previous shoulder dystocia - don't know what to do now!

[mollysmum2012]

Hi there

Currently 29 weeks pregnant with baby number 2. Awful experience with first labour / birth: long labour, failed epidural x 2, synto drip. Eventually had episiotomy and forceps with nothing but gas and air, which felt like someone was trying to murder me. My memory was very hazy after this but I do remember a lot of commotion, a quiet blue baby and some very frightened faces in the room. Luckily all turned out ok and I have a healthy, happy 2 year old. At recent antenatal appointment consultant mentioned that I had a shoulder dystocia. This had never been mentioned before.
I have now been offered normal labour, early induction or c section. I am swinging towards c section as my first experience was terrible and I have frightened myself by reading all the awful stories of shoulder dystocia complications. I don't think the early induction is really going to help as I was not diabetic and the baby was not overly large, more a case of my pelvis not being suited to childbirth.
Anyone had a similar experience? Any pearls of wisdom to pass on to help me make my decision?

Sorry for long post

Thanks

My eldest has erbs palsy as a result of shoulder dystocia.
my youngest was a vaginal birth and there was no repetition.
they should be listening to you, working with you and doing whatever you feel you need in ordef to feel ok.
In my case, there was a team on standby and my 2nd was delivered by the consultant. They did full risk assessment etc. They ensured they planned well.
perhaps contact the erbs palsy group as they know a lot about sd and how to manage subsequent births.

I too had a shoulder dystocia with ds1 but went on to have two more dcs naturally. I didn't realise how bad the sd was until I went for my booking in with ds2 and then I think I had a bit of post traumatic stress.
I was definitely worried about the subsequent births but like you was given choices. I really just wanted someone to tell me what to do! I decided that if I got to my due date I would have a CS but try naturally if it happened before. Up until the sd the labour with ds1 was pretty straight forward other then bring back to back and I was terrified of a c section. Ds2 came 3 weeks early and weighed 7lb 12. Dd1 came a week early and was 8lb. Both times I was under consultant care and had a lot of people in the room. I also had written in my notes early epidural advisable which I had with dd1.
I was told induction was a no go as forcing the baby downwards was more likely to result in them getting stuck. Dd1 was a long labour after 5 sweeps and was also back to back. Ds2 was short and emotional. It was also painful as I think I was very nervous.
Sorry im waffling and probably not helping too much.

thanks for replying. That must have been frightening for you 2nd time round. I hope your eldest is doing well. I will contact the group for more info. I have been given all 3 options and I'm sure they will respect my decision. I just can't make my mind up and OH is no use whatsoever, says it is all up to me. Have been told I will only be allowed to push for 20 mins once fully dilated and if no sign of baby, they will presume same problem and I will have an emergency caesarean. I think this is also making me think I should just go for a planned section, rather than going through labour and not getting the recovery benefits. Other half of me is hoping I will be better at this labour thing second time round and could have one of those lovely atraumatic births you hear people talking about. AArrrghh. Keep going round in circles!

Hecate sorry to hear that about your dc. My ds1 had a weakening in one side but this only lasted a few months.
The midwife did say my pelvis would be bigger as a result of ds1 but I'm sure I remember reading that if you have a sd you are more at risk of it happening again?

yes have been quoted 10-15% chance of it happening again. 20% of babies with shoulder dystocia end up with a neurological problem. Sounds risky to me. This is versus 0.5% risk of dystocia in general.

Yeah, he's doing ok, thanks. While your husband is right that it has to be your decision. Its your body and you are in control, his role is to talk through your options with you and support you.Is he not wanting to talk about it? I dont know if you are the same, but I need to talk, to bounce ideas off someone and to feel heard. It wouldnt be enough to be told it's up to you.

he's not really the talking type! Hence me having to come on here and bounce my thoughts about. It's so helpful to speak to people who have been in similar situations I have to say.

My DH was in total shock after ds1 was born. Really it was worse for him as he saw the whole thing while I was out of it on gas and air and don't really remember. He cried like a baby when ds2 arrived drama free. Maybe he just finds it hard to talk about it?

I think you might be right. Although I nearly lost it when he said he was still traumatised by it all and not sure if he was ready to go through it all again! Wrong person to be looking to for sympathy on that front! On a more serious note, I will try to speak to him again about it and get a bit more information about what he remembers etc

I'd go for elective c section to be honest.

I had very relaxed text book home birth but there's no way I'd want to risk that level of trauma again if I'd had a birth similar to OP.

A c section can be calm and planned and well prepared.

My Dd had shoulder dystocia (she was 10.5lbs). Followed by other horrible circumstances. She was ok, I am still traumatised and due with number 2 very soon. I have not been offered an elective c-section despite this. My hospital has a very strict policy. I would take that c-section wholeheartedly.

I would ask for a second opinion if I was you. sounds like you had a terrible experience. The nice guidelines now say maternal request is good enough grounds for a section as long as you understand the pros and cons and you have very legitimate reasons for considering one. Thank you for sharing your story with me and helping me make my decision x

In your shoes I would be begging for an elective section. I "only" had a third degree tear and will be begging for a section next time

I have recently had an elcs with DD. My son (DC1) was a long labour, forceps, shoulder dystocia, extended episiotomy and 4th degree tear. For me it was recommended to have elcs for future births due to tear but if i had wanted a 'natural' birth i could try for it.

Recovery from elcs has been really good and i was able to plan to have my mum stay for a few weeks afterwards to help. It was all very civilised and a much better experience and i've been able to enjoy these first weeks with my DD.

When discussing with DH he said the same as your DH that it was up to me, its my body etc but i pushed him and said that i wanted his opinion as he would have to experience it all with me and what his preferred option would be. He was (and i think still is) quite traumatised by DS birth. He said its a no brainer elcs but that he would support me with whatever choice.

