Do I *have* to have a c section? :(

[fairysnuff]

I had a ventouse first time after 2hrs + pushing (I think I was too excited and pushed too early), but babies shoulders got stuck and the placenta had to be retrieved ( I swear he was up to his elbow) They tell me I may need a csection next time (DH makes too big babies, for my body!8llb 2oz)
The whole thing frightened the life out of DH and my mum says that there is no option, I must go for the c section.
But I really don't want one

Any advice/stories gratefully recieved

I'm sure plenty of the doulas and midwives on here will come in -but in a word, NO
True shoulder dystocia is actually quite rare and affects small and large babies pretty equally - what is common is 'bed dystocia' and also failure to be patient
8 pound 2 is not huge by any means (thinking of buddy having a 13 pounder at home) and many women have interventions like you and then go on to birth much larger babies with no problem.
BTW - the retained placenta could have been due to them giving the injection too soon, shoulders got stuck, then your uterus clamped down bewfore the placenta separated properly.
By god i'm glad i stay at home!
Lisa x

Sorry, being dim, but do you mean the anesthetic for the episiotomy?
In the end, it was all so fast?
All I had was gas and air.
Sorry, I am being dim, aren't I?

Shoulder what?
bed what?

I had a c section first time as ds "got stuck" and was born at 9lb 11. But then went on to have dd at 8lb 6 naturally. Hopefully there is no "must" about it - I was definitely encouraged to have natural(but heavily monitored) birth 2nd time. If monitoring becomes an issue, ask for portable monitor as this allowed me to wander about delivery suite but not to be "tied" to the bed - made big difference in speed / ease of delivery.

Good luck!

Sorry fairy - coffee break no i mean the synto injection to make your uterus clamp down - If they miss the signs that it has separated and your womb clamps down then hey presto, retained placenta.
Was your LO in a back to back position BTW? your pushing 'early' could have been due to that if LO was back to back, you get an urge to push before full dilation and the baby is turned corkscrew stylee against your pelvic floor. As JJ says mobility is the key, If you are flat on your back or sat on your tailbone, the diameter of your pelvis reduces a lot (I've laboured on all 4's and both times DH says he could see my tailbone lifting up as baby came down. there should be no need for continuous monitoring - it doesn't improve the end result and indeed can give an excuse for carers to scuttle in, print a bit out and scurry away again, with intermittent monitoring they've got to interact with you a lot more.
I could ramble on all night - but i really need to get to bed , Where's klaw when you need her??
Lisa x

what jamila said

shoulder dystocia is not neccesarily going to recur, if it does, the RCOG advises the mcroberts manouevre..legs up round your ears! .. to open the pelvis, and most of the time that will resolve it

being on a bed makes it harder as pelvis cannot open up as much, being upright or all fours or a supported squat opens up more, so more room to get the baby out

you don;t have to have a c.s, and second baby's can sometimes be smaller than first ones!

I knew someone else would turn up Lulu! Had to drop ni on this because it makes me so mad when people make all these dire predictions based on naff all really and then proceed to scare the the crap out of women. It doesn't do anything for your confidence in your body, If you've had a hard time with a birth you don't need negativity.
Lisa X

i really admire your passion for this jamila, i think you talk a lot of sense and always offer marvellous advice

you will make a wonderful midwife.

fairynsuff... my first birth was an induced labour, diamorphine, epidural, stuck on a bed, had my waters broken, did not dilate past 2 -3 cm.........emergency c.s

second birth was a spontaneous labour, stayed at home as long as i could manage, had lots of gas and air, stayed upright and mobile as long as poss, had a small dose of pethidine, and went from 3cm to baby in arms in 3 1.4 hours

so , could not have been any more different second time round.

lulu TVM
Lisa X

Thank you so much jam I went to sleep a much happier person

They told me that cos of the complications and cos my DD was so big I would prob have to have a c section or be induced. But that they would monitory my next pregnancy to see if it was a big baby.
But I have head of that being no use, they sometimes get the measurments all wrong?

DD was in pefect position, I mainly pushed squatting (god bless DH's strong arms!) but then some merconium appeared and they popped me on the bed to monitor (yuck, also got really tired then and stuggled to push)
My knees certainly ended up around my ears when I was yanked down the bed when her shoulders were stuck.
They told me that was cos she was so big and could very easily happen next time? What is this shoulder thingy?

They broke my waters for me and, also cos I was on a bed for the first time during a contraction, I thought I felt the need to push. But I think it was just cos it was harder, for me, to labour when forced to remain still.

But it is hard because both DH nad my mum want me to have teh section 'to be on teh safe side'
DH less, he will go with whatever I want, it is my body. But he was really frightened by how it all ended. He thought we were both going to die (but he is a little melodramatic bless him) Still, I am really worried about forcing him to go through it my way and then ending up feeling sorry cos I have frightened him again.
I can just hear my mum, 'it could have been avoided'
Bless her too, she is worried for my well being and teh fear of having to break a limb to get baby out. How bad would I feel then??

