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

traintracks Thu 27-Sep-12 11:53:40

I clearly shouldn't have wandered into a mumsnet thread on home birth as I'm so out of step with the thoughts on here ! I don't want to derail the OPs thread so will bow out, but I will say that anyone who chooses to have a VBAC (which carries a small but significant risk of uterine rupture that can be fatal for baby and mother) distant from obstetric and neonatal facilities is, in my opinion, taking an unnecessary risk with the life of their baby and choosing the experience over the outcome. The last comment was very telling, that an IM helps a woman to feel safe. If they are high risk then this may well be a false sense of security

And yes I have met more than one woman who has rejected life saving obstetric care and in both cases it was on the advice of midwives who had the view that any birth could be normal and intervention is automatically a failure.

maxbear Sun 30-Sep-12 22:06:52

Shagmundfreud, it is all very well to say that it was not a problem to have a shoulder dystocia at home as it was easily managed. Sometimes they are very difficult to manage and the baby can require cardiac massage and intensive resuscitation. This happened to a midwife friend of mine a while ago in an out of hospital mw led unit, the baby was trapped for 5 minutes or so and the midwife had to do mouth to mouth (well bag and mask) ventilation and cardiac massage on the baby in a moving ambulance. The baby survived but everyone wished that it had been born in the hospital, it would have been far less traumatic for everyone involved and the baby would have had help that bit sooner. Yes they are managed the same in which ever place the mum delivers but the difference is that at home there are not the same paediatric facilities and fewer pairs of hands to help with baby and mum.

exoticfruits Sun 30-Sep-12 22:10:03

I can't see the issue- opt for safety.

Just a quick update - saw my midwife in the week and have decided on the birthing centre. She was appalled at the way the consultant spoke to me (I think her blunt manner and patronising tone was the thing that upset me the most) but was very supportive of my feelings and final decision and is very encouraging about my birth plan. She said that the consultant only ever sees emergency cases so her attitude may have been marred by that. Only 2 weeks to go until my due date (although I suspect baby will be late) - it still doesn't feel real. Hope I've made the right decision. Thanks again for all your comments.

Shagmundfreud Mon 01-Oct-12 13:35:46

Good result OP - glad you've been listened to. Good luck with the birth!

(oh and sorry to hijack the thread)

"but I will say that anyone who chooses to have a VBAC (which carries a small but significant risk of uterine rupture that can be fatal for baby and mother) distant from obstetric and neonatal facilities is, in my opinion, taking an unnecessary risk with the life of their baby and choosing the experience over the outcome."r

TrainTrack - why don't you ASK women who've opted for a VBAC at home why they've done it? Maybe you don't know anyone who's done it.

The women I know who've done it have made the choice because they believe they are more likely to have problems in hospital. Problems like stalled or prolonged labour. Some feel that a uterine rupture is MORE LIKELY in hospital because of these things. Or they have been traumatised by their first birth and feel unable to go back.

Seriously - glibly repeating that women who have been labelled 'high risk' who opt for a homebirth are valuing 'the experience' over the life of their baby is cruel and to be honest, a bit thick. Birth isn't like a fucking spa treatment. Women are desperate to get through it in what they believe is the the healthiest way they can - for them and their baby. And for some women this means choosing a homebirth even when they've been advised not to. It's not unusual for women to reject the advice of health professionals they don't trust or those they feel are not treating them and their baby according to their individual needs and obstetric history. You see posts about it all the time on mumsnet.

"Shagmundfreud, it is all very well to say that it was not a problem to have a shoulder dystocia at home as it was easily managed. Sometimes they are very difficult to manage and the baby can require cardiac massage and intensive resuscitation"

Yes - I understand that Maxbear. It's obvious that a baby born after a severe shoulder dystocia will probably need paediatric input and is not going to get that quickly if they're born at home. But oddly, given that shoulder dystocia is often completely unpredictable, and not that uncommon, it doesn't seem to have impacted on neonatal morbidity and mortality as a whole for babies born at home.

