C section after shoulder dystocia?

[dinny]

I'd quite like to think about maybe having another baby in the next year or so, but had shoulder dystocia with my second baby, ds (now 3), and am terrified it will happen again. Are C sections recommended in this case? Have a feeling answer will be no....

Can you tell us any more about the birth? Do you know how bad the shoulder dystocia was - did it resolve easily, what was the time between the head and shoulders, did the baby need any resuscitation? Also what position were you in for the birth - eg on your back, kneeling etc? Did you have ventouse or forceps? How big was the baby? Are you diabetic?

I imagine you would be allowed to have a CS if you wanted one, but it could be that it was related to your labour last time and would be less likely to occur this time round.

hello, Daisy,

yes, it resolved easily with McRoberts (thank GOD) but am terrified of not having such a fab midwife next time (who realised it was SD very quickly and did McRoberts straight away)

no, ds was absolutely fine and so was I.

I was standing up in labour (about 4 hours) and kneeling leaning on a bed for delivery.

had no intervention at all - no pain relief either, if that's relevant

ds was 9lb.3oz and I'm not diabetic

I just keep thinking what could have happened had mw not done Mc Roberts so quickly.

you must be a midwife/dr/nurse??? thanks Dinny

No, just a doula, so not medically trained and just speaking as a layperson I can understand a bit how frightening it was having been at a birth where this happened recently. Like yours it was resolved fairly quickly and the baby was fine.

Things such as being on your back (which is more likely if you have any epidural), having a ventouse or forceps, being diabetic etc are all things that make a shoulder dystocia more likely to happen, but as you've shown they can very unpredictable and happen to almost anyone.

What I will say is that shoulder dystocia is a scenario for which all midwives should have been trained very thoroughly and the vast majority of midwives should be able to deal with it as calmly and competently as yours did.

Have you de-briefed with anyone from the Birth Afterthoughts service at your hospital about what happened? It might be that if you can talk it through with someone who has seen your medical notes that you would feel reassured and happy to have another vaginal delivery. On the other hand you may still feel that a CS would be a better option, in which case they can refer you to the consultant to talk this through with him/her. CS does prevent shoulder dystocia but carries its own set of risks so it's important that you get a chance to discuss these and make an informed choice. HTH a bit.

My ds has erbs palsy because he got stuck and they pulled his fecking HEAD!!

6 months later I was accidently (pill failure) pregnant again and I shit myself! I considered abortion! I initially refused to go near the hospital. Anyway, needs must and all that, and I had ds2 naturally. They were very well prepared, the consultant stayed - even though I had ds2 at midnight! And they kept a theatre on standby and they made me have an epidural. Apart from the cord being round his neck, he came out fine - they were ready for problems, I think that made the difference - even though he was 10lb 5oz and ds1 was 10lb 4oz it was a much easier delivery. So I don't think shoulder dystocia means you HAVE to have a cs. It does mean they are very VERY careful with you.

Ds1 had SD but with no lasting effects. When it was realised that ds2 was also likely to be large he was induced early to avoid SD. He still got stuck but this time there were people on standby for the pushing stage and so ds2 was freed very quickly.

By the time I was pg with dd they no longer did early inductions but I was induced on my due date. Again the idea was to have people on standby but this time it wasn't needed.

No-one ever mentioned needing a c/s but obviously it's worth talking it through with the MW etc to make sure they are aware of the SD. For some reason no-one had checked my notes for ds2's birth when I was pg with dd and they had no idea about the SD until I mentioned it during a check-up.

Hecate, so sorry to hear your ds was affected - what exactly is erbs palsy? who pulled his head? the mw? that is exactly my fear, I'm sure most of them are really competent but you obviously had one who wasn't.
so glad your 2nd birth was straightforward.

Daisy, I didn't mention, I did have a doula too (she was fab!) wasn't you, was it??

I just think I'll panic in labour, I really do. but the thought of a C section terrifies me too...

erbs palsy is brachial plexus paralysis. Basically, by pulling on his head while his shoulder was jammed, the midwife caused damage to the nerves that run to the arm. They left his left arm paralysed. He also had to have lots of physio on his arm and also on his head/neck by pushing his head to the side and holding it there! - to counter the possibility of something called Torticollis, where the baby turns away from the paralysed arm which eventually shortens the muscles in the neck and leaves them turned to the side! He's had 2 operations and made a partical recovery but has been left with a permanent disability.