DD is 1 now and we are trying for #2, I have been thinking about this since the day she was born
Mum won't really entertain my musings and DH hates to talk about the birth, it makes him sad.

Hi Fairysnuff - sorry you didn't have such a great experience last time {{{hugs}}}.

Shoulder dystocia is when the head is delivered and the shoulders get stuck. If the baby doesn't come free it can be extremely serious for both mother and baby BUT as Jamila said, true shoulder dystocia is very rare (around 0.6% of births in the UK). Sadly bed (or midwife's ) dystocia is much more common, which can lead to everyone getting very stressed for no good reason.

If you think you'd benefit by talking through your birth, contact your maternity unit - round here there's a "birth afterthoughts" service where they will make an appointment for you to sit down with an appropriate person (midwife or Dr) with your notes and go through what happened and why.

Re. large babies, what problem is size in and of itself going to cause? A long labour that doesn't progress. How is that cause for a huge panic? It's not! So why plan a CS? Especially when predicting the babies size before birth is so dodgey!

Re. large babies and shoulder dystocia, the only studies I've read of that have been done have shown that size of baby is not a good predictor of shoulder dystocia (even once you know how big the baby actually is ). So the logical conclusion of "have a CS to avoid shoulder dystocia" is that ALL babies are delivered by CS! (have a look at RCOG guidelines for more info).

You might also want to do some research into CS's. Whilst lots of them are done, they are major abdominal surgery and are not without their own risks and implications, particularly if you want to have any further children.

Good luck - it's not easy when your family have concerns that lead them to a conclusion you're not happy with, even if they do think they're doing it for your best interests. I hope you can find some answers and information to help you make a good decision on your next delivery

Hi Fairysnuff - good luck with your decision.

You might want to research all the possible risks of c/s (plenty of threads on that here) and point out to your mum and dh that you will need full time help for at least the first 6 weeks following the birth if not longer. Although you may be cited examples of people your mum knows who had no problems and were up and about 5 days after the op that's not the case for everyone. Plus the scar pain continues for long after 6 weeks (I still feel it occasionally ie cripplingly painful at 8 months).

Obviously where a c/s is medically necessary and it's a case of saving a life those factors don't really figure.

Lots of people have a first birth with lots of intervention and then manage subsequent ones with none at all. At the end of the day a lot depends on luck e.g. how the baby is positioned, birth supporters, level of pain, medical complications etc but if your body has done it once it will remember how to do it again.

Good luck with your pregnancy and birth.

I must get my mum and DH to have a read through some of these things.
Mum is so adamant and DH is so worried that I was just going to go with the flow instead of worrying everyone, but now I think I will have a good look into it all and prob go and speak to someone at the midwife unit, so that I have someone who will actually discuss it with me.

I just felt unjustified in speaking to anyone about if buts and maybes when I wasn't actually pregnant.
I still am not pregnant but we are trying, so I am beginning to think seriously about it again.

You know how it is, you felt it was all taken away from you a little teh first time and that there was a note on your files saying, must do better next time ( I would have written it, not the midwives, they said I did great) I also didn't really feel, at the time, that it was all so bad as all that. But everyone around me was in a paddy over it. Mum and DH remain so??

I want to do better next time. Not just lie back and be sliced open

Sorry, just read through your post again tangle what do you mena by bed (midwives) distocia??
What could that/they have done to cause it?

I from what the others have written, sticking you on your back to keep you monitored whilst pushing god have caused it - it is the one of the worst positions - it restricts your pelvis opening up I believe

I pushed for well over an hour the first time, the next 3 were a matter of minutes and were much much bigger babies!

god = could fingers gone a bit mad!!!

oh, I guess that makes sense, by moving from squatting to on my back, my pelvis changed shape and, as baby was already crowning, she was all ready to drop out when all of a sudden, hang on mum, your pelvis has caught my shoulder.
Then they jab me with a needle too soon and my placenta decides to stay put?

Does that sound about right?
If I told DH and mum that, they may stop pushing for the csection.
But, obviously don't want to say any of that if I have just simply made it up.

I think cargirl got it pretty right, but Jamila's probably the one to really comment.

My understanding is that "shoulder dystocia" is often written in the notes when that wasn't strictly the case - my mother was told she had shoulder dystocia with my sister, but they had time to run around the hospital trying to find a Dr with tiny hands that could come and try and help: if it had been true shoulder dystocia then they wouldn't have had enough time to do that.

Your summary certainly doesn't sound implausible, and for your own peace of mind I think you need to talk it through so that you can understand. Probably worth having a list of questions you want answers to (like the timing of the synto for 3rd stage, whyt they ruptured your membranes, etc). I'd also push to find out how likely these things are to repeat and whether you can do things to help avoid them.

