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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Midwife led unit after shoulder dystocia

36 replies

Livvy3 · 14/08/2017 01:02

Hi there,
I had a shoulder dystocia with my first baby. As far as my husband and I were concerned it was pretty mild and over very quickly. I had been having a water birth but when my waters finally broke there was meconium in them so I ended up on a bed in labour ward.
With my second child, the hospital advised that there is a risk of another shoulder dystocia (as this is now in my notes) and that I could labour in the pool (on labour ward not birth centre) but would have to get out for pushing. I listened and did this but there was no issue at all despite the baby being the same size and I luckily had a very easy birth.
I am now 32 weeks pregnant with my third child and would ideally like a water birth in the birth centre. The hospital say I am still high risk because of the previous shoulder dystocia with my first child despite having no issue with my second and that I will have to follow the same procedure as before (get out of water for pushing).
What say do I have in this? Do I have any rights or will I have to do what the hospital say?
It seems to me that they are just being extra careful however the more I read about shoulder dystocia it's all about the position you are in which surely would be better in the water?
I feel like the hospital is covering themselves and I feel like worrying about when baby is coming and having to jump out the pool like last time will stress me out, rather than just peacefully giving birth.
Do I have to just do what they ask because it's their hospital? Should I have any say?

OP posts:

Bue · 14/08/2017 03:49

Well you are still more at risk of another shoulder dystocia, however you could just always refuse to get out of the pool at the time. The midwife is not going to lift you out! And if there is another SD and the midwife asks you to get out, usually that action alone will dislodge it.

NameChange30 · 14/08/2017 04:18

The doula who ran my antenatal classes said that if you really want to use the birth centre (MLU) and are being pushed towards the labour ward (DU) you could always start talking about home birth and that might make them more amenable to allowing you to use the birth centre

I don't think I'd go for a home birth after having shoulder dystocia (although I agree with you and think mine was also due to being forced to labour on my back on a bed) but you are within your rights to have a home birth whereas I don't think you can insist on MLU over DU.

Is the MLU completely separate from the DU or are they attached/near each other?

NameChange30 · 14/08/2017 04:26

www.birthrights.org.uk/library/factsheets/Choice-of-Place-of-Birth.pdf

lightcola · 14/08/2017 05:50

I'll be honest, I don't understand why people feel the need to go against medical advice. Surely having your baby delivered healthy and with minimal risk is the most important. In my experience once baby is here how he/she was born becomes a small part of it (unless of course it was traumatic).

sororitynoise · 14/08/2017 06:17

I agree with @lightcola.
You wouldn't argue about taking insulin if you were at higher risk of diabetes, so why risk an unsafe birth?

NameChange30 · 14/08/2017 07:22

Well, if we're just talking about shoulder dystopia, a birth in a pool or comfortable position is lower risk than birthing on your back on a bed.

Obviously there are other complications that could arise, but that's why a midwife will be present and will advise on transfer and/or interventions if necessary.

NameChange30 · 14/08/2017 07:23

dystocia not dystopia!

wheredoesallthetimego · 14/08/2017 07:28

If you're happy for your baby to be brain damaged in the event of another SD them go for the MW led unit. There won't be time for transfer.

CashelGirl · 14/08/2017 07:34

Is the MLU co-located (is, in the same building?). Since The SOMs no longer exist, I would find out what the Trust you are booked in has replaced it with, and speak to them. TBH, there is little that can be done on a Labour Ward for a shoulder dystocia that can't be done on an MLU - the actions to correct it can be done by Midwives or Doctors. Best of luck.

elQuintoConyo · 14/08/2017 07:42

DS had shoulder distocia and, if a 2nd baby magically implanted itself a la Virgin Mary, i'd ne going for cesarian, not a pool.

DS' birth was a horrendous experience - he was halfway through the birth canal when he changed his mind and shot back up. I had male obstetricians leaning on my stomach, several midwives pushing my knees up to my chest and forceps. I was all prepped for EMCS. I had a room full of people - 11 DH counted. My last couple of pushes broke through the epidural. Poor DS was in a right fucking state.

I would trust the doctors/midwives. It's not like they don't know what they're talking about

Original poster

Livvy3 · 14/08/2017 07:53

Ah thanks for all your advice, I really appreciate it!

The midwife unit is literally just upstairs from the labour ward in the same hospital so not far at all!

To be honest it's more the knowing I have to jump out the pool at the pushing stage that stresses me out. I obviously did this with my second child and it made me a bit edgy throughout labour waiting for the moment I needed to jump out.
Also it was a midwife who sorted the first shoulder dystocia before any doctor was present so I trust the midwives completely and like you say Cashelgirl I feel like they could correct it themselves.

I'll take a look at that link now! Thanks x x x

OP posts:

brightlightceiling · 14/08/2017 08:00

It sounds that your birth with shoulder dystocia went really well. My youngesr nephew almost died and was starved of oxygen for several minutes. If my SIL wouldn't have been on the hospital bed he actually would have died. A healthy live baby is more important than you feeling better in the pool imo. I understand that you want to get as comfortable as possible though, are there other options there available for you like a shower?

Chinnychinnychinnychib · 14/08/2017 08:01

Sorting a shoulder distocia on a bed is entirely different from flailing about in a fucking birthing pool so, if you trust the midwives to manage it, perhaps you could do it the way they recommend? You are being really precious. It's not about you, it's about your baby. Third labours are fairly notorious for throwing up difficulties.

welshweasel · 14/08/2017 08:08

Just take the advice and go with it. The best chance of you going home with a healthy baby is to deliver in the way you've been advised. Why on earth would you go against that just do that you can feel a little bit more relaxed? Utter madness and pretty selfish IMO.

flumpybear · 14/08/2017 08:14

Namechange that Doula unqualified PITA in my opinion sounds like a manipulative arse !

