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??

[Spudulika]

"but you will find very few takers for the lunatic fringe view that a surgical incision is 'injury' and 'wounding.'"

Maybe you should ask yourself why that is, given that it IS an 'injury' and 'wound' according to any dictionary you would care to open!

And I really can't see why - if the bruising and tissue trauma caused by a forceps delivery is accepted as an 'injury' sustained during birth, tissue trauma cased by abdominal surgery isn't!

Or don't you consider the bruising and damage to the pelvic floor often caused by forceps deliveries 'an injury'?

Anyway, there is no judgement implied in the phrase 'birth injury'. A birth injury is one which is sustained during the process of birth. It may well be necessary to ensure a safe delivery for a mum or baby, but it's still an injury. My interest in this issue stems from what I know of the debate about the rising c/s rates among midwives and other health professionals involved in birth, which has been rumbling on for years and is growing ever more worrying, given our problems with midwife numbers in hospital. I appreciate that most people see c/s as pretty 'normal'. And actually if it continues to rise at the same rates it's done over the past two decades may actually BE the normal way to give birth by the time our daughters are having babies. And this is despite the fact that the WHO, and pretty much all midwives, and the majority of doctors saying that at least a quarter of c/s are avoidable.

Personally I find it odd that most people don't find the thought that there tens of thousands of new mums arriving home from hospital every year to care for their newborn while recovering from major abdominal surgery they they probably could have avoided (with better intrapartum care) worrying.

So that's my concern. The fact that very serious wounds (whether it's a c/s incision, pelvic floor damage, bruising from forceps, episiotomy etc) sustained in the process of giving birth aren't considered to be particularly important. I think they are important and if they can be avoided while leaving the mother with a healthy baby, then they bloody ought to be.

As for your toenail surgery - first off, YOU used the emotive word 'brutal' - I didn't!

In any case - assuming they slice into your toe (yum!) to cure your ingrowing nail, you'll come away from the process with an INJURY. IE, a cut in your foot. The fact that this cut will stop your toenail being painful doesn't mean it's therefore not an 'injury'!

BTW - I find the personal, accusatory nature of some of the responses to my comments quite intimidating and unpleasant, particularly the insistence on bringing up my previous user names. I've not criticised anyone's choices on this thread and the stereotyping and distortion of my arguments makes it very difficult for me to engage in this discussion without feeling bullied. I think that's unfair. It makes me want to leave mumsnet.

[fruitybread]

No one is bullying you, Spudulika. People will disagree with you, but that's not bullying.

And you won't leave MN. Not unless you find a substitute for the AIBU board elsewhere!

Oddly enough, I believe very strongly that the birth injury, perineal damage and pelvic floor injury are not taken nearly seriously enough. It seems to me that CSections are held up as the worst possible physical outcome for a mother, occasionally to the point of scaremongering - whereas women who have significant injuries as the result of a VB are not given the attention they need, and find recovery much harder as a result.

I have friends with tears and episiotomies that are still painful months and years after birth - who have incontinence issues ranging from mild to severe - who have faced a range of embarrassing and painful investigations and treatments to address the damage done by a vaginal birth. And then there are the women who suffer in silence, living with the damage done because they can't face approaching a doctor.

Compared to the friend who had a 4th degree tear simply because her baby was huge, not because of intervention - and the friend who had over 40 stitches in her cervix after an exhausting 3 day labour -

No, in all conscience, I couldn't call my tiny, neat and painless Csection incision a wound or an injury. Especially not given how painfree and quick my recovery was. I think it would be remarkably tactless.

[fruitybread]

PS just checking - spudulika, you do know the WHO has withdrawn its recommendations about 'targets' for reducing CSections, don't you?

Here - www.bbc.co.uk/news/10448034

They say there is no evidence for a limit.

Worth pointing out. They changed their guidelines last year, but I still see some posters wrongly claiming the WHO has a 10-15% target rate.

[Spudulika]

"No one is bullying you, Spudulika. People will disagree with you, but that's not bullying."


Another unkind comment. If I felt 'bullied' by people simply disagreeing with me I'd obviously be being very unreasonable and actually downright wet and silly. Which I'm assuming what you're trying to imply by suggesting it. Actually you know that what I find upsetting isn't being disagreed with, but having my viewpoint distorted and ridiculed. I also do find it intimidating that people will bring up my previous user names. The whole point of being able to name change on mumsnet is to help users remain anonymous. If I haven't said anything which contradicts posts under a previous name then why the need to publicise the fact that I've changed my user name?

And no, you are right - I won't leave mumsnet. It's too wonderful (and addictive!) to turn my back on. But it spoils my enjoyment of the boards when I feel under personal attack.

