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Childbirth

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

homebirths and shoulder dystocia.

27 replies

LuckyStarOfBethSalem · 24/12/2007 12:20

I've had my MW checkup today for the homebirth and she was explaining about shoulder dystocia. I am now panicked. Can someone explain what the difference is to having this happen at home and hospital.

I mean am I causing more risk of this being at home or is it not much different at home as to how it would be at hospital?

Hope that makes sense
Thanks all.

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lyra41 · 24/12/2007 12:27

this happened to me last year and it was extremely scary, but mercifully it is also very rare. I would def have my next baby in hosp as it is more likely to happen again once it has happened. In fact i would opt for c section as it is really unpleasant.

Basically it is when the shoulders get stuck once the head is out, and you really need at least 2 midwives to do a special procedure to "pop" the head out of the pelvis. I only had one mw so it was very touch and go, but all worked ok in the end.

i think the advantage of being in hosp is that there are more doctors mw's etc. available to help, and can obv do an emergency c section quickly if nec.

JingleBelgoHoHoHo · 24/12/2007 12:27

Is this your first birth? If not, how was your first birth?

Does your MW think that you have a higher risk of shoulder dystocia?

JingleBelgoHoHoHo · 24/12/2007 12:29

I think that the main advantage of being at home is that you are free to move about however you like - the midwife will encourage you too - hopefully getting the baby into the best possible position.

LuckyStarOfBethSalem · 24/12/2007 12:31

It's my first baby and she doesn't seem to think i'm overly likely to get it. She did stress that it's rare and probably unlikely but she needed to explain about it.

There was a small issue of whether my BMI was too big but according to her calculator it's all ok.

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lyra41 · 24/12/2007 13:05

I'm sure you'll be absolutely fine. Hope it all goes well. x

LuckyStarOfBethSalem · 24/12/2007 13:08

Thanks Lyra

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Snaf · 24/12/2007 13:09

No, you are absolutely NOT more likely to have a SD because you are at home. In fact (whilst no emergency situation can ever be completely ruled out, wherever you give birth) you are probably less likely to experience this at home, as you have far more freedom of movement.

At home, you are unlikely to be giving birth lying on your back on a bed. It is this position that is a major contributory factor in SD, as it reduces the pelvic measurements, so the baby's shoulder can get stuck behind your pelvic bone. If you're lying down, your sacrum/coccyx cannot move back and out to enlarge the pelvic space and let the baby move through as it should. This is especially important if you have a raised BMI.

The maneouvres that free a shoulder dystocia in the vast majority of cases are simply ways of opening up the pelvic diameters (getting you onto all fours, or doing something called McRoberts which is pulling your knees right up by your ears). But if you're not lying on a bed in the first place this is far less of an issue, iyswim?

These manoeuvres are exactly the same at home as they would be in hospital, and all midwives are trained and updated yearly in performing them. (Re: doing an emergency c-section - the head is already out, for a start, so doing a section would involve replacing the head into the pelvis, a manoeuvre called the Zavanelli. I really cannot emphasise enough how incredibly rare and unlikely that would be - virtually all cases of SD are resolved with McRoberts or all-fours positions.)

Please do try not to worry - it really is unlikely. Have a lovely birth.

Snaf · 24/12/2007 13:09

Sorry - bit of an essay there!

LuckyStarOfBethSalem · 24/12/2007 13:11

Thanks Snaf - I tried to read all that on the homebirth website but I couldn't make sense of it, you've managed to do that for me.

Thanks again

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Snaf · 24/12/2007 13:14

My pleasure

lulumama · 24/12/2007 13:18

what snaf said!

sometimes MWs tell us scary things with the best of intentions, so we are fully informed of the risks , but it can make you a bit wobbly!

AFAIK, the royal college of obstetricians and gyneacologists recommends that the first way to attempt to resolve a SD is the mcroberts, which is usually succesful.. so the fact that is recommended rather than c.s should tell you something

it is not the head that is stuck it is the shoulder.

i wish you a happy and smooth homebirth x

macdoodle · 24/12/2007 13:43

Different POV here - my MAIN concern having a HB would be shoulder dystocia (along with a flat baby and a PPH = post partum haemorrhage) - I am medical and having seen ONE (and I stress as above it is extremely rare) but one was enough to scare the bejesus out of me (and I was just watching)...in this cae head needed to be pushed back in and an em section carried out ....IN MY MIND any risk especially of this kind is to high but that is my personal opinion (not trying to terrify or dissuade you just offering another POV)....
The reason the MW are warning you - is when things do go wong unfortunately people are very quick to apportion blame and guilt and they need to cover themselves..
Risks are low you just have to decide for yourself what level of risk you are prepared to accept !

lilylilyrose · 24/12/2007 14:23

This also happened to me with my DS in August. It was very very scary but my son is fine. It took me 2 hours of pushing to get his head out though, and I think with hindsight that if I'd been at home the midwives would have probably asked me to transfer in as they may well be able to anticipate a SD. (I'd planned a HB but ended up in hospital after concerns about my baby's size - justified in my case!)

There are several manouvres they can try with a shoulder dystocia - there were 3 listed in my labour notes. On rare occasions the baby's collarbone has to be broken with force to get the baby out, and there is a risk of nerve damage. My DS thankfully is fine, though his APGAR at 1 min was only 4, and he needed oxygen to get going.

