Shoulder dystocia and subsequent "good" experience

[simpletwistoffate]

Hi folks,

Looking for any advice you can give me. I had dd 22mths ago, and it was an extremely traumatic birth for both of us - induced 12 days over, failed ventouse, followed by forceps, followed by shoulder dystocia. DD had a little paralysis for the start and limited arm movement which necessitated physio for 18mths. she also had really bad reflux all of which I now believe were related to the birth. She was 9lbs 4oz.

I had a 3rd degre episotomy which took quite a while to get over, and also pelvis probs for a number of months after as dd was lodged behind this and they had to get her out. I found the whole experience really bad, as did my dh. No one explained why things went wrong, and I kinda thought that maybe it was normal - but that I just coldn't hack it. This time around, I got the consultant to go through my old notes and she explained quite a bit to me and also said previous baby never fully engaged and was op, hence increasing the difficulties.

This time around, I have the chance to have a c-section due to the last birth and because they can't say that this one wil not also result in another dystocia. I have been scanned quite a bit during it due to a few other unrelated problems, but they feel the baby is very big. At 33wk scan, it was estimated at 7.5lbs. I know these scans can be very unreliable, but he/she obviously has a very big head from the measurements... They are going to scan again next week and then I have to decide on natural/caesarian. I would prefer to have natural because of recovery etc, but if I thought it was going to be like last time, then c-section recovery may be even easier. I also have quite severe spd - which the physio this time feels is related to last birth, and I don't want these to disimprove again due to another bad birth. The baby, at 36wks still seems very high, and I could therefore go another couple of weeks over again.

After this long post, what I would like to know is if you had a shoulder dystoci, did you have a subsequent fairly normal delivery, or a section. If you had a section, how did you feel the recovery compared, and if you had another traumatic "normal" delivery how was it?

thanks in advance for all the advice.

[weezl74]

hiya,

no personal stories to share, sorry, but I've been doing research on shoulder dist myself of late, and although previous shoulder dist is one of the risk factors, it isn't the highest,

Prepregnancy

Maternal birth weight
Prior shoulder dystocia
Prior macrosomia
Pre-existing diabetes
Obesity
Multiparity
Prior gestational diabetes
Advanced maternal age

in pregnancy
Excessive maternal weight gain
Macrosomia
Short stature
Postdatism

during delivery
Prolonged second stage
Protracted descent
Failure of descent of head
Abnormal first stage
Need for midpelvic or assisted delivery

I hope this helps, I can give you a linkie to a few journal articles if you'd like to read more... although you sound like you've done lots of reseach already!

I hope apart from this concern that you're having a good pregnancy and feeling well, love weezl xxx

[littlemisslozza]

I don't have a 'second birth story' but I'm in a similar situation. Had DS 21 months ago, he was 8lb 14oz. Was induced at 41+5, went from 2-8cm dilated in less than an hour but once I reached 10cm things slowed down. Had prolonged second stage (about 2 hours I think)they realised that there was shoulder dystocia (severe according to my notes), did a failed ventouse and then Neville Barnes forceps, which did work.
Very scary and made us realise how lucky we were that DS was unharmed. He did take 5 days to establish bf and was very battered and bruised - he still has a slight dent in his skull, not that it affects him.
We had our first appointment with the consultant 2 weeks ago where we went through the options and I suppose I was hoping that he'd tell me what I should do!!! They just don't know if it will happen again but he did say that having had it once, my risk is about 10 times higher than if I hadn't had it (16% as opposed to approx 1-2%). Then he went on to say that this figure wasn't totally reliable as so many women choose to eliminate themselves from the statistics by having a planned cs instead. The other thing is that it's not just big babies that it can happen with - my cousin had it with a 6lb baby, having had normal deliveries with her first two.I have to make a decision by 36 weeks , and the consultant told me that he wouldn't bother with growth scans due to their unreliablity at predicting large babies.
I am probably going to go for the planned CS option, simply because (as the consultant pointed out) I am quite petite (and DH is tall...this baby feels like it'll similar to DS in size so far) and although he wouldn't say which option I should go for, he suggested that I could quite easily be one of the unlucky 16% of women who get it again because the statistics are obviously for women of all sizes. The trouble is that they just don't know!It's a case of weighing up the risks - and a planned CS seems less risky to us than another potentially traumatic and dangerous VB. I had been quite open to VB again if I could have been induced at 39 weeks ish but apparently this can actually increase intervention and not reduce shoulder dystocia rates so that's not an option. It's so hard isn't it? I'm still coming to terms with the planned cs idea, it's not definite yet.
I hope you get some good advice from people who've actually been through it second time, just thought I'd share my thoughts and what consultant had said. Good luck with whatever you choose.