"Oddly enough, I believe very strongly that the birth injury, perineal damage and pelvic floor injury are not taken nearly seriously enough."

Why do you think I'd find it odd that any mother on this board feels that birth injuries sustained during a vaginal birth aren't given enough attention? I agree with you - after care is often very poor and women go into labour not knowing that problematic tears are a significant problem for far too many women.

But this isn't a CS vs VB discussion. ( in any case it's completely futile to compare the health outcomes of women having planned c/s with the health of women having vaginal births, without discussing the fact that the first group of women will have about 10 times the amount of resources allocated to them to ensure a safe and healthy birth. I'm sure if even half of the money spent on c/s was spent on providing one to one care high quality care involving at least one highly experienced midwife, for women having vaginal births we'd reduce the number of birth injuries and emergency c/s experienced by a very large amount).

"No, in all conscience, I couldn't call my tiny, neat and painless Csection incision a wound or an injury".

Of course you don't HAVE to call it a 'wound'. But it is! No matter how you like to think of it.


"Especially not given how painfree and quick my recovery was. I think it would be remarkably tactless."

Why is it 'tactless' to refer to a surgical incision as a 'wound' or an 'injury'? I had a second degree tear during my second birth that healed without stitches or any further problems. I have no problems referring to it as a 'wound' or an 'injury'. I really can't get my head around the problem you have with these words which are just factual descriptions. It puts me in mind of those bizarre (usually American) natural birth books which describe contractions as 'baby hugs'. We're adult women surely? We don't need fluffy euphemisms to describe the physical realities of birth do we? Whether those births are surgical or vaginal?

Re: the revision of the WHO'S stance on c/s rates - I'm off to the park and don't have time to respond to this, but would be happy to discuss it on a different thread.

[fruitybread]

Calm down, spudulika.

You are not being bullied.

You are making me laugh, sorry, by your relentless insistence that we must refer to all surgical incisions, and surgery in general, as 'wounding.'

What on earth do you say to your kids when you take them to the dentist? Or, heaven forfend, if they have to go to hospital?

I think there is a useful, tactful, sensitive distinction to be made between me calling my small, painless and surgically precise C section scar a 'birth injury', and my friend calling her awful, disabling 4th degree tear a 'birth injury.' Others may disagree. Maybe someone with a painful CS scar might feel more comfortable calling it a birth injury. I don't know.

You say - "I really can't get my head around the problem you have with these words which are just factual descriptions."

Don't worry about it.

It's partly to do with tact, as I've said - partly because I like to be taken seriously ('so, Dr so and so, thank you for coming to talk to me - can you talk to me more about the operation please? Gah - sorry, can you tell me more about my WOUNDING? How do you plan to INJURE ME??').

Partly because it's not standard use. I don't think many MWs, when carrying out an episiotomy, use the phrase 'I'm going to wound you now', or 'I've had to injure you.'

(Silly midwives, eh, failing to use such emotive language, using 'fluffy euphemisms' instead! Cor, I dunno...)

I don't honestly think many people will struggle to get their head round why that might be.

[cowboylover]

Sorry and not to get involved but you have both now rail roaded the OP question to an extent.

I agree that home birth should be supported but what would be nice and supportive to hear more of from some experienced mothers is as someone mentioned earlier "you can still have a good experience in a CLU" it's not all doom, gloom and epidurals compared to the lovely sunny home birth because for some of us our choice is to embrace the CLU and make the best of it or beat ourselves up over something we can not safely have. Yes as you may tell this is raw and sorry if unsuitable but I felt it had to be said.

Hopefully the OP can get a birth experience she is happy with.

[Spudulika]

"You are making me laugh, sorry, by your relentless insistence that we must refer to all surgical incisions, and surgery in general, as 'wounding.'"

It's a wound ffs.

Like that thing on the end of your leg with toes on it is a foot.

You can call it what you like - your 'sun roof' or whatever you want.

But a c-section incision is a 'wound'.

And a foot is a foot!

And yes - I'm insisting that this is what it is!

"I think there is a useful, tactful, sensitive distinction to be made between me calling my small, painless and surgically precise C section scar a 'birth injury', and my friend calling her awful, disabling 4th degree tear a 'birth injury.' "

Actually they are BOTH birth injuries, whatever the sequalae.

It's great your c-section was so well done and that you healed so brilliantly.

But an incision in your body of the magnitude that it requires a medical team and a large amount of equipment in order to stop you from instantly dying after it's been made is a 'wound', whatever immense benefits surgery has conferred on you and your child.

Anyway, this is all just semantics. And it's not fair on the OP to keep whittering on about it.

