C section after shoulder dystocia?

[IveGotALovelyBunchOfCoconutss]

Hi all,

I had my DS 2 years ago and the birth was quite traumatic. He was stuck and twisted, I had no pain relief as they were so busy and no one could do it, I didn't even have a midwife present for most of my active labour. It ended in episiotomy, forceps (head out on last pull) and he had shoulder dystocia so was an emergency button press, room flooded, I was folded in half with my legs behind my head like a deck chair and stopped breathing. Thankfully DS was ok and well.

I'm now pregnant with my second and can't stop worrying about the birth. He wasn't a big baby (7lb 8) and shoulders aren't particularly wide, midwife said it may be because of my pelvic structure and mentioned a planned c section. I'm absolutely terrified of either and the recovery after a c section is worrying me so much although I think it may be safer for baby. I'm also an older mum (41) so worried I will struggle with recovery more, especially with a toddler to look after. I do have a supportive DH but he will only be able to take a couple of weeks off work. Limited family support in MiL who lives over 2 hours away.

Anyone managed a successful vaginal birth after a previous with shoulder dystocia? I can see a lot of threads with advice on planned c sections that I'm reading constantly but open to all and any advice. I'm only 10 weeks so have time but it's on my mind constantly and causing a lot of anxiety. Thanks in advance for any responses

Yep, I did.

caveat, I have been told my first might have been only a “slight” case of Shoulder dystocia. 🤷🏻‍♀️I still ended up with my legs up, in the McRoberts manoeuvre.

with the second, I opted for induction at 39 weeks. Lovely, normal vaginal birth. No painkillers, didn’t even bother with gas and air until pushing the head out. Hurt like a motherfucker but I went hard into hypnobirthing this time & managed to keep myself super calm for Labour. And found a birthing comb to clench onto was invaluable.)

A forceps delivery is a risk factor for a shoulder dystocia and more likely to be the reason than an issue with your pelvis. Though yes having a previous SD is also a risk factor for another. But less likely to happen if you don’t have a forceps this time. Forceps are less common with second births than first births. But sadly nobody has a crystal ball regarding how your labour will go.

You’ll also get extra appointments with a consultant, extra growth scans and form a plan of action.

my consultant essentially left it to me to decide what I wanted to do.

they in no way pushed for c section. I actually found they were leaning towards vaginal birth if anything.

I'm sorry about your first birth experience, it sounds as if you were really let down by the healthcare professionals and the system. Hope you made a full physical recovery (although the emotional trauma doesn't heal so easily). Did your baby have any injuries from the shoulder dystocia?

Every woman is different and every labour is different, but here is my story for what it's worth.

DC1 was 9lb4, born by vaginal delivery after I went into labour naturally at 41+4. There was meconium in the waters so the midwife hooked me up to a monitor and insisted I lie on my back on a bed, which wasn't what I wanted at all. I ended up giving birth in that position and baby got partially stuck (one shoulder not both) so emergency button, consultant and loads of people came in, they did the mcroberts manouvre and got baby out quickly. I'd already had an episiotomy before baby got stuck, it might have helped them to get baby out, I don't know. No forceps, no injury to baby. I was very sore and swollen afterwards (couldn't actually sit, used a donut cushion and other cushions for ages) but did make a full recovery.
i had a debrief with my antenatal class teacher. I strongly suspected that the reason for the shoulder dystocia was being forced to lie on my back (it's a terrible position for opening the pelvis) and she agreed. Of course we couldn't be sure.

DC2 was 9lb1, born by vaginal delivery after I went into labour naturally at 40+1. Born at home, all very fast and I was alone for most of it, midwife arrived at the end. I was instinctively on all fours so that's how baby was born. No complications, no shoulder dystocia, small tear for me but I was much less sore afterwards and recovered more quickly. After that, I was even more convinced that the main cause of the shoulder dystocia first time around was having been forced to lie on my back.

