the most medical ir thief there was any risk tbh, but I don't have any acts and figures t say what the risks are.
My nephew may be a really severe case...

Dorisday13 Sat 22-Sep-12 08:15:27

Hi I haven't read all the posts, I'm booked for a home birth and had a conversation with the Community mw who would attend the birth about shoulder dystocia specifically, she said that they all had emergency training it in and although rare does occasionally happen at home, they said they could handle the situation but would request a hospital transfer after the birth to check the baby for any problems. Obviously this advise is different to that you have received. I think in your position I would make an appointment to see the supervisor of midwives so you can discuss it further, that way whatever you decide you know that you have all the available information and have made the best choice for you and your baby. GL whatever you decide xx

Dorisday13 Sat 22-Sep-12 08:17:29

Also try not to listen to anecdotes and scare mongering its not helpful, speak to the supervisor of midwives, discuss training and procedures, and listen to your own feelings xx

HecateHarshPants Sat 22-Sep-12 08:22:10

I wouldn't risk it.

My first was SD and he has been left with Erbs Palsy. I wouldn't go for a home birth after that, even if the risk was small.

Whatever you decide, make sure that everyone knows about the SD and get them to tell you about their SD training and go through what would happen in the event of SD

ChiefOwl Sat 22-Sep-12 08:39:59

Having had a baby with sd I can't even believe you woud consider a home birth. I actually had an elective section with dc2 on consultant advice, he said although there were no guarantees it was very likely the same would happen again. My dd needed resuscitating after her sd birth - horrific experience all round.

What happens if you deliver the babies head and the mw can't get the baby out? There must have been 10 people in the room when I had dc1... Whats one mw going to do? I had my feet up in stirrups, one person physically pushing her down out of my stomach as two people pulled her out.

Northernlurkerisbackatwork Sat 22-Sep-12 09:50:04

Rainbow - I'm sorry for your loss and I hope you have a lovely birth. Thank you for clarifying what you meant. I have to say I am a little bit hmm about your midwives claim to take high risk cases the NHS won't touch for homebirth. Undoubtedly a medicalised approach can lead to complications and a cascade of interventions. Undoubtedly this is avoidable HOWEVER there are some risks that can be predicted and the NHS guidelines are evidenced based and designed to protect parent and child. I hold no particular brief for them myself. I've gone against several in my time grin However there are some risks that I would take more seriously. For example having had a PPH and being overweight, my local Trust would want me to have a cannula put in when I was in labour in case of further PPH. Now I don't much like that idea (and tis all academic as I won't be having anymore dcs!) but I would accept that because the relatively minor intervention would be worth it if it helped me in the face of a more likely complication. On the other hand the same policy would like a woman like me to have an epidural as soon as I hit delivery and they could go whistle for that! grin You are right, informed choice is vital. I just think we have to be cautious about the safety of home birth because home birth is very safe, safer than hospital for most women but not for all women. If you're in the latter group then it's important to recognise that. Once again all the best for your delivery.

Mumlar Sat 22-Sep-12 10:25:48

Here is my experience:
Dc1: 8lb 13oz, failed ventouse, forceps delivery.
Dc2: 9lb, straightforward labour, shoulder dystocia, third degree tear, baby eventually delivered by moving internal shoulder, no movement in arm, recovered in a few days.
Dc3: 9lb 2oz, straightforward labour, difficult to deliver, not true SD but got stuck.

After a truly terrifying second delivery, (dd navy blue on delivery, needed rescuitating with an Apgar of 1), I assessed all my options and plumped for paying for an obstetrician to deliver my third in an NHS hospital. I would NEVER have attempted a home birth and was worried that I might go into labour and be unable to get to hospital on time.

SD is not a predictable event unless you have had one before. I did put a lot of weight on with all my babes but my own BMI was around 20/21 when I got pregnant. As a previous poster said, position of the baby is very important, dc1 was back to back, dc2 came out flat on her back which is why she got so stuck I believe. These factors do play a part but, in my case there was no indication of impending SD until after dc2's head was delivered, I had a textbook labour up until that point.