[Spudulika]

"but what would be nice and supportive to hear more of from some experienced mothers is as someone mentioned earlier "you can still have a good experience in a CLU" it's not all doom, gloom and epidurals"

No - and I've acknowledged this to be the case. I've also had two hospital births in a CLU myself (one transferred in from home) and know that with a fantastic midwife you can have a good experience birth anywhere.

"because for some of us our choice is to embrace the CLU and make the best of it"

But doesn't the OP want a homebirth?

As it stands, I feel very strongly that CLU's ought to be made massively more accommodating to the needs of normal birth than they currently are. It infuriates me that you're more likely to get one to one care on our local MLU than you are in the CLU next door. Mothers birthing in CLU's deserve just as much of a chance to have a straightforward birth as anyone else.

[fruitybread]

Bless you, spudulika -

"Anyway, this is all just semantics. And it's not fair on the OP to keep whittering on about it."

Do feel free to stop typing at any point!

I don't mind myself (although yes, sorry OP, this isn't helping, is it). I am still loving that MWs in your world (spudlika) should be saying 'I'm going to wound you now', or 'I'm going to carry out an injury' and not using 'fluffy euphemisms', like incision. You should let them know!

I also love that you don't see any reason why someone doesn't use that kind of language. Splendid.

I'm not sure it helps me take the rest of what you say seriously though.

[stella1w]

I am the OP and although this has got very heated I think there are some interesting personal experiences in here..

SD sounds very serious, but the problem with how my antenatal care has been managed is that it has been completely disjointed eg. never seeing the same person twice, two consultants telling me different things... no chance to meet the midwife, or even a member of the home birth team that might attend.. no reassurance about how I could still have a peaceful birth in hospital, no real explanation about how big is too big - when then scan says "within normal measurments" and the baby is on 95 per centile doesn't that just mean the baby might be on the big side, but not "too big".

I am an intelligent, reasonable person and if there was better communication at this stage, I think I would be a lot more reassured. Instead I get about ten minutes at each appointment with someone who hasn't even read my notes!

[Leilababyno1]

Hi stella1w,

I had my DD1 3 weeks ago and she suffered from shoulder dystocia. I was 13 days overdue, I am also quite small being a size 8-10 and 5'3' -she was a large baby for me at 8lbs 12oz..

I had a horrendous time of it and feel quite traumatised by the experience. There was a delay of 1 minute between the birth of her head and the rest of her body. The McRoberts and corkscrew manoeuveres were needed to get her out. She was born blue and needed stimulation to get her breathing, which also took around a minute. The experience has put me off having further children, as I am terrified of SD recurring.

I am curious as to whether I would be entitled to an elective c-section, considering my previous complications?? I think this is the only way I would comtemplate having another baby at the moment..

Having said all this, I am so grateful I gave birth at hospital- they were absolutely fantastic and the care I recieved was second to none! There is no doubt in my mind, that if SD occurs hospital is definitely the best place to be. It was a very scary experience..

[clareanna]

Hi OP. I am 5"9 and had SD delivering a 7lb 10oz baby. I was also told the baby was going to be big at a 36 wk scan.
I had a fully active labour and was in birthing pool etc. I think the main criteria is to understand the size of your pelvis and pelvic opening. I had a relatively small baby for an SD case, but he got well and truly stuck. After pushing for 3 hours with just gas and air I was taken into theatre and given a spinal. After failed ventouse and failed forceps it took 5 mins after his head was born for his shoulders to follow. I had a 3rd degree tear, episiotomy and was left with pelvic, hip and shoulder problems that needed physio.
I am eternally grateful for the spinal I had and the medical team around me to help me recover and manage the pain - I wouldn't underestimate that.
However, SD is very rare and very hard to predict from what I've read, a likely big baby isn't necessarily and indication that you would suffer from it.
I think it ultimately comes down to where you feel YOU would feel the most comfortable giving birth - a relaxed, confident positive mum has the best chance of an uncomplicated labour IMO, and as long as you're aware of hospital transfer times and are happy with that then the decision is down to you. An another option could be a MW led birthing unit?

leilababy I have just had my second baby and had an ELCS. My notes from DS1 clearly stated that due to my pelvic size a CS would be the preferred route for any future pregnancies. At my booking in appt I asked to be referred to a consultant. We reviewed my notes and a C section was recommended, unless a growth scan at 36wks indicated the baby was going to be smaller than DS1 and then I might be able to consider a VB.
The ELCS was a lovely experience, the recovery was intense, but almost exactly the same in terms of pain management as after the SD delivery . The benefit was that it was only my tummy that hurt, it didn't hurt to sit down!!!
I would recommend having a review of your birth with the hospital (often offered for traumatic births at 6 weeks). This helped me process what had happened a bit. Take care.

[Tangle]

clareanna
"I think the main criteria is to understand the size of your pelvis and pelvic opening."

