Previous shoulder dystocia-ELCS?

[sparklingharbour]

Hi
I'd like to see what other people think about my situation. It is long, sorry.

I am due Dc2 in a few weeks. My previous birth was a shoulder dystocia. The labour progressed like this:
17 days overdue, but no refused induction
Spontaneous labour at home in birth pool, very quick to 9cm
Hours stuck at 9cm, waters broken
Meconium in water, baby distressed, transfer to hospital
Epidural, baby still distressed, 45 minute wait for emergency theatre for caesarean as all theatres full.
Into theatre, instrumental delivery, two forceps and ventouse, feet in stirrups
Shoulder dystocia, 4 manoeuvres to release
Baby 7 pounds 11
Baby in Special care overnight.
No injuries to baby or me.

Despite all this, I am not at all traumatised by the birth, never was. But it does impact on this birth.

My risk factors for recurrence of SD are:-
Happened already
I am short and small, DH tall (with v wide shoulders)
Baby was a good size for me
History of going overdue
This baby is slightly over the average size

Supervisor of midwifes wants me to go into hospital for the birth, but has not agreed to any special treatment (such as guarantee that I will be attended by most experienced staff in duty or even that I won't be turned away as they are full (busy trust). At least with homebirth I will have a midwife with me-no guarantee of that if I go to hospital as they often are full and nearest alternative is 45 minute drive.

I think I am good candidate for an ELCS. Does anyone have any thoughts?

[sparklingharbour]

Sorry, I mean I refused an induction so last labour was spontaneous (following a dose of castor oil, which I do jot recommend!)

[notoasthere]

Would an early induction at term not be preferable to a section?

[Rikalaily]

My second was a SD (was 8lb 11oz so not massive), I've had another two babies since (one was bigger) and had no issues (in fact both of them flew out, one in two pushes and one all in one go with one push).

Most SD are caused by babys position and won't happen again. I was offered a ELCS for no.3, I refused and booked a HB as I knew it was no2's position and not her size that caused the SD (she was back to back then came down while she had only half turned, I was on hands and knees when it happened!). I did end up transferring in due to mec in waters for no.3 (midwives just wanted me in as 3 days before xmas) which was not needed, they lied on my notes saying fresh mec when it was in fact old mec and called the ambulance without consulting me, the transfer led to a cascade of interventions and I ended up with birth trauma. I wish I'd just refused to get in the ambulance but they know how compliant you are when you are in the last stages of labour and took advantage.

With no.4 I decided on MLU with 1 hour discharge... because of previous birth trauma my confidence was low. I should have just stayed home with her too, was only in the MLU for 7 mins before she was born and was home an hour later. I'm opting for HB next time.

Personally I wouldn't have a c section because of previous SD (unless I knew baby was 11lber lol), but it's totally your choice. You have to weigh up the risks and decide what is best for you, baby and your family. For me the c section risks/longer recovery is not worth it.

[sparklingharbour]

notoasthere-no, induction increases risk of SD.

rika- can't believe MWs lied to you. Appalling. Did you complain? It's not size of the baby necessarily, but size in relation to you, plus the other risk factor. There is a big chance it won't happen again I agree, but I do have several risk factors, which makes me reluctant to take the chance.

[DinoSnores]

There is NO WAY I'd have a homebirth with that sort of history.

The RCOG guidelines on shoulder dystocia support the mother making a decision about ELCS with her midwife & medical team.

www.rcog.org.uk/files/rcog-corp/GTG42_25112013.pdf

An elective section is a lovely, calm affair and recovery is often much quicker than after an emergency section as you'll have rested before rather than gone through however many hours of labour and there isn't the panic/hurry to get the baby out. Friends who have had ELCS have all recovered very quickly. (I've never had one but I have assisted at them.)

[sparklingharbour]

Thanks dino. I do feel very positive about a ELCS, even though I know that has risks too. What I haven't been convinced on is that a normal hospital birth would be safer than planned homebirth, unless I was guaranteed admission, proper attention, available theatres and experienced staff. Neither a homebirth or vaginal hospital delivery feel safe.

[sparklingharbour]

Bumping for evening traffic

[cravingcake]

I had SD with my DS, he was 4 days from waters breaking to actually arriving. I had to be induced as waters broke but no proper contractions, ended up with forceps delivery after 3 hours of pushing and i had a 4th degree tear and pph, post natal depression, post traumatic stress disorder and DS had 3 neck vertabrae out of line . Sounds like you & your DS were lucky not to have any injuries or trauma. I'm short and DS weighed 8lb 2oz and he was born at 38+4.

I recently had DD by elcs, it was much easier recovery and a calm relaxed experience. What was interesting was when the consultant was booking in my ELCS the reason they stated was previous SD, not the 4th degree tear (which is more of a reason as far as i was concerned). DD weighed 7lb 12oz at 39+1 so not all second babies are bigger.

In your situation i would definitely request the things you have stated above as its not unreasonable as you are higher risk and if they cant put it in writing in your notes then either say you will have a home birth or ELCS depending on which you feel would be better for you. Personally i found ELCS recovery alright, 2 weeks of stiff/limited movement, a couple of weeks of 'light duties' and then after that just being very careful when lifting DS into carseat etc. if its planned then you can arrange to have help (i had my mum stay for 4 weeks - she lives abroad) for the older DC for those first few weeks.

[dontevenblink]

I've had two shoulder dystocias, despite having none of the risk factors - dc1 was 6lb14 and dc2 was 7lb15 so not big babies either. When pregnant with dc3 I was told it was very unusual to have 2 and there was obviously something not right. Given that they thought dc3 was going to be even bigger I was advised to go for an elcs which I did. It was a very relaxing experience compared to two traumatic births, and as it turned out he was so wedged into my pelvis they struggled to get him out and was told there was no way I would have been able to give birth vaginally, it would have ended in emcs.

I don't want to worry you as mine is a rare case, caused by a narrow pelvis so there is every chance you'll be fine this time (obviously I went for a vaginal birth after first SD) but I would advise being near medical help if you need it, I was very glad I was.

I'm expecting dc4 now and will be having my 2nd elcs in just over 4 weeks time

[sparklingharbour]

Thanks, it's great to get positive ELCS stories. I've asked for one now, and am just awaiting a consultant appointment.

[littlejohnnydory]

My ds1 had a mild shoulder dystocia - he came out with no problem as soon as midwives pulled my knees up to my shoulders (I forget what the manouvre is called and it was all so quick). His birth was in hospital and labour had been augmented by the drip, also had an epidural. he was 8lb 7oz.

His 2 younger sisters were both born at home, both bigger than he was (10lb 4 and 8lb 13) and very straightforward - labour was long and slow with all 3 though and I am convinced that the shoulder dystocia in the first birth was caused by augmenting labour rather than letting it progress naturally - I think he didn't have time to turn.

I did raise a few eyebrows having my large baby (16 days overdue) at home - but having looked into the risks, I honestly didn't feel that a hospital birth was any safer. Nobody mentioned ELCS and it just didn't occur to me. We didn't actually know how big she was until she arrived and I was offered ELCS with the third but declined, as I already knew that I could deliver a big baby safely, and all indications were that she wasn't as big.