shoulder dystocia

[stella1w]

The doctor thinks I am going to have a big baby so is against a home birth because he says there is a risk of shoulder dystocia that a midwife would not be confident of handling at home.. because she needs a team! er.. what team?? why can't a midwife handle the dystocia manoeuver at home??

"The aftermath of a SD is when most midwives would agree that hospital is the safest place for a mother and child

Yes - I agree.

But for me I felt that the increased likelihood of it happening in hospital (where it would be no easier to resolve than at home - medical technologies don't help when it comes to freeing a baby with s/d, the thing that makes the difference is the skill and experience of the doctor/midwife delivering the baby) to a certain extent offset the advantages of having high-tech after care. For me the choice was - have a baby in hospital where it was a gamble whether I'd get a highly skilled midwife, or have my baby at home (which is a 5 minute drive from the hospital) where I was guaranteed two brilliant midwives (they were independent midwives. One is now a consultant midwife at a large London teaching hospital).

I think the point I'm trying to make is that I don't accept that one 'rule' applies to everyone. ie: all people at increased risk of s/d SHOULD give birth in hospital. In my case I felt it was - on balance - better for me and my baby to give birth out of hospital.

I did mention before on this thread that I experienced s/d in the event of my homebirth, and was very satisfied with the way it was dealt with. I had no cause to regret my decision to have my son at home. I'm sure though that had I made a different decision and had the same event occur in hospital I would have been saying 'thank goodness that didn't happen at home'. It's all about happy endings. If the outcome is good we feel vindicated by our choices.

Useful blog post and discussion on shoulder dystocia here, midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/ for anyone who wants further reading/opinion.

Have been subscribing to this blog for a while - it's very interesting isn't it?

My best friend had a recent sd delivery at home. I was birth partner. The mw's looked a bit pale while it was going on, but baby and mother both fine.

My friend has already decided that in her next pregnancy she will have additional private scans to try to get a more accurate idea of the size (this baby was 10.4. She'd had a previous 8.11 with no problems).

More research studies are being done at the moment into writing a new algorithm for predicting babies size. At the moment the algorithm is just not reliable. But at least having extra scans means that freak growth spurts can be evened out, potentially.

WHen DS was born he had SD. I was in hospital and he wasn't particularly big (8lb3oz).... no-one predicted it, labour progressed quite quickly, but then he got stuck, suddenly everyone got very serious and they got him out with a mcroberts (knees up by ears etc) and a ventouse. He was pretty blue when he came out and I didn't even really realise what was going on at the time (had had QUITE a lot of gas and air by then......).

IT was a consultant lead birth, he was brilliant, MWs were fantastic too, there is NO WAY I would have wanted to be at home for that.

No plans for any more dc, so don't know whether I would now be at higher risk for subsequent SD and therefore be advised to go for ELCS, which seems to be the way it goes...... I don't think it was anything to do with his size tbh. I'm not particularly small and he wasn't particularly big.....

"But at least having extra scans means that freak growth spurts can be evened out, potentially"

By doing what?

In my experience (as someone who's had an 11 pounder) all the scans do is put the fear of god into you.......

bandgeek my delivery of DD, now 5, sounded just the same as yours.
So traumatic, very pleased I was in a hospital.
I was measuring normally for dates but my belly was huge. Little wonder she was 10lb10!

Re: Countess and orangina,

As I said earlier - if you have a good outcome (as both of you and I did), and the situation was dealt with professionally and calmly, don't you think you would have been happy where ever you were?

Why would you be less pleased to have experienced a s/d at a homebirth, if it was dealt with successfully? If we're talking about your feelings now, after the event?

I was led to believe that after a shoulder dystocia, even if you were at home when you gave birth, you would need to be transferred to hospital as matter of routine for monitoring - both of the mother and, crucially, of the baby?

I am not a HP, btw, but used to be a NCT antenatal teacher.

I think I just felt I was in the right place if it hadn't been resolved as nicely as it had been. Plus DS was whisked off for a bit as he was so blue (dh was terrified, I was a bit out of it), and we had great facilities backing us up just there.

Mind you, while I am not a huge hospital fan per se, if I were ever to have another baby, I would still go back to hospital and plump for a consultant lead birth. It just suits me. Am not pining for the home birth I never had.

My sister + baby had sd. Baby was very big, 5kg (no idea what that is in pounds). The mw broke baby's collarbone as they were desperate. Baby and mother ended up in icu for a couple of day as a result of the blood loss, baby took long to recover (but is fine now). Extensive physio is still needed two years on.

