Anyone elected for a C-section due to risk of Shoulder Dystocia/larger baby?

[Daisy2017]

Hi all,

I am looking for advice/other peoples experiences around shoulder dystocia risk.

I am 32 weeks with my second baby and she is tracking larger for her gestational age (no diabetes). The abdomen is tracking large on 97th Percentile v's the Head Circumference around 70th.

One consultant raised the risk of shoulder dystocia due to the ratio of the tummy being large and larger than head and therefore getting stuck once the head is delivered.

However another consultant at the same hospital said she wasn't concerned and I could have an early induction at 38/39 weeks due to size if I wanted. She is almost 5lb at 33 weeks.)

My last baby was 6lb12oz and delivered with Ventouse/manual placenta removal 2nd degree tear and episiotomy and I then had a prolapsed bladder. Can't see how a larger baby will help this time.

So the question is, is there a real risk of shoulder dystocia even though I didn't have that last time. Has anyone elected for a c- section due to similar worries and to also protect their pelvic floor!

I have another growth scan at 36 weeks.

Any thoughts / experiences welcome.

Hi all,

I am looking for advice/other peoples experiences around shoulder dystocia risk.

I am 32 weeks with my second baby and she is tracking larger for her gestational age (no diabetes). The abdomen is tracking large on 97th Percentile v's the Head Circumference around 70th.

One consultant raised the risk of shoulder dystocia due to the ratio of the tummy being large and larger than head and therefore getting stuck once the head is delivered.

However another consultant at the same hospital said she wasn't concerned and I could have an early induction at 38/39 weeks due to size if I wanted. She was almost 5lb at 32 weeks.)

My last baby was 6lb12oz and delivered with Ventouse/manual placenta removal 2nd degree tear and episiotomy and I then had a prolapsed bladder. Can't see how a larger baby will help this time.

So the question is, is there a real risk of shoulder dystocia even though I didn't have that last time. Has anyone elected for a c- section due to similar worries and to also protect their pelvic floor!

I have another growth scan at 36 weeks.

Any thoughts / experiences welcome.

Hi Daisy, I am currently 33 weeks pregnant and have had a C section booked due to risk of shoulder dystocia.

I'm in a slightly different situation in that DS1 had shoulder dystocia, and previous shoulder dystocia significantly increases the risk of it happening again.

Here's a link to the NICE guidelines on shoulder dystocia if that helps: www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg42/

Also, I forgot to say that my son's head was massive (off the charts) and his tummy was 97 percentile, so there were no red flags for us before labour... but he does have very big shoulders.

Sorry, I know you were wanting posts from people in a more similar situation to you, hopefully some others will be able to help!

I requested an ELCS as I had been told throughout pregnancy that baby is large
and was concerned about the risk of shoulder dystocia. I saw one Doctor (a Senior Registrar) who agreed with me and said she would be happy to book me in for an ELCS at 39 weeks but she was then overruled by a consultant who said that a big baby is "not sufficient reason for a c section". They did offer to induce me at 38 weeks due to baby's size but I declined. After much discussion, a lot of back and forth and the consultant insisting on referring me for an assessment with a Psychologist (despite me having no MH issues) we've now reached a compromise. We've agreed that I will not be induced, I will be booked in for an ELCS in my 40th week but if I go into labour spontaneously before then I will try for a vaginal birth. The consultant was not concerned about shoulder dystocia as baby is just above 90th centile so big but not massive, but agreed that it would not be wise for me to go overdue. She did say that if baby was above 95th centile she would have offerred ELCS.

I've found it quite stressful and frustrating that every time I've been to clinic I've seen a different doctor and they've all told me different things. It took weeks to actually get to see my named consultant and get a decision. This meant there was no concrete plan until I was over 38 weeks. In your position I would be very insistent at your next appointment that you want to have a discussion about options for birth and don't be fobbed off if they try to tell you it's too early to talk about that yet.

One of mine had shoulder dystocia - born 10lbs at 39 weeks. No ventouse or forceps though - was really, really hard work. Doable but hard work.

I booked a c section at 41 weeks due to large baby and previous 3rd degree tear.

She came at 40 ish weeks, super quick, and was 9lb 10oz, with a head that was off the charts (bigger than 99.8 centile)

We didn't have any shoulder issues in the end, although I was worried.

I guess I'm saying you may not have issues, but there is no way of telling. Personally I felt the risk after 41 weeks was increased as she'd be so big, but I accepted the risk until then.

Good luck

Thanks for your reply. Sounds like they have been very unsupportive to your concerns. Yes it seems that a big baby is not reason enough for a c section but nor is shoulder dystocia. I was told by the first consultant that the worry may not be necessarily the size of the baby but the ratio of a large tummy to head. It’s so confusing when you hear different opinions.

Mine suggested a section due to risk of shoulder dystocia as I was already consultant led I think they are just more open to it than midwife led, he was over 97th on head and abdomen and 75th on femur. I said no to CS but said I would consider an early induction if they felt necessary, was induced at 38 but it failed and I had a section at 38.3 and he was just short or 9lbs so not huge but very chunky, CS was great much better than I expected and would choose that over an induction anytime

This is interesting as my first child was should dystocia. It was horrendous. In those days they didn't have ways to predict it ,or they weren't doing so. I nearly died and so did my baby. I had sections with the second two, but i have a small pelvis. I had to show the doctor the measurements to convince her to let me have a section second time. My second child was much smaller than my first even though delivered early, so it probably would have been OK.

@CathyandHeathcliff Cathy could you help this lady? I think yours was similar as you were worried but all was good.

DS2 was 10lbs 2oz and had shoulder dystocia (? if that's the right word? Do you 'have' shoulder dystocia?) on the way out. He was always going to be big but I'd never heard of shoulder dystocia until they pressed a button and the room filled with people! Luckily he came out on the next push with McRoberts which was bloody awful but luckily very shortlived. I think DH was more traumatised by it than me! Even then I didn't realise how bad shoulder dystocia could be until all the midwives winced when they read my notes afterwards.

Perhaps try and speak to a consultant to get to the bottom of whether it's a genuine concern or whether they've made a thoughtless comment which is now (naturally) worrying you. Unfortunately birth is a very uncontrollable thing but having had 2 big babies I don't think they tend to be any worse than the small ones overall!

Best of luck x

Is this based on growth scans? I was similarly cautioned with DS2, he was estimated over 10lb at term so warned of risk of shoulder dystocia. He was 7lb 12 9 days early!