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Shoulder dystocia question

(25 Posts)
toddlerhip Thu 05-Mar-09 12:08:10

I am likely to have another large baby and asked the midwife what happened to the babies she'd delivered where there was shoulder dystocia. This was the risk with my first one that ended in my having a section. The midwife said all the babies had needed resusicitation and oxygen -she didn't know what happened to them afterwards. But afterwards i thought if the baby's head is out, can't it still breathe? So that's my question: when the baby's head is out, how is it getting its oxygen: by breathing or through the cord? Does anyone know?

nuttygirl Thu 05-Mar-09 12:19:16

I recently saw a birth program where, once the head was out, they suctioned the baby's mouth/nose so it could breathe so I'd have thought they'd do that. Though until the cord is cut it will still be getting some oxygen from that - on Homebirth Diaries they made a point of saying on one episode that they had more time to 'resus' the baby because the cord hadn't been cut.

Snowsquonk Thu 05-Mar-09 14:01:01

When the head is out, the chest is compressed in the birth canal and most babies don't breathe at this point, they are getting their oxygenated blood via the umbilical.

Once the body is out, the chest expands and the baby can start breathing for his/her self.


Crazycatlady Thu 05-Mar-09 16:59:04

I had shoulder dystocia and my baby didn't breathe independently for 3 minutes. Lots of neonatologists running around massaging her chest etc... Was a traumatic forceps delivery after 2 day labour though so not sure how much of this was due to the SD... all OK very quickly afterwards but it was the scariest and longest three minutes of my life!

HecatesTwopenceworth Thu 05-Mar-09 17:00:12

I had it and my son has erbs palsy as a result.

CoteDAzur Thu 05-Mar-09 17:05:22

Iirc, the problem with shoulder dystocia is not lack of oxygen (breathing) but damage to a major nerve bundle in the neck (from pulling/extension).

CoteDAzur Thu 05-Mar-09 17:06:19

Hecate sad

HecatesTwopenceworth Thu 05-Mar-09 17:09:14

yup. That's the one. leaves the arm paralysed.

madwomanintheattic Thu 05-Mar-09 17:15:21

dd2 had shoulder dystocia and the cord round her neck - she had all the luck lol.
as snowsquonk said - we were told that as the chest is still compressed the baby doesn't 'breathe' but continues to get o2 from cord. (unless cord is somehow compromised)

dd2 has cerebtral palsy. no idea if it was anything to do with the shoulder dystocia or cord per se (mw says not as both relatively easily resolved - although they did break her clavicle in the process - didn't find that out for 3 days lol) but MRI confirms birth injury (and cp) due to hypoxia.

my friend's ds also had a broken clavicle from shoulder dystocia.

madwomanintheattic Thu 05-Mar-09 17:16:04

cerebral lol. no t.

bandgeek Thu 05-Mar-09 17:24:06

DS had it, plus the cord was wrapped around his neck and there was a true knot in it too! (didn't find that part out until I was talking to the consultant when pg with DD) He needed oxygen at birth but was fine afterwards.

I did opt for an elected c-section with DD though, as she was measuring big for her dates and I didn't want take any risks.

jes74 Thu 05-Mar-09 17:28:48

My dd had shoulder dystocia, the birth was very traumatic, despite attempts to change her position the only way they could get her out was by giving me a fourth degree cut, by the time this was done she wasnt breathing. She was resusitated but this took over 10 mins then she spent a week in special care. She is now a very bright and active nearly three year old but we have been warned she may as she gets older display concentration issues due to the lack of oxygen.
With ds3 I was monitored fortnightly from 7 months with a scan to predict weight and size at 38 wks the consultant advised a c section as predicted weight of 9lbs 11oz(the birth weight of dd) 16hrs later ds4 arrived 9lbs 7ozs. I had wanted to have another natural birth as I had had with the other 3dc but the consultant was adament that it was a risk not worth taking,

toddlerhip Thu 05-Mar-09 21:09:34

Any other info on what consultants have advised re predicted weight relative to shoulder dystocia risk would be much appreciated - i am having trouble getting info. DS1 was predicted 10-12lb, came out at 11.5lb (but 2 weeks overdue) in an elective section due to SD risk (though i didn't have much info at the time, it was all decided in 24 hrs). Am trying to decide whether to go for VBAC or second elective section this time. Would prefer to try VBAC but not if the SD risk is significant.

iwantitnow Thu 05-Mar-09 21:35:45

One of the reasons I had a section the first time and the reason I'm having my second in a few days time. Its not worth the risk IMO. I've been having growth scans not sure how pregnant you are but worth asking for.