Which leads me to conclude: that's because it's probably less likely to happen at home, and that when it does it's generally managed appropriately and safely by midwives. I appreciate your friend's experience (and the mother's she was caring for) was hideous, but the occasional scary birth (with a good outcome in this case) is not a rationale for a mother who is not at specific risk to be refused a homebirth. And that was the focus of my response to the OP - she was deemed to be a 'high risk' for a birth at home on the basis of a 'possible', mild, shoulder dystocia, which was easily resolved, during the birth of a massive first baby BY FORCEPS and following an epidural! Would you really say this mother was any more at risk of a repeat, severe shoulder dystocia? More at risk than a mum with a BMI of 30, known to be carrying a 9lb baby, who in most places would be ok'd for a homebirth?

The other point I made on this thread, and which I really can't get my head around, is why it's OK for those mothers who are considered at risk of a shoulder dystocia to be positively ENCOURAGED to have an epidural, when we know that forceps and supine birth put them at an additional risk of shoulder dystocia? Is the attitude, 'oh well, it doesn't matter if they have an SD in hospital - the increased risk is OK, because we've got pediatric intensive care services on standby?' I think that's shit.

mayhew Mon 01-Oct-12 16:20:18

Just want to say Go Shagmund!

LilyBolero Mon 01-Oct-12 22:13:57

I honestly think if I had another (which I'm not), that I would go for an elective CS, because that experience of the baby being stuck, and not knowing how or if he would get out safely was too horrible. I feel like I wouldn't want to push my luck!!!

AnotherTeacherMum Tue 01-Jan-13 23:11:40

Hi

I also had shoulder dystocia with my first, although they had a few more probs getting him out. He was 9 lb 13.

It came as a complete shock to all. I had a low bmi before I had him ( I am about 5'4" and weighed 9st), I put less than 2 stone on whilst pg, every scan/ check up they told me his size was normal and there was no hint of a problem until my 2nd stage became very extended (2 hrs) there is no way I could have transferred to hospital in 2nd stage labour - it was lucky I was at a hospital, the MW hit a panic button and in minutes there were more MWs, obs, paed team to resucitate(sp?) ds if neccesary.

I know you are worried about leaving your LO but if all is straightforward as you feel it will be, you will be back home really quick. I asked to be discharged 6 hours after dd was born and they were fine. But if anything had gone wrong at least I was in the right place.

Shoulder dystocia is SERIOUS. You sound like yours was minor, but I have a friend whose dd has no use of one arm because her nerves were damaged by a shoulder dystocia birth.

I really think you should go for hospital.

AnotherTeacherMum Tue 01-Jan-13 23:22:45

Shagmund I'm a bit concerned by your post suggesting that SD is no reason to be out off homebirth. I know its a natural process and too medicalised in hospital etc but in countries without medical care 1 in 7 women die in childbirth(disclaimer- I recall reading this in the news but cannot recall where).

What is at risk is the OP's life and that of her baby.

The birthing centre is a good compromise as at least there is extra equipment/ staff SHOULD it be needed.

Everything will probably be fine, but it's just not worth taking the risk (however small) when there is a history of something as serious as shoulder dystocia.

We like to think it is all in our control- low BMI,don't have an epidural, our 'intuitive' idea of how big the baby is- but actually I had a low BMI, active labour, no epidural (fucking wish I had though as he ended up being manhandled out by a burly obs with forceps only after a couple of attempts with ventouse failed) but I still had SD.

I also fully support home birth when there are no indications that there will be a prob. A previous SD is a clear indication that there may be probs.

However I am sure all will be fine for OP- 2nd time is very often easier... good luck xxx

AnotherTeacherMum Tue 01-Jan-13 23:30:15

I've only just realised how old this thread is blush you've ppss even had baby by nowgrin

MrsHBaby3 Wed 02-Jan-13 20:29:58

Just because it happened before doesnt mean itll happen again, and ahomebirth is much more relaxing than a hospital birth. Being restricted in moving imo is a big factor why baby got stuck, especially if you felt your instinct was to go on all fours. Theres a well known manouvere called Gaskin manouvere which is basically moving to all fours to release shoulder distocia. Look it up on google, its named after an amazing lady called Ina Gaskin.
Perhaps as a compromise you can go to a birth centre? Personally I would judge each preg and birth on its own merits, and if it does happen again, you are definitely better equiped than first time around. Dont let anyone scare you into doing what they want. Noone would risk their baby, so using that as an arguement is absurd.
Good luck!

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