BUT the point of my first post was actually - you'll laugh now! - to reassure you! I was telling you that my second child was fine because they were aware of what had happened to ds1 and they made damn sure they were prepared! So looking back, I think ds2 was actually SAFER than normal. And that I think they will take every precaution and have it in your notes and will discuss among themselves in advance what might happen, so there'll be no surprises.

they're trying to advise me to have a CS this time too as dd1 had bad shoulder dystocia eventually resolved by keilan (sp) forceps - I was ruined and she was black and blue but fortunately no lasting damage. she was 10lb4 - trauma team/consultants etc all in room at 23:00 - very scary as had no farking idea what was going on at all

dd2 was EMCS after failing to progress, I was 10cm etc after 29hr labour but she just wouldn't move down even though cons was up there minus only flippers and miners lamp - I REFUSED keilan (again sp) forceps so they had to go down route of EMCS - she was 11lb1oz and 59cm long

am now pg with dc3 and they were asking me about my birthing wishes, cons came to see me at 20wks and I said would be keen to try VB but he said to wait and see when scanned again at 34wks and 38wks - all very confusing

for you hecate what a terrible thing to happen to you and ds

was the C section awful?

so glad all worked out ok

dinny by the time I was having the cs I was so off my face I didn't know what was going on or who was having a good luck at my bits - the cons brought in another surgeon to assist and I remember looking up and thinking he was GORGEOUS and OMG I hadn't shaved my legs or waxed my bikini - FFS as if he was even looking at me in any way other than pity and disgust by that stage

the C-sec was a necessity and I wouldn't recommend either way I did it but needs must and I'd like to get it right 3rd time lucky

at least the surgeon had the good grace to come to the ward and apologise the next day as when she was trying to deliver her vaginally she announced that she didn't think dd2 was 'that big a baby'!!

would you not prefer to have an elective C this time, do you think?

this is the million dollar question. Would prefer natural VB as don't have a great deal of help after the birth, dh has little time off work and the recovery time after CS is longer, I wonder though if I had such a hellish time getting over it because had gone through long labour first then CS

my friend will be having her 3rd elective CS in May and she gets over them relatively easily but her dh is a teacher and can spend the summer holidays running about after her and she FF so he does the nightfeeds etc

I don't know, will wait and see. I want to try VB again but am not going to go against medical advice if they think I won't be able to deliver again

I was thinking about it as my sister had her first baby yesterday by Caesarean and seems to think it was all fine and dandy...

oh lovely auntie dinny - I hope she and baby are well

thanks he is LOVELY (broody emoticon)

Im 34 wks pregnant and dd2 (9 pounds) had shoulder dystocia, quickly resolved with McRoberts. I know the odds of real risk to the baby are low - I've read its about 11% of the child getting stuck if one has been stuck before - but we don't think its a fear we can face after a tough time with this and a previous pregnancy. A CS has risks and is certainly very inconvenient but surely its not such an awful option? At the moment the placenta is still low anyway but we think we will ask to have one for our own peace of mind.

o, will you ask for and be allowed an elective, Beezmum?

I think, if I was to contemplate another, I would too.

I had various complications with my pregnancy (all of which affected primarily me and not DD) and was strongly advised against a vaginal birth because of risk of permanent damage to me.

The one thing that did make me agree to an early CS was when they told me they were concerned about SD with DD, as they thought she was a huge baby (she was a petite 7lb 6oz at 38 weeks - not the elephant they predicted ). As soon as the risk was to DD I forgot my, "But I want a vaginal birth" and the decision was easier.

I doubt I will ever have a VB and have been advised that another pregnancy is not particulary sensible, but I can say that an elective section can be made to be lovely and welcoming and not scary surgery.

I'll stop waffling now, but wanted to give you another experience.

In most hospitals the midwives have shoulder dystocia drills and are well aware what to do if it should happen. It is extremely unusual to have a bad one and in someone like yourself you would be watched carefully as it had happened before. It would be a shame to have major surgery to avoid something that might happen, but probably wouldn't. Of course you would probably have growth scans and lots of consultant input antenatally.

I suppose its a fear that isn't entirely rational.
We see the consultant in two weeks but my impression is that although we have been told that the advice is to go for a natural birth, having had a previous SD combined the possible size, we would be allowed to choose a CS.

If you had one SD then they'd monitor second stage VERY closely in your next labour, and would have a senior midwife to care for you. She'd have reviewed her drill for SD and would be ready to act immediately at the first sign of any problems.

I had SD with my second (10lbs 12oz) and went ahead and had vaginal birth with my third. It was completely straightforward.

I had a SD with ds2. Resolved with McRoberts and suprapubic pressure. He was a little flat and covered in haemorrhages but ok otherwise. With ds2 consultant recommened a cs. basically said I had 1/10 chance of a rpt SD and 1/100 chance of dead baby.

However I am now pregnant with ds3 and am under a different consultant. He is happy for me to try a VB. I am very confused and scared but at the end of the day I think I am going to give it a go.

What I am trying to say is that there is no evidence either way and comes down to individual doc and woman. I just would rather avoid cs if poss as found the recovery pretty long last time.

Hi Beezmum, just wondered how you had gone on??

Dizzydixies - "dd1 had bad shoulder dystocia eventually resolved by keilan (sp) forceps"

I think you've been misinformed? Its impossible to have a shoulder dystocia resolved with forceps. With a shoulder dystocia, the head is delivered but the shoulder is caught internally on the pubic bone. Keillands forceps are used to rotate the baby before the head is delivered. Are you sure it wasn't a 'Labour' dystocia you experienced? It sounds like you had cephalopelvic disproportion (CPD).

To the OP - most shoulder dystocias occur in women with NO predisposing factors. However, a previous SD is a predisposing factor! A CS will only be necessary if they suspect this baby is bigger than your last.