shoulder dystocia-personal and midwife opinions please

[muppety]

DS1 3 hour 2nd stage with ventouse and then shoulder dystocia. He was 7lb 14oz.

Ds2 I developed poyhydramnios plus big baby on scan. Consultant said I needed CS as previous SD and 1/100 risk dead baby. He was 9lb 5oz.

Anyway I would love another baby but HATED the cs experience and am scared that as nothing has changed would definately have to have another. This is to the point that it would put me off another baby.

Is there evidence that you do need cs after a previous SD? I know studies show no reason to do cs to avoid one but this does not seem to qualify if things are different if you have had one before (IYSWIM!. Any mumsnetters personal experience of this?

Thanks.

Ds1 had SD. He weighed 9lbs 8oz and finally arrived after a 40hr labour.

When I was pregnant with ds2 no-one suggested at any point that I would need a C/S. Instead the Consultant wrote on my notes that SD was a possibility. He also suggested that ds2 be induced early as growth scans indicated that ds2 would be a large baby. Ds2 arrived at 38wks weighing 9lbs. His shoulders got stuck but the MWs had already planned that the doctors should be called into the delivery room just in case. Ds2 was quickly freed after an episiotomy.

I'm now 31wks pg with no.3 and so far the plan is to repeat the same precautions that were in place for ds2.

sd with ds1 (10lb 4oz) - resulting bpp (erbs palsy) - does yours have erbs too?

ds2 delivered naturally (10lb5oz) cs not required. - i was very against cs

Cutting very long and painful story short so as not to disturb or upset people!

but you can read about it on my blog, if it helps.

here

I think Copper is right.
Also there are some leading midwives who say that to sort a SD "all you need to do" is to turm the mother from usually flat on her back to all 4s... so a 180 degree turn that will get the shoulders dis-lodge... let's see if Mears' around...

Didn't 2 MN-ers have their babies delivered with a "corkscrew" method due to SD recently?? Lyra and, erm, another one...?

Hi Muppety

My ds1 had sd, 10 lbs 14 ozs and i had to fight to get my consultant to agree to a vaginal delivery with my ds2. However once he realised how determined I was he did everything he could to ensure that I reduced my chances. I was encouraged to monitor my blood sugars as i was borderline gestational diabetes and cut back on sugars in my diet. I also armed myself with knowledge, read about other cases of sd and ensured i was happy with my decision, shouldre dystocia for me was a very traumatic experience so there were issues to be dealt with on an emtional level. I have also read that there are several positions a midwife can get you into once it is apparent the shoulders a stuck and with experienced midwives women have delivered without even knowing that there was a problem due to the skill of the midwife.

On a positive note my ds2 was born vaginally, unassisted, weighing 9 lbs, so it can be done.

Message withdrawn

Muppety, a weight increase of almost 2lb in your babies, coupled with shoulder dystocia at less than 8lbs would cause concern for me if i was your hp. Prolonged 2nd stage can indicate probable shoulder problems.

Maybe you could contact your local maternity unit and ask to discuss your experiences. Why was cs such a bad experience? and what can be done in your next pregnancy to make birth safe and enjoyable for you

I went for a home birth with DD2 but ended up with a last minute hospital transfer, vaginal delivery with a lot of people helping "pull", large baby girl with SD. She was fine and no worries despite SD, in fact this is the first I had heard about c/s after baby with SD. My limited experience of SD had lead me to think it wasn?t that serious a problem! I had intended to try for home birth if we are lucky to have a 3rd baby.... I guess it all depends on circumstances and size of baby. It isn?t always the case that each baby gets progressively bigger either.

muppety - the information I would want regarding your first delivery it what kind of pain relief did you have for labour? What position were you when you delivered? Were you in bed?

Shoulder dystocia can be 'caused' by delivering itn a propped up sitting position in bed where the sacrum is not able to move back to make space for the baby to descend properly.

Shoulder dystocia is where the bony anterior shoulder of the baby gets trapped above the symphisis pubis of the mother's pelvis. An episiotomy will actually not help this situation. It is only helpful if you need to make more space to put a hand in to help the baby's shoulders rotate.

here is comprehensive information

Shoulder dystocia ia a real emergency that is frightening for both the mother and the midwife.

Adopting a position for birth like all fours gives the baby more room. Also a natural lablour tends to progress better than an induced one. Size is baby not the only factor to be considered with shoulder dystocia as it can happen with 'normal sized' babies.

For some women C/S is the type of delivery they would choose next time round. There is no right or wrong approach - it all depends on how the mother feels. The risk of recurrence however is at least 10% so options for subsequent delivery do need to be carefully considered.

Shoulder dystocia is an increased risk with an instrumental delivery (ventouse/forceps) as the shoulders may not come into the pelvis in the correct position. Prolonged second stage is often a result of havng an epidural.

If you can avoid these predisposing factors then the risk of SD lowers. There are other signs such as baby's head advancing really slowly and retracting between contractions.