[littlemisslozza]

Oh, meant to add - the recovery is one of my concerns too - especially with DS around this time. Having spoken to a friend who had a planned CS recently she said it really wasn't as bad as she'd thought and that getting up and about and taking all your painkillers meant that it wasn't too painful. She also has toddler to look after and that was the hardest bit she said. She was driving again in 3 weeks with drs permission.
Recovery after VB can also be long as you said.

[exasperatedmum]

I had SD with dd - she was 9lb 3oz, and I had a long and drawn out labour - syntocinon, epidural, episiotomy, ventouse... she was born with breathing problems, and I suffered a lot with my pelvis afterwards. Saw a chiropractor as I was still having difficulty walking comfortably many months later. Pleased to report that I recently had a second baby. Despite my concerns about having an even bigger baby, I wasn't offered extra growth scans. Mw joked that it "definitely wasn't going to be a 10 pounder". In fact he was 9lb 13oz, and despite my concerns that there were bound to be problems, I gave birth to him with gas and air after a much shorter labour. Stayed active throughout, and although my episiotomy site tore, the birth was un-traumatic although had to be at consultant unit because of previous SD and post-partum haemhorrage. Has helped me to put the trauma of dd's birth behind me (finally) after analysing it constantly for the best part of two years. Good luck whatever course you choose - just thought I'd offer my experience to show that it can be ok second time around.

[exasperatedmum]

Forgot to say that dd was described as 'high' and when they said that ds was this time around was very worried. He was back to back, and things didn't really get going until my waters were broken - but was amazed at how quickly things happened after that. 4 hours compared to a nightmare 32 hours last time!

[jellybeans]

Hi I had shoulder dystocia (not as severe as yours though) with DD2,she was a VBAC. I had twins next and the first twin came out no probs but was 2 lbs smaller than DD. Had a section for 2nd twin but that was for cord problems. My cousin's 1st baby had SD too and her 2nd was born normally and no SD and they were about the same size. I have had 3 sections and they are very painful fterwards but worth it if advised to be safer for the baby.

[jellybeans]

Just to add that I had severe tearing with DD2 (with SD) and was in agony for weeks but my c sections were still worse. My scar still hurts 6 months after my last c/s. I also had severe life threatening bleeding after my 2nd c/s. I don't regret them as my children are OK which is all that matters after all but would never choose one unless was strongly advised by a doctor/doctors.

[simpletwistoffate]

Thanks for all the replies - and I suppose as expected they give more questions, but its great to talk it out a bit and put it into perspective.

weezl74, my dh laughed so much when he read your last line - about everything else in the preg going well. This has been the 9mths from hell, so maybe in a way my almost resigning myself to a cs is a way of saying I just want it all over asap. (3 possible miscarriages early on, still suffering morning sickness, had a month of hell due to choroid cysts found, now on crutches for spd etc...!)

I'm only 5ft1 and my pelvis is out of line so that may affect the delivery too. Delighted to read your story exasperatedmum - in a way, would love if junior would arrive early and take away the decision.

loopymumsy, I would like not to have induction this time, but if it went over as much as last time, god knows how big it would be - and so far they would like not to do this. I have decided not to have an epidural this time if I do go natural, as it would help - I really think I was in shock last time and just wanted anything that would help the pain.

jellybeans, I am afraid of the recovery post section too - its so hard trying to make the right decision. The only thing in my favour either way is that my husband is a stay at home dad so will be there to help with my toddler dd and new baba.

littlemiss, sorry youre in the same boat - will keep you posted as to how it turns out for me - hopefully like exasperated!

[weezl74]

simpletwistoffate I'm sorry for my insensitive post, I'm new here so haven't followed your story. Sounds a horrid time you've been having. I do hope things get easier and I hope you'll post and let us know how it all goes.

All the best love Weezl x

[gabygirl]

Hiya,
I had SD with second (10lbs 12oz). Next baby was normal delivery with no problems at all (well - the labour was 32 hours and was blood horrible, but the birth was quick and uncomplicated). He was quite a bit smaller though - 9lbs 3oz.

[simpletwistoffate]

Hi folks,

Had my appointment with the consultant yesterday. I'm opting for an elective section on June 26th, on her recommendation.

It is really due to a combination of all issues. From yesterdays growth scan, there is currently a predicted weight of 10 and a half pounds - and that coupled with the earlier one seems to follow. That and the fact that my spd has left me very immobile at the moment, so all in all for safer delivery of me and baby, opting for section.

Best wishes to you all and thanks for the advice - it definitely helped me put things in perspective.