No, I wouldn't have been happy having a home birth anyway.
I'm very pro-consultant led birth, I believe they know best.
I was happy with the treatment I received at the RVI in Newcastle, (but a bit overwhelmed with how different birth was to how I imagined it!)

"I'm very pro-consultant led birth, I believe they know best"

Even for uncomplicated births?

Wondering if you're in the UK. Consultants in the UK have very, very little experience of normal birth, compared to your average midwife as they have so little involvement in it.

I think I would have found the experience of s/d at home very difficult if my baby had had to be blue-lighted into hospital afterwards. Luckily for me resus was successful and we were both snuggled up in my bed watching the sun come up within an hour of the birth. Bliss!

My son had SD. I thank god every day I had him in hospital. It wasn't a horrible rush with loads of people panicking - my very competent midwife calmly called for help, then I was put into mcroberts while another applied suprapubic pressure and DS literally shot out down the bed. We were both quite poorly afterwards and needed lots of monitoring. An emergency transfer from home would have been necessary and would've been a horrible thing to go through.

And I laboured on a birthing ball then on all fours, so did everything "right" in terms of positioning - and it still happened. Sometimes these things are just bad luck. In my opinion OP - and it is of course only an opinion and I'm not a medic, but you did ask what people think - if you are at all considered high risk (even for apparently spurious reasons) you should have a hospital birth. It can still be a lovely experience, you know...up until the last 10 minutes when SD presented, mine was!

"if you are at all considered high risk (even for apparently spurious reasons) you should have a hospital birth. It can still be a lovely experience, you know...up"

Yes, it can be. But the reality is that it's frequently a poor experience.

"even for apparently spurious reasons"

Given that what you are risking in choosing a hospital birth is a very much higher chance of coming home with a SERIOUS birth injury (which is what a c/s incision is), then I think you have the right to expect real and considered reasons for opting out of a home birth.

Spudulika If hospitals are deliverying poor experiences for women with risk factors, isn't the right approach to improve hospitals?

We KNOW (fact - not disputed by any health care professional that I have spoken to or any research I have seen) that homebirth is NOT safe if you have risk factors. (There is masses of evidence for this). The OP is being told she has risk factors.

I'm all for home birth for low risk women who want it but the OP has been given a clear explanation of why it is not advisable - shoulder dystocia is no joke and she has a higher risk of it.

Don't quite understand why you are so adamant about sticking with the homebirth plan.

Spudulika, are you the artist formerly known as Cleofartra, by any chance? and Tittybangbang before that?

Sincere apologies if not. The style and sentiment is similar.

FWIW, and this is of course the OP's dilemma - I think many women would take the increased risk of having a CSection over the risk of having a baby that desperately needed resus and special care in an environment where that wasn't available.

And a CSection isn't 'birth injury'. Unless you want to refer to all medically necessary surgery and operations as 'injury.' And I don't really think any sensible person would.

Ushy - you are wrong about the research.

There is no research which compares outcomes for women with higher risk pregnancies having planned homebirths with matched controls giving birth in hospital.

All we know is that women with risk factors (which will cover a HUGE spectrum from diet controlled gestational diabetes and borderline high BMI, to life threatening complications like pre-eclampsia) have poorer infant and maternal outcomes when compared to low risk mothers giving birth in hospital.

We also know that many of the complications they experience - the higher rates of c/s and assisted birth, will be the result of the interventions they experience in hospital, (particularly continuous monitoring and induction).

"And a CSection isn't 'birth injury'"

Would you class a big cut or tear to your vagina as a 'birth injury'? Like a c/s both might be necessary to deliver a baby. The dictionary definition of an injury is a "wound or trauma; harm or hurt; usually applied to damage inflicted on the body by an external force". I think that's a pretty accurate description of what is done to a woman during a c/s. Her body is harmed. Cut open. Wounded. Maybe it's necessary and welcome because it's done to bring a baby safely into the world. But it's still a serious injury to the body which happens as part of the process of birth. In other words - a birth injury.

"I think many women would take the increased risk of having a CSection over the risk of having a baby that desperately needed resus and special care in an environment where that wasn't available. "

Given that epidural and induction are also associated with increased rates of s/d, would you also advise that women carrying large babies should doctors also advise they should avoid these? And also giving birth on their backs? I mean, if we're talking about the things women can do to optimise the chance of them and their baby having a safe birth?

Spudulika, a c-section isn't a birth injury and in your quest to promote 'natural' birth, you come across as an extremely ill informed and blinkered person. FFS, give it a rest!

Meant to say, I take a special interest in this issue because as one of a very small number of women in the UK with risk factors who've actually HAD their baby at home, I feel I have a perspective on it which might be useful to someone considering this choice.