I am not being judgemental, but please think very carefully. Initially on pregnancy 3, I wanted a C section, but with the advice of my obstetrician I successfully delivered my baby normally. I would never have attempted it at home. For my third delivery there was one obstetrician, two midwives and two paediatricians in the room with me- that gives you some indication of how risky they thought it was. Thankfully they managed the situation carefully and everything went well, but it could have been different.

Mumlar Sat 22-Sep-12 10:28:13

I forgot to mention, NHS midwives are regularly drilled on SD procedure using the HELPERR mnemonic as it is viewed as a true emergency.

Shagmundfreud Sat 22-Sep-12 17:46:24

Your pelvis is capacious enough to get out (with a small amount of suprapubic pressure and with your thighs aducted) a very large baby, despite being unable to push or move effectively because of an epidural.

Honestly - to me this says that there is NOTHING to worry about as far as your pelvis goes. As long as your baby is a normal size I can't see why you are any more at risk of a SD than anyone else.

By the way - I speak as someone who experienced a shoulder dystocia at a homebirth with an 11lb baby. The SD was easily resolved, as they usually are. Even with a very large baby.

Shagmundfreud Sat 22-Sep-12 17:50:48

Want to add - both induction and epidural (because of higher risk of forceps) are associated with increased incidence of SD. I'm surprised that people are so clear about a homebirth being inadvisable in this circumstances, but no concern about any other issues that might make a SD more of a likelihood this time around for the OP.

LilyBolero Sat 22-Sep-12 17:58:02

I absolutely wouldn't risk it, have had 1 hospital birth (1st), and 3 homebirths, and on the 3rd homebirth, ds3 had shoulder dystocia; such a scary few minutes, and my amazing mw did brilliantly to get him out, but she was so scared too, because it is a sudden, high-consequence event. He has no ill effects, but it was a close run thing.

Fwiw, all mine were average or small on the scans, none were under 9lb12, and the biggest was 10lb12 having measured bang on average.

Shagmundfreud Sat 22-Sep-12 18:22:28

Lily, there's always the argument that hospital birth makes SD more of a likelihood (because of high rate of epidural/induction/supine birth). Why is higher rate of SD associated with hospital birth not a problem?

Would also like to point out that most SD's come out of the blue - to women with no risk factors. This means you'd expect a good number to happen at home every year. And yet for second time mums anyway there is NO increase in poor outcomes associated with homebirth.

I think my questions now are starting to be things such as "if I go to hospital can I avoid internal examinations/being strapped on my back/having a canula/epidural/forceps/being timed and told how and when to push?" it seems that once one gets into hospital there begins a pattern of intervention, none of which I wanted last time and some of which I believe may have contributed to the SD.

I don't want to go to hospital but I also know I could never forgive myself if something went wrong at home and I'd been warned that being at home was not deemed as safe. I have an appointment with the supervisor of midwives on Monday and intend to give her a grilling ask her lots of questions. She was with me on my transfer to hospital last time and I feel comfortable asking her advice, I just hope that if I do choose the hospital route that I am able to express my wishes and actually be listened to. A doula would be great but fortunately DH is passionately on my side, I know he will diplomatically argue my corner if needs be

Shagmundfreud Sat 22-Sep-12 19:56:17

Well - whatever you do NiceCup, just remember that your pelvis is big enough to accommodate a very large baby, and that's with all the obstacles that an epidural put in the way of you giving birth normally. In fact, I suspect you could probably drive a bus through your pelvis!

smile

Would an epidural really make that much of a difference? I'd pushed for 2 hours before having it and DS was out in 2 pushes with the forceps once it was given. I've been so at peace with the whole 1st labour because I felt I tried my hardest at each stage before 'giving in' to each intervention they were suggesting but now I'm starting to go over it all in my mind wondering if it will really be possible to avoid them all if I go into hospital again.

As an aside has anyone had an SD in a birthing centre and can tell me how it was handled? Especially as a comparison to a hospital or home birth?

My head doesn't feel much clearer today, how on earth am I going to get a baby, a toddler and all our stuff back from the hospital without a car? I'm so pfb about our rf car seats that I don't want any of the gps to pick us up (1 won't fit, 1 awful driver, 2 smoke in the car) - there's just so much more to consider if I'm not at home. I wish I could think straight!

