Giving birth again after previous shoulder dystocia - options?

[NoRoomForALittleOne]

Of course this will be discussed properly with midwife/consultant but I'd like to enter the discussion having an idea of what to say. I told the consultant that DD3 was big at a 34 week appointment. She said not to growth scan me because I only measured 1cm more than I should on fundal height measurement (DD3 was back to back) and that I would look bigger because I was on DC4. Consequently everyone else was surprised when she was born, in the pool at 38+6 weighing just over 9lb 13 oz. I am only 5'3"ish and was a size 8 pre-pregnancy so she was pretty big for me. My labour was fast (25 mins of active labour - I went in to labour on the triage ward while I was in for monitoring and thank goodness they ran the pool as soon as I started contracting) which I believe adds to the risk of shoulder dystocia.

Anyway, it was relatively easily resolved with no permanent after-effects for DD3. We have moved since then and now live near a hospital that has been put in special measures by the CQC and has had investigations in to the number of avoidable maternal and infant deaths I would like to know what my options can be (realistically) and I'm open to opinion of what is the best option. If it helps, my labours have been 4 hours, 2 hours, 1.25 hours and 25 mins. We live about 15-20mins drive from the hospital.

[mrsmaturin]

So this is baby number 5, your last was nearly 10lbs and you had dystocia and your labours have been shortening every time? My first instinct is to consider an elective section. Obviously that has risks of it's own but given your history of quick labour I think you stand a good chance of delivering in less than controlled circumstances. There are lots of reasons for dystocia and plenty of women will have this with a small baby and a slow labour too. That in itself wouldn't make me think a section was a good idea, it's more the speed of the deliveries that is giving me pause.
I'm sure they will offer you growth scans this time in any case though so you can have more information. If the baby looks big I'd be asking for a section at 38 weeks. If size looks good you could go totally the other way and consider a home birth - certainly more comfortable then delivering in the car on the way to the hospital.
How much blood did you lose with your last labour btw?

[NoRoomForALittleOne]

I always lose more than 'normal' apparently but managed very well without any 3rd stage drugs. My worst bleeding by far was with DC1 - PPH + haematoma under stitches meant that I needed iron infusions.

I should probably add gestations/weights for other babies:

DD1 born at 34+6 weighing 6lb 3oz
DD2 born at 39+2 weighing 7lb 9oz
DS born at 37 weeks exactly weighing 7lb 8oz

All normal vaginal deliveries. Only tore badly with DD1 (on back and non-controlled pushing as all hell breaking loose due to her apparently having a HB in the 40s - clearly not as all was well).

[NoRoomForALittleOne]

Oh and I'd love a home birth by the way. The idea of an ELCS scares me!

[mrsmaturin]

I think you have to go with the growth scans and see what the outcome is. Your last baby was a lot bigger than the others and not that much later than most of them in gestation. The thought that immediately comes to mind is that you don't want to be going to 42 weeks as you could be looking at 10lb plus - but with your dates history that seems unlikely anyway.
Hmmm - well if you don't want a section then that's your bottom line isn't it? I would go in armed with: 4 previous successful vaginal deliveries, a dystocia with a big baby/fast labour that was resolved without harm, previous PPH following tearing, blood loss tolerated well at all other times and be clear that therefore you expect a vaginal delivery this time with growth monitoring beforehand. Incidentally don't be surprised if they suggest a glucose tolerance test too. Again you can refuse or accept that.

[NoRoomForALittleOne]

I had two GTTs last time due to constantly having high levels of glucose in my urine. Both were within 'normal' limits although bizarrely with the second one, my second reading was exactly the same as my first reading! I'm expecting a GTt this time as DD3 was so big. I'm fine with that.

[mrsmaturin]

I think the GTT is a bit of a blunt instrument. You could consider some variation on a low GI diet in any case. It's a perfectly healthy pregnancy option and might help.

[higgle]

My youngest (of two) was a home birth, 9lb 10 oz - I'm 5'3" and he had shoulder dystocia. It was quite painful as the midwives sort of pushed him back in and fiddled about a lot, then I felt as if I was in a tug of war and they were pulling him ( but I don't think they were) anyway we were both unharmed, though he looked a little astonished and his apgar was 7 to begin with (rapidly improved).