From everything I've read, the problem here is that your pelvis and pelvic opening are a moveable feast during pregnancy and birth. Unless a woman has a congenital pelvic deformity and/or has had pelvic trauma (such as in a bad car accident), then the size and shape of the pelvic opening should change during labour to allow more room for the baby to come through - as I understand it that's why our body's make the hormone relaxin during pregnancy, especially towards the end (and taken to excess, that's why women get SPD). This is the main reason why pelvimetry is no longer recommended in the UK - the size and shape of your pelvic opening at, say 20 weeks, is not representative of they size and shape of your pelvic opening during labour. Combine in with that the inaccuracies of estimating the size and shape of a baby in utero and the way in which a baby's head moulds during birth, and trying to predict which pregnancies will run into problems based purely on relative size of baby/pelvic opening becomes an impossible challenge.

"I think it ultimately comes down to where you feel YOU would feel the most comfortable giving birth"
Completely agree :)

Leilababy - I hope you can find some peace with what happened. It sounds like a horrible experience and I'm glad you feel you were in the right place when it happened. From reading other women's stories, I think a lot of consultants would be very sympathetic to you reasons for wanting a CS for any future children - IIRC the NICE guidelines state that maternal request is a valid reason for a CS (although they may well want to discuss why you're requesting it as for some women there are alternatives that they may not be aware of). It would be worth discussing it with the consultant if you have a post-birth debrief (and you can request one of those if its not offered - your GP should be able to help arrange it). If the consultant you see is unsympathetic then ask for a 2nd opinion - again, your GP should be able to help you find a consultant who is prepared to take a less clinical view.

[peanutdream]

isn't the gaskin manoevre supposed to be shit hot at relieving shoulder dystocia? don't have any pain relief if poss and get on all fours - opens the pelvis an extra 30% i'm told .

and something the mayans use which involves twisting and turning the woman and apparently the baby pops right out. no idea how this actually happens but sounds like it might be better than some options that we have over here with legs up to ears .

[firstforthought]

I planned for a h/b if labour started at night. Fortunately it started in the DAY. very quick labour all was well until the actual birth. head 'turtling" s/d alarms pressed, team rushed in like they were waiting outside! Got baby out, 8.6 so not huge but I am quite small. DS needed resus as grunting then taken to scbu for 6 hours while Iwas taken straight to surgery for repair due to 4th degree tear. Was VERY grateful that I was in hospital and not at home tbh. But these things are unforseeable.

[ishchel]

Peanut: the Gaskin Maneouvre is what Ina May learnt from a Belizean Midwife who practiced in the Guatemalan highlands for many yrs. This Belizean Midwife learnt it from the Mayan traditional birth attendants who said they learned it from 'god' (or maybe the Mayan goddess Ixchel). but you are right. getting on all fours sounds like a better strategy to alleviate SD than being stranded on one's back like a beetle.

[Spudulika]

My s/d happened when I was already on all fours.

McRoberts works because having your knees pressed against your shoulders levers the pelvis open - it's like doing a very, very deep squat, but lying on your back. It also puts you in a position where the midwife can apply suprapubic pressure, which can help free the anterior shoulder.

And it worked for me!

Also, at a homebirth if a mum is already lying on her back, with a big head halfway out between her legs, it's easier to get her to hold her own thighs than to get her off her back and onto all fours - especially considering the size of some pregnant women....... Remember, it may only be one midwife dealing with this, perhaps two.

[peanutdream]

i love mumsnet for this reason. the info sharing is just fab! good luck OP with whatever happens/you decide .

[chocolatecrispies]

I had a hb with shoulder dystocia yesterday! midwives were amazing, delivered in mcroberts position with suprapubic pressure. I didn't realise how serious it was until afterwards but am
very glad I wasn't in hospital as am convinced it would have been much more traumatic and I and possibly baby would be in a worse state than I am now. Having said that I know I was lucky but midwife said that 95% of s.d is resolved by manoeuvres like mcroberts. they also said there is no guaranteed way of predicting it but outcomes are better if you haven't had an epidural which of course you are more likely to have in hospital. I'm not saying it's not serious but the midwives are trained to deal with it and I would guess that the huge majority of even large babies do not have it, so just having a large baby doesn't sound like enough reason to give up plans for a hb if that's what you want and think will be the best place for you to labour. If you have other risk factors however of course you might want to think again. I'm also sure that if I had been in hospital the doctors would be saying I was lucky not to be at home and I would probably be agreeing- you just can't know how things would go in each scenario.

[ishchel]

fruitybread surgery for your ingrown toenail is a medical need caused by an abnormally growing nail. pregnancy is not an abnormal growth and with decent intrapartum care, 25% should not be needing surgery.

comparing an ingrown toenail with a c/s is just wrong.