I was told by my consultant when 39 weeks pregnant with sc2 that I had 10% chance of another shoulder dystocia and 1% chance of a dead baby. I had an elcs that afternoon!

The risk factors associated with shoulder dystocia are... Induction of labour, obesity, diabetes, instrumental birth (forceps and ventouse/kiwi), augmentation of labour (synto drip).

I wouldn't look at your pelvis not being adequate but more your situation. You need to look at reducing the risks, so avoiding IOL. IOL is an intervention associated with a lot of poor outcomes. More likely to have an epidural, therefore automatically more likely to have an instrumental, massively increasing risk of SD. Also alongside the epidural you're reducing mobility so more likely to have a malpositioned baby, increasing likelihood of instrumental, requiring augmentation of labour or just a more difficult birth.

Ideally you need a debrief with your notes, and look at the manoeuvres whichever were used, also how you could avoid similar things happening again. Ideally your trust would have a midwife who could do this with you, and make a plan for this birth, ie. no IOL, low threshold for CS, avoid epidural, if instrumental needed senior practitioner present, etc etc.

Definitely not black and white yes or no answer

Mollysmum glad you have come to your decision. Really happy for you to have some control over your next birth.
Unfortunately for me I have tried to obtain medical notes from previous hospital and so far no success (have been hassling them but they keep fobbing me off telling me it takes time). Every MW I have seen so far has brushed me off about ELCS. Just looked at current medical notes for this hospital (different to first DD) which states clearly their position on ELCS (that it is pretty much not an option unless very clear medical reasons which are so far my word against theirs). I went for a growth scan (booked privately as they would not offer despite Dd1 being macrosomia) and growth was in 75th which isn't as bad as Dd1 (99th) but that was at 33 weeks so still not sure I believe she will not be another big'un. Trying to accept my fate and hope for the best. Might be easier since everything is already 'stretched' so to speak. Bleugh.

Thanks everyone for your advice. I think I will go for the elective c/s. I could not forgive myself if there was a problem with my baby. I know the risk is pretty small (2-5% of neurological damage) but the serious nature of the consequences and the horrendous experience last time are swinging it for me. Also don't like idea of doing all the hard work in labour then getting an emergency c/s at the end, seems like worst of both worlds.

Mummymidwife87: I was told biggest risk factor is a previous shoulder dystocia, which I of course have. Risk of repeat 15%. BMI 29 at booking so overweight but not exactly morbidly obese. No diabetes, either before or during pregnancy. Spontaneous labour with dd1 but needed synto as everything seemed to slow down at 7 cm. I had a forceps at the end but I think this was because she was stuck and nothing was happening when I was pushing. Never had a working epidural so moved about during labour a reasonable amount. Certainly felt everything, including my large episiotomy, which stung a little, as did the hour and a bit of stitching afterwards!! Never really looked at or held baby for first couple of hours as I was so traumatised by it all and I still feel guilty about that, although bonded great thereafter, breastfed etc and no lasting issues.

Baby was back to back for a large part of the labour but turned on her own eventually. DD1 was 9 lb 2 so big but not massive. I am tallish at 5'8" and my husband is 6'2". Don't think there has been a baby under 9 lbs on either side of our families. This one is a boy which I think tend to be a bit bigger if anything. I think this was why consultant was worried - nothing very modifiable in terms of risk and it still happened anyway. Thanks for the info on induction - I wasn't keen on this so will totally discount it.

Hi, I had a very long labour with dc1, long story but basically wasn't listened to, she was back to back and ended up in theatre with forceps, where it turned out she was completely stuck and ended with shoulder dystocia. Dc was fine but it was incredibly distressing. Nobody ever talked about the birth with me and still feel quite upset by it all sometimes. Nothing was discussed about my past birth when I was pregnant with dc2, had a very quick labour, but birth also ended up in shoulder dystocia - dc was fine again but had all the alarms going off and people rushing in, big tear and lots of blood and DH was really traumatised by it all, although I don't remember too much as it all happened so quickly.

It wasn't until I was pregnant with dc3 that they said I needed to see a consultant this time due to two shoulder dystocias which is considered rare, especially as I am not in any of the risk factors, I have a BMI of 23/24, no diabetes, wasn't induced, and my dc were only 6lb14 and 7lb15. The consultant I saw with dc3 was very blasé about it all and said he would just try for a vaginal birth again, which I wasn't very happy about at all but felt a bit bullied into attempting it.

We emigrated to NZ when I was 27 weeks pregnant and saw a consultant here again who was absolutely shocked that a hospital would even consider advising me to birth naturally after two shoulder dystocia and said that she highly recommended a elcs as there was a very high risk of it happening again - she actually said that there weren't any studies that she knew of about the chances of it happening 3 times as often after just 1 people would opt for a elcs.

When I had my elcs (at 39 weeks) they struggled to get dc3 out as he was so wedged into my pelvis and I was really bruised after. I was told after that if I had tried to give birth naturally he would not have been able to descend into my pelvis and we would have ended up with a emcs and it is likely he would have suffered injury - terrifying to think about. He was 8lb3oz. They think it's likely my pelvis just isn't big enough.

I don't want to scare you as the chances of it happening twice are rare and I know people and have heard several stories of people having a shoulder dystocia and then one or more natural births without any issues at all. Just felt needed to share my experiences, I am pregnant with dc4 now and it is on my mind, I had a really easy second birth apart from the end bit and I really would have loved another natural birth, but I don't think my body was made to give birth naturally :(

Good luck with your pregnancy, hope all goes really well for you whatever you decide :)