It may be that labour should spontaneous with good progress of descent of baby. Where signs are that progress is slow then a C/S should be resorted to earlier than later. Definately all staff attending women in labour should have training in the maneoevres that have been shown to help deliver a baby that has got 'stuck'

Each discussion needs to be on anindividual basis with your own obstetrician/midwife.

Hope the link is helpful and not TMI!

I don't know if this was classed as SD. Ds1(3rd baby) was induced at 15 days overdue.Head delivered easily but then got a bit stuck.Emergency bell pulled and there were immediately enough m/w:- was laid flat then 2 m/w on each side pushing hips apart, 1 on each side pulling legs back, one receiving baby and one explaining to me what they were doing. Despite the emergency it was VERY calm and two pushes later he was out safely, and only a couple of stitches required.Dim recolection seems to think it was called the 'robertson procedure' or something like that. Maybe mears would know. I wasn't scared at all- my delivering m/w had twigged he was big and had forwarned her colleagues.Ds was 10 lbs 2 0z and very long, I am only just 5 ft. Hardly a dignified labour-it also transpired they had a book going on the size of baby!Gas and air only.

McRoberts manoeuvre Pudmog.

This is where the woman's legs are supported and raised upwards towards her ears. This makes more space in the pelvis to allow the shoulder to escape under the symphisis. It is successful in 40% cases.

Sometimes more help is neded so someone will press on the woman's abdomen, aiming behind the baby's shoulder to make it flex forward. That is called suprapubic pressure. That combined with McRoberts is 60% effective.

If that does not work then the baby's shoulders need rotated internally.

Sometimes the first thing that is done is that the women is asked to turn over onto all fours. That in itself can dislodge the baby.

May be they did push on my abdomen- there were so many of them there- They were brill and made me feel totally safe.

pudmog - that was the mcroberts procedure, they do this to flatten out your cocyx area and to amke the pelvic outlet as wide as it will go. basically it sounds like you did have a'small' shoulder dystocia that was quickly remedied by the postion that the midwives got you into.

muppety - there are midwives and consultants out there who will support women with vbac after 2 c/s, but it is an effort to find them. i ahve had 2 c/s (for different reasons) and this time queried if there was any chance of trying anturally (out of curiosity more than anything else) and was told not a chance.
that doesn't mean that its not a possibility for you though. i would arrange to see someone asap and ask to speak regarding your concerns and the fact that it is putting you off trying for another child and the hospital should be able to arrange some counselling re previous births and answer all your questions re future births.
good luck hun!

Would it also explain why I have had problems with my coccyx ever since? Basically long car journeys are hell-anyone know what i can do-would a chiropracter help?

i had the same thing as pudmog, except no one ever told me why there were a billion mw's in the room all of a sudden, i thought it was coz my hips had sprt of locked. rememeber them saying he was a bit stuck and rememeber a hand going up too...not nice! but he was fine, i just needed help opening my legs a bit wider!

Pudmog - migyt be a contributing factor or may not. I had terrible coccyx problems and did not have SD. My posture was poor when sitting feeding though and things improved after seeing a physio for ultrasound treatment and sitting with straight back. Sitting slouched puts pressure on coccyx.

I look after my back-always feed with a straight back, feet on telephone directories as I am short etc- only had probs since I gave birth, especially immediately after.

Could be then - worth getting a referral to orthopaedic person.

Could be then - worth getting a referral to orthopaedic person.

Could be then - worth getting a referral to orthopaedic person.

Only just had chance to get back to the computer. Thanks for all your replies.

To answer a few questions.

With ds1 I went into spont labour. 1st stage was pretty active and textbook. Only had gas and air. Second stage tried lots of positions including all fours etc. After 2 and half hours I was exhausted so had a ventouse. I had a very full bladder and after being catheterized his head came down well. All ok until panic of shoulders. It Seemed to take forever but ds1 finally born. Apagrs about 5 at 5 mins I think. He is ok now but had terrible congested face and haemorrhages of his eyes. I was in lithotomy because of the ventouse and they had already done an episiotomy.

The thing is although the birth was traumatic I felt fine the next day. With ds2 I lost a lot of blood. I was very anaemic after the cs. I also had a lot of pain and could not care for ds1 properly. I was on my own a lot and really struggled. I really regret not being referred by the mw earlier to discuss this with the hospital. I might have made the decision to go for a cs but this way round I only had 2 hours notice!!

waggledancer are you a HP. You seem knowledgable?

Mears thanks for the link. I will try and read it tomorrow.

I suppose I am scared if I did have a vbac then I would not be able to relax at all until the baby was out and I would never forgive myself if there was a problem.

muppety - do you know what they had to do to deliver your DS1? By that I mean did he need to turned internally to get his shoulders out?

You certainly did have risk factors such as long second stage and ventouse delivery in lithotomy.

It might be that if you laboured again, that would not happen. You need to know exactly what went on at last delivery though.