Do your homework , decide what you want - and then start working on others. Fingers crossed you can get some answers

Hi Fairysnuff - Have just seen your thread and have to comment. First of all, its your body that you are thinking of subjecting to a major op, because you dont want to upset your mum???

You have had lots of good advice here and I would absolutely agree with them that being up and mobile is the best thing you can do if you want a normal birth next time. It sounds like DH and the midwives were doing a great job keeping you up and pushing whilst squatting and were not suffering too much from midwife dystocia.

With you in lithotomy, the doctors in the room, the midwives the paeds and probably the odd onlooker, it can look really scary and there is usually a fair bit of raised voices, blood etc and your poor DH is looking on at the whole scenario something like a spectator, taking it all in and of course is frightened and traumatised by it.
Shoulder dystocia is basically when the anterior shoulder gets stuck at the pelvic brim and McRoberts maneuver (knees up at ears and suprapubic pressure) is very effective at freeing the stuck shoulder.
You probably had syntometrine after delivery which has a nasty habit of clamping the cervix closed and trapping the placenta, syntocinon works in a similar way but is not so fast acting. Also, doctors are often impatient to get the placenta out immediately, so probably they didnt wait for seperation and just pulled it out by hand.

If its any consolation, I care for lots of women who have had equally crappy first labours, and almost invariably, they cant believe how different it is second time round - no comparison, much, much better.
No guarantees of course but your body has done it once and it can do it again, and without the doctors interference this time.
In fact, women who have been traumatised by a previous delivery are the most satisfying to care for as a midwife, they are usually so happy and amazed when it is a good experience and you know that you have helped them to get over their previous trauma.

So, I think going to speak to the consultant midwife if your unit has one or one of the senior midwives in the birth centre would be a great idea. You dont have to be pregnant to do this. Might be a good idea to take your mum with you, as she is obviously a strong influence in your life, and if she does not change her tune about a c/s, then ask her nicely to back off and let you make your own decision. Lets face it she is not the one deciding to have a baby - you are.

Be strong - you can do this naturally.

Sorry this is one of my long and rambling posts again, but hope it helps.

Your pelvic inlet - where the shoulder gets stuck - wont change shape to catch the shoulder by being on the bed, especially in lithotomy, and neither will the timing of the needle make the placenta get stuck. When I trained, we were taught to give it with the delivery of the anterior shoulder, and I now think that that is too early. It wouldnt have been given any earlier.

Sorry

I've been skim reading this thread too.

A CS is not the safe option at all! A VB is statistically safer than a CS.

Research shows that almost half of the cases of shoulder dystocia occur in infants weighing less than 4000 g (Enkin et al, 2000) so the argument that baby is expected to be big fails!

You can do lots of reading on Shoulder Dystocia here at the Radical Midwives archives and here at Homebirth.org

With all due respect, it is not your Mum's decision to make Fairysnuff, and she needs to keep her opinions to herself. You need to be supported to research your birth choices and make your own informed decisions. Read as much as you can, Ina May's Guide to Childbirth is a good start!

Just what size are you btw? I don't believe that you could grow a baby too big to birth and 8lb 2 is not big!

You've already had fab advice and info from Jamila and Lulu and Mintpurple! Enjoy TTC and know that you can do this, make your own informed decisions by learning about childbirth and about yourself.

Fairy, here is a link to RCOG guidelines on shoulder Dystocia, which describe what it is, common causes and what is done - you'll see that even when babies are over 4.5kg (just under 10 pounds) it's still hard to predict what will happen.
You should see if your hospital runs a birth afterthoughts service - you should be able to review what happened with someone who can explain what went on and why, it can help a lot.
Mint, do you think the above is useful? I was a bit vague last night, twas very late so i tried to explain in terms fairy could get her head round based on the OP - I do understand the mechanisms - honest!
Lisa x

Bugger, forgot the link (DS1 trying to push the envelope on bedtime)
www.rcog.org.uk/resources/Public/pdf/shoulder_dystocia_42.pdf

Yay klaw!! I knew you'd show up

No, you don't have to, I'm 5ft2 and a smallish size 10, I gave birth to my first, who was a 9lb10oz monster. Had a 26 hour labour, followed by a failed forceps attempt and a ventouse. The hospital told me I would have to have a c section with my next.
When I got pg with dd (9 years later), I told the mw that I did not want a c, if it was at all possible. She fully supported my decision and helped me plan for a home birth. In the end, we ended up in hospital and dd was a forceps delivery but, it wasn't traumatic at all. I felt fully in control and the baby was not distressed at all, she just wouldn't come out on her own.
You need to make your own decisions and you need a good midwife who will make you feel confident about that.
I don't like the idea of a c section (for me) because I hate the thought of being cut into and it's a major op, which means at least 6 weeks recovery time and however bad my first birth was I was at least mobile within a week.