CoteDAzur Thu 05-Mar-09 21:55:47

DD was a big baby and this one measured slightly larger in 5 month scan recently, although I put on much less weight. If he turns out larger than DD in 8 month scan, I will have a c-section.

I didn't have shoulder dystocia with DD because midwife did a huge episiotomy, apparently so she could do some sort of maneuver to avoid shoulder dystocia.

All great, baby fine. Except that I was in excruciating pain for three weeks and the pain in that area lasted for close to a year.

If I am going to have so many stitches again, I'd much rather have them on my tummy aand not down there in my delicate bits where it is also impossible to keep dry and clean.

pigleychez Thu 05-Mar-09 22:18:31

My DD was born with Shoulder dystosia too. She too only came with a 4th degree tear after an episotemy.
I dont really remember much about it as I was all drugged up in theatre but DH says he was horrified the the woried looks on everyones faces. Thankfully she didnt need resus and is a happy, sociable 7mth old.

They still recieve oxygen untill the cord is cut.

orangina Thu 05-Mar-09 22:34:52

DS was born w shoulder dystosia... like pigley, I was too out of it to really realise what was going on, but definitely, there was a bit of a panic on. Luckily he was hauled out w ventouse and I only had 2nd degree tear, and though he did look a bit blue for the first 1/2 hour or so, he didn't need recus and is a very lively and lovely 2 year old.

I really didn't have a clue (honestly) until months after the event, though DH knew what was going on at the time....

(too much gas and air emoticon)

For what it's worth, if I were to have another child, I would seriously consider a section, as SD can be serious (sad hecate...). Ds only weighed 8'3" or something, he wasn't massive...

MrsMattie Fri 06-Mar-09 11:31:01

When I had DD I was on a ward with three women who had all had shoulder dystocia issues giving birth. Two women had perfectly healthy babies, but one woman's baby was very ill and in intensive care. All of the women had very big episiotomies (Oh, the things you discuss on the postnatal ward!) and one woman had severe damage to her back passage and was told she would not be able to have any more vaginal births. It frightened the life out of me, actually (and I had a high risk pregnancy and c-section, so it took some scaring!).

madwomanintheattic Sat 07-Mar-09 13:18:37

dd2 was vbac2 (other info above) but only 9lbs. given the cerebral palsy outcome, i have a consultant letter which says i am to have cs for future pgs. there is no way on this earth i'm having any more vaginal births. tried it twice and didn't like it lol. didn't particularly enjoy the cs either tbh (dd1, 1st pg) but it was a lot calmer and a lot less traumatic than either of the other two. (elec cs due to alleged big baby - not offered for the other two as no clinical reason. german efficiency.)

mumof2rugrats Sat 07-Mar-09 16:40:07

when i had dd2 she sd but iam a bit blush to say i didnt need any stiches as there was no cuts or grazes and she was a big baby at 10lb 6 oz . i had never heard of sd till it had happened . i had asked my mw a number of times to scan me as i was hugh and i thought i was having twins i went from a size 6 to a 16 but she said baby would be 8lb max .

if i had another baby what are the chances of having a sd again because i dont think i would like a cs ..

jes74 Sat 07-Mar-09 19:40:32

The consultant said no one knows for sure how likely it would be to happen again as most women have elected cs for subsequent births. He did say that in alot of cases it is a one off all down to the angle the baby gets into the birth canal, he did also say bigger babies tend to come out of it worst and that he believed in some cases the more pregnancies you have can cause your pelvis to tilt which was his belief with me. I hated the c section I had with the next one and suffered complications throughout but I would rather that then go through what we went through with dd. Those ten minutes not knowing would she come to were horrendous followed by a week in special care of tests and drugs and pessimistic staff.

birthjoy Sun 08-Mar-09 21:53:28

I feel for those of you who's babies have suffered shoulder dystocia. It is quite rare and difficult to predict, with an incidence ranging from 0.15% to 2.1% of all births.