Medics don't give advice unnecessarily - if everyone at risk just did their own thing then doctors, specialist equipment and emergency transportation etc would be all over the place unnecessarily probably meaning fewer emergency cases could be seen or dealt with at top speed. Yes it may not he the birth of your dreams but it's Jess likely your child will encounter perhaps life changing problems - besides which, how would you feel if your child's life was severely impaired because you listened to a doula over a team of doctors who are extremely qualified and seen loads of potentially life changing births?
No brainer

Unexpectedbaby · 14/08/2017 08:17

Honestly I would maybe get a second opinion from a different HCP and see what they say.

But realistically the midwifery team won't just say this because they don't want the hassle of you being in a pool. Shoulder dystocia can happen quickly and is always serious. First time round, unless you have a small pelvis, it cannot really be predicted.

You were extremely lucky to not have had a severe SD but if there is even a slight increased risk of this happening I would not put your baby at further risk being in a pool. The likelihood of you being able to get out once it is already noticed is slim and the likelihood of the HCPs being able to manage it in the pool is even slimmer.

eternalopt · 14/08/2017 08:20

You say you think they are just "covering themselves". Not a particularly nice thing to say about people giving you advice which they think is in the best interests of you and your child, but even if you think it's true, covering themselves from what? A bloody big lawsuit that's what, and what would lead to that...? A horrible injury to one of you... I know you say you'd be anxious about needing to get out of pool, but wouldn't you be more anxious about being in the wrong place if SD happens? When I was at risk of it, they didn't want me to give birth downstairs in the MLU, when the consultant led unit was directly above. In their words, if there was a SD, they'd have 7 mins to sort it out and they wouldn't want to waste any of it messing around getting a doctor to me or me to a doctor. Seemed fair enough to me!

NameChange30 · 14/08/2017 08:22

Wow. So far the OP has been called "precious" and "selfish" and threatened with a brain damaged child, all because she wants to consider her own comfort as well as the safety of her baby

There are always risks and it is up to the individual to make an informed decision based on the recommendations and evidence. In an ideal world every health professional would be aware of the latest evidence and recommendations and would discuss them with their patients. In reality that doesn't always happen.

I think it's sad that someone can't even ask the question on here without being accused of not caring about her baby's safety. Of course she does. She just wants to make an informed decision.

AliciaMayEmory · 14/08/2017 08:23

I had a shoulder dystopia with my DD. She was absolutely and completely stuck. Nothing they tried could free her. They ended up having to pull her out with a ventouse, damaging her neck and shoulder, leaving her with erbs palsy, paralysed arm and facial palsy. She has some mild symptoms of oxygen delay even now at age 10. The midwives in who were with me could not cope on their own and in the end there were 3 Drs in with me.

Some babies have to have their collar bone broken to free them from the shoulder dystopia, some will suffer from paralysis for life. Please don't take any chances with your baby. I had my second in the labour ward, induced 2 weeks early to keep him smaller than my DD was (she was 8lbs, so it a huge baby). The Drs know what they are talking about. Please take their advice. Not all babies who suffer a shoulder dystocia are as lucky as my DD. Some don't make it at all.

YouCantArgueWithStupid · 14/08/2017 08:24

As someone who works very closely with a consultant MW & her colleagues it can also depend on who your MW is at the time of delivery. If she is confident in dealing with SD/high risk patient in the MLU then you're automatically in a better place.

As a high risk pregnancy due to other reasons I recommend you speak with the consultant MW and really take on board what they say.

AliciaMayEmory · 14/08/2017 08:26

Bloody autocorrect. Dystocia, not dystopia...

YouCantArgueWithStupid · 14/08/2017 08:28

@flumpybear Not all doulas are PITAs who which to flog their own anti medical intervention agenda

NameChange30 · 14/08/2017 08:28

flumpy
No she was not a manipulative arse
She delivered an extremely informative, balanced and empowering antenatal course. She gave us information about interventions and pain relief options in a neutral way, and encouraged us to ask questions and make our own decisions based on advice from medical professionals, rather than allowing them to make all the decisions for us.

FWIW I would agree to get out of the pool for the pushing stage if it meant I could be in the pool beforehand. I think the second birth was a good way of managing the risk (higher during pushing) while also giving the OP the opportunity to be in the pool while the risk was lower.

evilharpy · 14/08/2017 08:31

My daughter had shoulder dystocia and was well and truly stuck. They got her out in the end with a ventouse just as the spinal was dropping but it was incredibly scary with a lot of worried people in the theatre and apparently we narrowly avoided a crash section. I still have flashbacks about the anaesthetist shouting "you're running out of time".

If there was a number 2 I would be going straight for a planned section. I wouldn't even entertain another vaginal birth.

SleepThief84 · 14/08/2017 08:46

I had a severe shoulder dystocia with DD (first baby). So severe that it took 3 goes with the forceps, an episiotomy, male doctors shoving at my stomach with huge force and the Ob sticking her hand in and basically dragging my baby out to actually get her born. She had erbs palsy down one side and terrible facial bruising as a result and I was torn to bits. It was horrible.

Still, I consider myself lucky. We had no lasting injuries, horrible as the experience was, and some SD babies fare so so much worse. Broken bones, brain damage and death tragically DO happen.

Elective section for me next time, no question.

Sounds like your SD was far more easy to deal with, however I would still be cautious and follow all medical advice. They are the experts, trust them. It's important that you are able to have the birth experience that you want - as far as any of us can, however it's more important that you have a healthy baby to take away at the end of it. I'm sure you'd never forgive yourself if something went wrong.

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