It is rare, but as a PP has said, all MWs are fully trained to deal with this sort of emergency, and I expect an ambulance would be called too - babies with a SD usually need to be checked by a paediatrician for nerve damage/broken bones as mentioned above.

Best wishes for your birth!

madChristmasmouse · 24/12/2007 15:43

Lucky, I posted something on our antenatal thread, which basically boils down to misquoting snaf from an earlier thread [sgrin] sorry snaf, I love your posts, they are so sensible.

Snaf · 24/12/2007 20:13

LOL - thank you madChristmasmouse

Sabire · 26/12/2007 23:48

Hmmmm - interesting that the risks of rare obstetric emergencies are discussed with mothers opting for homebirths, but the risks associated with c-section - something that appears to be twice as likely if you opt for a hospital birth as a low risk mother, aren't discussed at all.

Can you imagine the conversation: "Now I have to warn you that if you DO decide to go to hospital to have your baby instead of staying at home you are twice as likely to end up on an operating table. This means you're also more likely to end up with a haemmorhage, hysterectomy, thrombosis and your baby is more likely to need to go to special care. Oh yes - and you're more likely to die. But don't worry - it's very unlikely this will happen to you."

Yup - that would put women at their ease before they go into labour wouldn't it?

Shoulder dystocia occurs in 0.6% of all births - your risk will be less than this because you are (presumably) neither diabetic or obese (these conditions make SD more likely).

The Zavanelli manouvre described above is only used - literally - a couple of dozen times a year in the UK, if that. It's very, very rare to get a SD that needs that sort of intervention to resolve.

I had SD at my second birth at home, with a 10lbs 12oz baby. An ambulance was called and was there within a few minutes. In the meantime my midwives had dealt with the SD calmly and efficiently.

Don't let your midwive panic you - there are risks and benefits associated with both hospital and homebirth - just try to keep things in proportion.

LuckyStarOfBethSalem · 27/12/2007 19:15

Thanks Sabire - I know they have to tell me these things (had to sign a piece of paper to say they'd gone through it with me) but I just wanted to check is all.

And I agree - They don't tell you about risks with hospital births!

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macdoodle · 27/12/2007 20:09

ummm they do actaully - I am booked for planned section (second baby big breech vaginal ventouse with first)....tomorrow
And boy did they go through the risks with me ...

LuckyStarOfBethSalem · 27/12/2007 20:11

I didn't know that Macdoodle. I expect its cos you're not having the "norm" though.

C-Section isn't "the norm" same as homebirths aren't.

Good luck for tomorrow!

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CarGirl · 27/12/2007 20:18

I was just going to say what a few others have they are covering their backs explaining what can go wrong and under what circumstances they would want to transfer you/not continue with the homebirth.

They do not tell you the risks of natural delivery if you are booked into to have a hospital birth. In fact the only time anything scarey was ever mentioned to me in hospital was with my 3rd ARM (3rd birth!) when they warned me of the risk of prolapsed cord (I guess cos dd was still so very high up and nowhere close to dilating my cervix).
It was only when I stupidly asked what were the chances of the ARM not working to establish my labout that they told me 50/50 -eek!

Macdoodle all the best for tomorrow, Lucky all the best for a fab homebirth (I booked for my last 3 births but never went into labour at home to get one!)

CarGirl · 27/12/2007 20:18

I was just going to say what a few others have they are covering their backs explaining what can go wrong and under what circumstances they would want to transfer you/not continue with the homebirth.

They do not tell you the risks of natural delivery if you are booked into to have a hospital birth. In fact the only time anything scarey was ever mentioned to me in hospital was with my 3rd ARM (3rd birth!) when they warned me of the risk of prolapsed cord (I guess cos dd was still so very high up and nowhere close to dilating my cervix).
It was only when I stupidly asked what were the chances of the ARM not working to establish my labout that they told me 50/50 -eek!

Macdoodle all the best for tomorrow, Lucky all the best for a fab homebirth (I booked for my last 3 births but never went into labour at home to get one!)

Pannacotta · 27/12/2007 20:21

My MW mentioned it to me when discussing my second home birth. Not sure why other than that DS1 was a big baby (over 9lbs).
I didnt do too much reading (didnt want to know all the scare stories).
DS2 born at home in the pool, all went very well. I moved around a lot in both labours and gave birth kneeling and on all fours which am sure helps a lot.
Am sure you will be fine, try not to panic.
Home birth is fab, cant recommend it highly enough.

Sabire · 27/12/2007 22:14

"They do not tell you the risks of natural delivery if you are booked into to have a hospital birth".

No - I didn't mean that women should be told about the risks of birth per se - I was raising the issue of what appears to be additional risks to you and your baby that come with opting for a hospital birth - increased rates of infection, baby more likely to need special care, higher rates of c-section, higher rates of assisted birth and higher rates of breastfeeding failure, when compared to similar mothers giving birth at home.

Surely mothers have a right to be warned of the risks and benefits of both hospital and homebirth?

LuckyStarOfBethSalem · 28/12/2007 14:47

Sabire - I agree. When we went through where I was going to give birth etc at one of my first MW apts, I said I was unsure and the first things out of the MW's mouth was... "You should have a hospital birth... there's a hell of alot less risks than a homebirth where loads can go wrong"

I'm glad I researched and was clear in my convictions.

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CarGirl · 28/12/2007 19:51

Actually when you think about you are told very little about anything in this country about birth etc you have to hunt everything out yourself.