Ushy Sat 22-Sep-12 21:55:59

NICE if you were pushing for two hours before having the epidural, it is hardly likely it caused your problem - you gave it your best shot and it sounds like bad luck. It sounds like you had a really difficult labour and the interventions only happened as a result - they didn't cause the problems.

Have you thought about making a list of what is really important?

If you do, you will probably put you and the baby being safe and well (physically and mentally) right at the top of the list.

Forget the car - tell someone that problem and I bet you'll be amazed at how many people offer to help. People like to help and like to be asked.

Take care and good luck

fuckadoodlepoopoo Sat 22-Sep-12 22:00:55

I had various problems with my first labour which made me high risk for the same complications for my second labour. I didn't even consider being anywhere other than a hospital during the birth.

In the end there were complications, similar to the first time. Why would i have wanted to take the risk.

Viewofthehills Sat 22-Sep-12 22:10:32

I have had one hospital and two straightforward home births. Sorry, but I wouldn't feel this was worth the risk. I would go for a more active hospital birth, less monitoring and possibly early discharge home. I went home after less than 12 hours with my first.
I found it quite inhibiting to be in labour at home in broad daylight, on a lovely spring Sunday with the windows open and people mowing the lawns outside on our busy estate- I certainly didn't feel I could make a noise. I think I assumed all my DC's would be born in the depth of night. Hospital seemed quite attractive at one point.

Thumbwitch Sun 23-Sep-12 00:29:58

Taxi back from the hospital? Depending on what type of carseat you have, fixing wise, then that should work ok for you.

Glad your DH is able to advocate for you - just give him very clear instructions about what he needs to challenge smile

Shagmundfreud Sun 23-Sep-12 07:00:30

NICE - SD is handled the same way where ever you are.

The people who are caring for you use the same manoeuvres to try to free the baby, whether at home, in hospital or in a birth centre. There is no difference.

Northernlurkerisbackatwork Sun 23-Sep-12 09:29:02

The drill is the same but in a hospital the resus facilities available to the baby after birth are obviously much better.

Freud so it's more a matter of more hands on deck and access to more advanced resuscitation equipment if in hospital? Rather than a different way of handling the situation I mean

I suppose I could call local cab companies and see what cars they use.. Both car seats come with a list of suitable cars. I wish RF was the norm in this country, it always seems to be such a palava to travel anywhere with them but I won't compromise on my children's safety so we'll have to find a solution.

So I'm thinking the birthing centre is probably my best option - I just want to find out how much of my birth plan will stand/be acknowledged there. Of course the health and safe delivery of my baby come top of my priorities list but I know from last time that if I don't have freedom of choice/movement in labour I'm not going to be able to relax enough to let it happen. I'm very keen to avoid the medicalisation of what I feel should at least be attempted to be a natural thing (I'm purely talking about the experience for me and my body, I know lots of people feel differently) - thank you to everyone for your input, I'm starting to be able to put together all the pieces in my head, it's important to me to do this in order to feel ready for labour so all experiences and opinions are gratefully received.

LilyBolero Sun 23-Sep-12 16:38:14

shagmundfreud I think in a hospital setting, you can push for mobility, active labour, etc, but in the OPs position of having had a mild SD, I would not want the risk of being at home when in hospital you can have paeds on hand, NICU and all the other resuscitation facilities.

I'm not having any more, but if I did, I would either have an early induction (my babies all grow in the last 2-3 weeks), or an elective CS, because I don't think I could deliver a bigger baby, and the consequences are too serious.

Also, if the OP chose to have a homebirth, and something, God forbid, did go wrong, she would have a lifetime of wondering 'what if'. Generally I am the biggest advocate of Home births that there is, but I really wouldn't risk it in this case.

LilyBolero Sun 23-Sep-12 16:40:22

As far as making sure your birth plan is observed as much as possible, what about hiring a doula? I think that would be your best option tbh, because she will be a female support for you, and would also represent your best interests (in labour isn't always the best time to give reasoned, logical and calm arguments!!!). And in the event of a problem like SD, she will be there purely to support you, whereas a mw attending the birth would be totally focussed on getting the baby out.

That would be my option I think!

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