I feel very aggrieved when people imply that women considering homebirth whose pregnancies can't be classified as 'completely straightforward' are somehow selfish or careless of their baby's welfare. In my case, while I was advised against a home birth by my consultant, I had the support of a highly experienced homebirth midwife, and a consultant midwife from a large teaching hospital. I had to weigh up the risks and benefits of going to hospital - which are unique in every case, as every mother and every pregnancy are different. In my particular case I felt the benefits to me and my baby of staying at home outweighed the risks. If I hadn't felt this I wouldn't have done it.

Discussing 'risk' in pregnancy is incredibly difficult and complex and hospital protocols are often very crudely applied with broad sweeps of the brush. Some MLU's will 'allow' mothers to deliver in a birthing pool. Some won't. Some won't admit VBAC mothers to their MLU's. Some will. Some hospitals routinely induce at 10 days post-dates. Some at 14. Some will induce VBAC mothers with a drip. Some won't because of the increased risk of scar rupture. Some hospitals offer mothers pethidine. Many won't because of the link with respitory problems in newborns. Often there isn't consistency with these things across the NHS, and when it comes to things like gestational diabetes and macrosomia, there is a dearth of really good quality evidence and screening to help individual mums make a choice about how best their births should be managed.

"Spudulika, a c-section isn't a birth injury and in your quest to promote 'natural' birth, you come across as an extremely ill informed and blinkered person. FFS, give it a rest!"

Who's promoting 'natural birth' here? I'm talking about safe and healthy births, that's all.

Are you also going to argue that having a large cut in your vagina is also not a 'birth injury'?

Or is it only an abdominal wound sustained during the process of birth the only one which shouldn't be classed as a 'birth injury'?

What's your reasoning?

Ah, hello Tittybangbang/Cleofartra, now spudulika. A typical post.

It's weird how people don't call Csection a 'birth injury', isn't it?

Only the other day, walking through my local hospital, I was thinking, all these signs just aren't accurate. They say 'Day Surgery', when they should say 'Day WOUNDING'. Not 'Outpatients', but 'Short Stay VICTIMS'. No 'Cardiac Surgery', but 'Open Chest ASSAULT.'

You know, there are plenty of sensible and well informed people who support homebirth, and you really don't do them any favours with your 'homebirth at any cost' approach.

There are some things women can do to minimise the risk of shoulder dystocia. However, we can't control everything, and despite someone's best efforts, they will still be high risk. That's not their fault.

And my point stands. I think many women would take the increased risk of having a CSection over the risk of having a baby that desperately needed resus and special care in an environment where that wasn't available.

"you really don't do them any favours with your 'homebirth at any cost' approach."

Oh for goodness sake - where have I said I support 'homebirth at any cost'?

You're being very, very unfair. I haven't said or implied that ALL women, even those with serious health problems, SHOULD have their babies at home if they want. I've said this is a complex issue and that the system of maternity care in the UK is not designed to cater well for the needs and circumstances of individual mothers. I've also said that there are difficult discussions to be had around the subject of birth choices, for mothers trying to weigh up the risks and benefits for themselves and for their babies, particularly given the fact that evidence of benefit and harm in relation to many issues related to intrapartum care is so poor and so patchy.

Why are you distorting my comments and creating silly straw man arguments?

Is it because you don't have anything to contribute to this discussion which is actually thoughtful or considered?

"I think many women would take the increased risk of having a CSection over the risk of having a baby that desperately needed resus and special care in an environment where that wasn't available".

Yes - that is true.

But there are also other women who would rather not expose their baby to increased risk of problems during birth in the first place, even if by doing so they also improve speed of access to advanced perinatal care (which of course a baby is more likely to need if the mother experiences complications in the birth)

As I said - you weigh up the risks and the benefits and you make the best decision you can for yourself and your baby.

And I will also repeat my question: is a large cut to the vagina which is done to facilitate birth also not to be seen as a 'birth injury', even though, like c/s, it's a deep wound, one which is done deliberately and is sustained in the process of giving birth?

Oh, spudulika....

I'm sorry, but you will find very few takers for the lunatic fringe view that a surgical incision is 'injury' and 'wounding.' You use emotive (and wrong) language in an alarmist way.

Let homebirth be something that sensible people choose for good, intelligent reasons, please.

Meanwhile, I've got to have an early night tonight - I've got to have some surgery on an ingrowing toenail this week, and a lot to get done before I have to rest up. Did I say 'surgery'? Sorry, I meant A BRUTAL ASSAULT ON MY BODY BY THE FOOT BUTCHERS!