What do you know about Shoulder Dystocia risk?

[StarshitTerrorise]

To summarise, my baby is measuring on the 95% apparently.

I wanted a MLU birth at a stand alone unit (or homebirth) due to a VERY traumatic first birth caused imo by mismanagement in a MLU attached to a hospital.

Now, the MLU hasn't yet refused completely but are making noises about preferring me to give birth in a CLU due to the risk of SD.

Now I KNOW that SD is potentially very dangerous, and I want to decrease the risk. However, in maternal causes, the ONLY risk I have is a big baby.

Having read up on it some more the other risks are prolonged 1st stage, prolonged 2nd stage, epidural, labouring on back, augmentation, instrumental delivery etc. all of which are FAR more likely if I agree to a CLU, and, I believe, almost inevitable given my unresolved FEAR of these places.

It seems to me that the safest place to birth a SD risk FOR MY BABY is well away from a CLU.

Any thoughts?

Risk of the baby getting stuck = risk of oxygen deprivation - happened to a friend of mine a couple of months ago, they still don't know if the little boy is all right, they have to wait and see how he develops.

My eldest son has erbs palsy as a result of SD being thoroughly botched by people who panicked and didn't have a clue what to do.

What is vital in these cases is that the staff are prepared and know exactly what to do. They should talk with you about it, go through how it is managed, explain about the mcroberts manouvre, etc. And you talk about whether the risk is so high that it might be best to opt for a cs.

Thank you Hecate and Thumbwitch.

And Hecate, I didn't know that about your eldest. I'm sorry.

I guess I am trying to figure out how much of the 'risk' is real, and what that risk means for my individual circumstances. I have been so badly failed by the CLU route that I have absolutely NO faith in them being able to handle SD, but that comes across as rather illogical. I believe my ds' disability was caused by them and might have been avoided at home.

And also, the resus equipment is better in hospitals.

And also I have little faith in the tape measure or scanning assessments.

I believe my baby is bigger than my last two, but I don't believe it is too big to get through my pelvis.

I had a labour with SD and none of the risk factors - not overweight, I had an active labour, baby wasn't huge etc - it just happened. So I don't think you can necessarily predict it. I'm pg again now and have to say I'm v scared about the possibility it will happen again. It was all resolved quickly last time, but still bloody scary.

No experience of SD but I had a scan at 35 weeks that estimated baby's weight at that time as 6lb2oz. I gave birth 7 weeks later and she was only 7lb11oz - so given that they expect around half a lb per week weight gain in the latter weeks, the earlier scan was obviously considerably off the mark. It did get me very worried that I'd have a huge baby, especially when she didn't turn up until nearly 2 weeks late, with midwives muttering about induction, no homebirth, etc.

From what I've read on SD I agree with you. FWIW if your labour took a long time and other risk factors were present, you could transfer if it was thought best.

Oh, he's fine. He's had a couple of operations and he needs daily physio for life, but he's here, that's what matters (and he nearly wasn't and nor was I!)

You need to talk to them and if you're not happy, then tell them that and insist that they transfer you or do whatever it takes to make you feel confident.

You need to know that whoever will be caring for you knows what they're doing and it's ok to ask them to prove it!

Scans don't seem to be that accurate, not in my case anyway. I had a 36 week scan which put DD on the 2nd centile, and she was born at 41 weeks on the 99.6th!

She did have SD, but fortunately was quickly freed with Rubins and Woods Corkscrew manouvres. They told me afterwards that if these hadn't worked then the last resort would have been a CS under GA, because I hadn't had an epidural.

I agree with Hecate though, you need to know that whoever is attending your baby's birth is competent, and you need to trust them and feel safe. I was terrified at the thought of a homebirth, so I felt much safer in hospital. If you don't feel safe in hospital, maybe somewhere else will be better for you.

I think your concerns about the CLU are reasonable. The ease of the second stage has far more to do with positioning than weight. Larger babies are often just chubbier, and how they engage in the pelvis, and rotate smoothly as they pass through is more important.
Most of the things you list as risk factors are avoidable though. You can labour at home until things are really established, get most of your first stage out of the way in a place where you can relax and are not subject to time constraints.
When you get to hospital you can ask for intermittent monitoring only, ignore the bed and labour in more favourable, upright positions (this doesn't mean you have to be on your feet, you could be on a ball, or kneeling on the floor resting your head on your arms on a chair or your partner's lap). Does your hospital have a pool you can labour in? That's really good for allowing you to get into the positions your body will want to get into, in a comfortable way.
You can bring in your favourite pillows, music, a lamp so you can have dimmed lights, whatever it takes to make the delivery room feel calm and comfortable for you. You have the right in refuse any intervention, if they suggest things are going on "too" long, but you are comfortable and baby is fine, then thank them for their opinion and ask to reassess in half an hour (during which they leave you well alone).
If this all seems like lot for you or your partner to deal with, then consider getting a doula to take the strain off you, having a doula also decreases the liklihood of the interventions you mention happening.

Thanks Future. I have absolutely no faith that I'll be able to access a pool in the hospital, which is one of the reasons I want the stand alone birthing unit, or a homebirth.

It was a pool-friendly, active birth lobbying MLU where I had my traumatic experience, being denied the pool and forced to labour and deliver on my back with people actually pinning me down as I was trying to get upright.

I'm pretty adamant that the only reason I'll go into a hospital is for a c/s, and I'd be fairly happy if they call my bluff and agree one.

I'd be inclined to HB to be honest, but with SD as the burning issue, it gets more tricky. SD is still one of the few complications that puts the willies up a lot of community midwives. There are manoeuvres that can help, but if baby is properly stuck, then they don't get a lot of notice and they are limited in what they can do. My local hospital will let you take your own birth pool in and fill it from the ensuite in the delivery room, might be worth an ask, you could hire or borrow a birth pool in a box pretty cheaply.