As I said, I don't know how helpful all that is. If you haven't yet had a debrief from the first birth, it might be helpful to do it now so you can better understand the possible causes first time around. But I think the problem with shoulder dystocia is that it's very hard to predict. From my reading about the subject (in my second pregnancy) I believe that induction increases the risk so I would advise against that. Personally I would be deciding between spontaneous vaginal birth and planned c-section. But do read up on it and see if you can get an appointment with the consultant midwife (or head midwife, I think job titles can vary) to talk it through.

www.rcog.org.uk/for-the-public/browse-our-patient-information/shoulder-dystocia/

My advice? Have an elective section.

I had one after a third degree tear (arguably a much less awful experience than yours) and it was such a lovely, chilled procedure. I spent the pregnancy not having to worry about labour. Recovery was a piece of cake compared with recovering from a perineal tear. I left hospital the next day (I insisted) and didn’t take anything stronger than ibuprofen and paracetamol.

People, especially on MN, love to talk about c section recovery being awful (most have never had a c section) but for most people it’s really straightforward.

See also www.aims.org.uk/information/item/making-decisions

Yes I did. First DS was born 41 weeks 9lb 8 similar story to yourself. No pain relief. Episiotomy. Two failed attempts at forceps. Ended in McRoberts manoeuvre. With my second I had an elective c section. DD was born on due date. 9lbs12 and the surgeon struggled getting her out. I didn't realise but she had called for baby doctors just in case. Surgeon told me I made the right decision she thought I would have had a second traumatic delivery if I hadn't opted c section. C section was very healing to my previous birthing trauma and I'm so glad I had DD that way. The whole C section process was calm and the staff were fantastic. I did have to wait all day which was difficult without food/water as emergency c sections obviously took precedent.

Thank you for all your comments, it's so helpful. I just can't get it out of my mind. Will read all the links and do some more research. I have heard others says a planned c section after traumatic birth can be healing too so that would be a bonus but it all seems so scary. I am so worried about recovery too

I think over the last 20 years or so, c section has been so demonised and it’s totally ideologically driven. The NCT has a lot to answer for. I actually read a really good Twitter thread yesterday about how the demonisation of c section has influenced midwives and obstetricians, to the real detriment of patient safety.

You see the same attitude on here all the time. Anything but a c section. Major abdominal surgery. And that may be true, but no one talks about the just-as-major insult to a woman’s body that can happen with a vaginal birth. Pelvic floor damage and continence issues are so normalised and downplayed.

No one has a crystal ball and can tell you what your recovery will be like. But the vast majority of women have smooth recoveries. You just have to be sensible - find the right balance between resting and moving, letting your partner do the bulk of the work with your older child (especially during the first few days) and generally not overdoing it.

One thing I forgot to mention, and the factor that really helped me make a decision, was that I just didn’t know whether a vaginal birth would go OK or not. Personally I couldn’t handle that uncertainty and fear. So it felt better for me to have a c section where the potential risks were much more controlled and quantifiable.

Here is the Twitter thread.

https://x.com/drruthannharpur/status/1828495712725705167

At 41 and after a traumatic complicated birth I would absolutely be requesting a nice calm elective section. I have a friend who had a traumatic first birth which put her in ICU and baby in SCBU. Her planned section for baby number 2 was delightful, she couldn't believe she could give birth and spend all day cuddling the baby. It just wasn't what she'd had before.
A section can have complications of course but it's a lot more predictable. I wouldn't think twice. I've had three vaginal births. Pelvic floor is ok but I had three episiotomys so undercarriage looks like bayeux tapestry. It's an absurd process, just get it done with the least fuss and drama.

I had a SD birth second time round. I went on to have 2 normal births- well one normal and my last was a forceps but not because he was a SD but because he was back to back and fucking HUGE!!

I also have a friend whose second baby was a SD at home (planned homebirth). No pain relief and no stitches- baby was manoeuvred out with the MW putting her entire hand up to help release it. Terrifying but effective!