Here' some information from:
Current Opinion in Obstetrics and Gynecology
(C) 2006 Lippincott Williams & Wilkins, Inc.
Volume 18(2), April 2006, pp 123-128.
Shoulder dystocia and injuries: prevention and management [Maternal-fetal
"Shoulder dystocia has been aptly described as being infrequent, unanticipated and unpredictable [1], features that contribute to the nightmare awaiting the person attending the delivery. Timely intervention
allows rapid delivery of the baby in the majority of cases; however, the
condition is associated with a significant risk of fetal hypoxia and injury
to both mother and baby."

Prediction and prevention of shoulder dystocia:
"The assessment of women for the risk of shoulder dystocia is a continuous
process, beginning even before pregnancy, when factors such as maternal
diabetes mellitus, obesity or a history of shoulder dystocia or macrosomia
in a previous pregnancy warn us of a significantly increased risk of
shoulder dystocia. Antenatal risk factors consistently reported are fetal
macrosomia, diabetes mellitus in pregnancy, excessive maternal weight gain
and post-date pregnancy. It is likely that absolute birthweight threshold is
not as important as birthweight percentile for specific populations. In an
Asian population, a birthweight above 3600 g (almost the 90th percentile for
the population) was associated with a relative risk 16.1 times higher for
the occurrence of shoulder dystocia compared to pregnancies resulting in the
delivery of an infant weighing less than 3600 g [18]."

"Intrapartum events such as a prolonged labour and the need for instrumental
delivery should alert us to the risk of shoulder dystocia [6]. In two recent
retrospective analyses, the risk of shoulder dystocia among infants delivered by vacuum extraction was significantly higher than those delivered by forceps."

"Despite the awareness of these well established and thoroughly reviewed risk
factors, our ability to predict the occurrence of shoulder dystocia in any
one particular pregnancy is deficient. combination."

Please also consider the risk to mother and baby from Caesarean section:

Another study concluded:
"Historic obstetric risk factors for shoulder dystocia are not useful predictors for the event. Furthermore, although shoulder dystocia was observed more frequently with increasing birth weight, current limitations in estimating birth weight antenatally with accuracy preclude its practical use as a reliable predictor."

This means we are not very accurate at predicting babies weight by scans etc.

saladsucks Sun 08-Mar-09 21:59:49

My DD was the same as Hectate, shoulders got stuck, doctor pulled too hard and result is a right erb's palsy. DD has had daily physio for the past 2.5 years, an operation and several years of heartache and my guilt over it.

When I had DS I chose an elective section as I couldn't bear the thought of having to go through any of that again.

higgle Wed 08-Jul-09 22:38:46

Hadn't realised how lucky I was until I read this thread. DS2 was homebirth and his shoulders got stuck - absoutely excrutiating pain, just as I thought he was about to be born, followed by a very forceful tug of war by the midwife. He was fine, but looked very shocked to be out in the world. I didn't need any stitches and didn't really realise much had gone wrong.He was a big baby 9lb 11 oz.

Ladyem Wed 08-Jul-09 23:04:11

I am so glad I looked on this thread. DD suffered from shoulder dystocia and like Hectate and saladsucks she suffered from left erbs. Luckily with the help of physio, she is recovering well and the future looks bright. I'm now 32 weeks and have been offered a c-section, pending a growth scan at 36 weeks, but I had not heard about the oxygen deprivation issue which could lead to cerebral palsy. I was just thinking about the possibility that another baby could end up with erbs, but I think after reading this I shall be leaning more towards the c-section as now I feel that a natural birth is even more risky. DD was only 8lbs (and I'm 5' 10", so I don't think this is overly large), so it's not just large babies that suffer from SD.

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