Elective C section after shoulder dystocia?

[dinny]

Newly pregnant with third, early days but am already panicking at thought of delivery as my ds (2nd birth) got stuck and am so scared of what could happen if it happened again.

I'm mainly scared because we have moved area away from the hospital where I had my first two children (St George's) and our nearest one has v bad reputation (East Surrey)

Can I book with St George's for an elective? on NHS? Or even privately...?

Thanks.

Brave? HAHAHAHA I was on the fecking pill! I didn't want any more kids after what happened - I was a wreck! But I guess it was meant to be - once he was in there, there was nothing to do but deal with it

I'm really glad you had a good midwife. I wouldn't wish my experience on anyone! Of course you must do what is right for you, but you don't need to feel a cs is your only choice if you don't want it to be. Of course you are going to be scared - I was fecking terrified!! but with help and support, you can do this!

Hatrick! Yes, am really shocked!!! You haven't had ds yet have you?????????

It is v early days for me yet, only just found out...

Where are you booked for ds's birth, H? Could I get SG from here or is it ES? xxxxxx

Hecate - OMG, it sure was meant to be!!!

oh, wow, wow - a week!!!!

you're a pro now, don't worry!!

which is best out of HH, W and ES you reckon?

God, reading Hatrick's and Dinny's accounts has made me realise how lucky I was. I had such good care. I didn't even need any stitches afterwards (not nice thought: is that down to my mw's skill or down to my giant fanjo...... given that a had a 10lbs 12oz baby wedged in there plus two hands right up to the thumbs at one point! )

Hi dinny, sorry I posted and ran,

yes as an NCT class we definitely disappointed our teacher! All 4 were EMCS, one under general anaesthetic. The other two births were assisted by ventouse.

I think the problem with ES is that they are sooo busy they try to fit pregnant and labouring women in with their schedule, rather then doing what's best for the woman. This seems to lead to more interventions

Eg

• refusing to do sweeps at one week overdue, as did not want any more admissions to delivery suite that day. Result that full induction required at 10 days/2 weeks overdue.
• Induction begun in the evening rather then the morning, in the hope you will be admitted to delivery suite the following morning when more staff. What happened to me is that went into labour straight away having waited all day to be induced having had no sleep & v pee'd off

had a great time on the ward afterwards as 4 of my NCT group were there!

lol, yeah, same her re stitches, Sabire, can vere work out if a good or bad thing, lol

God, ES sound s nightmare - don't get it though, St George's are hectic and have a much better reputation, how is that?

Hello, you.

Congrats again! Don't know re logistics of electives, but have you thought about contacting the Birth Trauma Assocation? Some excellent posts already on this thread though, so you may not need to!

hello Hatrick and Hunker

yes, Hatrick, my thoughts exactly

there's no way we can have a birth at Sg from out here is there, hatrick?

Hunker, yes, will have a look, I think - are you in today?

Approximately 70% of shoulder dystocia's occur in women with NO risk factors. Risk factors are:

Previous shoulder dystocia
Prolonged first stage of labour
Macrosomia (big baby >4.5kg)
Diabetes mellitus
Prolonged second stage of labour
Maternal body mass index > 30 kg/m2
Oxytocin augmentation
Induction of labour
Assisted vaginal delivery

The recurrence rate for SD is 1-16%

Hope that helps??????

Lisaxx

thanks Middy

hmmm, so I will have at least two risk factors (as sure this baby will be at least 9lb)...

do I ask for elective?

cna I just add that my labour with ds was active and had no drugs at all, stood up for most of it and was kneeling leaning on bed pushing when he got stuck. So, that makes me more worried as I feel labour was going so weel, ie. wans't lying down/induced/drugs etc etc

Exactly, 70% occur in women with NO risk factors! You need to discuss things properly with you midwife and obstetrician really. If you go for a normal delivery everyone will be prepared and ready should it happen again.

God, yes - my labour was sort of optimum, really, so if it can happen then, I kind of think it is bound to happen again (and the only reason it didn't happen with dd is that she was 5 weeks early).

I haven't read all of the replies to this thread so apologies if I'm repeating something already said.

Sabire - amazing post and one I can totally relate to. SD, TRUE SD is an emergency situation and one which if dealt with calmy and efficiently should hopefully not traumatise the woman. I have dealt with emergencies in the hospital and at home and I know that when dealing with them at home there is no headless chicken or panicking or shouting which often happens in the hospital.

I said TRUE SD because often a midwife will suspect that there is an SD because the shoulders are slow to emerge after the head is born so she will put in place the procedures needed to alleviate SD. The very words SD can put the fear of god into midwives so if you are called into a room and told there is an SD it is common for their to be an element of urgency and sometimes panic. A large percentage (the majority) of "SD"s are alleviated with the first manouvre - McRoberts - which involves lying the woman flat on her back with her legs pulled up to her ears. There is a school of thought that if SD is alleviated as easily as this then it wasn't ever really a true SD anyway. The really scary SDs are the ones that you need to put in place one or more full cyles of all the different manouvres.

Someone mentioned about midwives anticipating a SD because the baby was large - around 50% of SDs are with babies that are average size so it is not a large baby problem per se, it is a problem of disproportion between baby and mum's pelvis.

To answer the OP. Personally I can see no reason why you would need to see an obstetrician unless you truly feel that your only option is an elective section (very drastic option) I am so pleased to see that you are considering hypnosis as I think this is an excellent idea. I would also consider getting some previous birth experience counselling and I would recommend you get a copy of your notes and ask to go over them with the hospital's Consultant Midwife to see how best a normal birth can be achieved this time around - every pregnancy is different and every baby is different so just because you've had an SD in a previous pregnancy is not an indicator that you will have one again. There are various different risk factors for having an SD - being strapped to a monitor on your back being one of them as you are narrowing the outlet of the pelvis straight off. Instrumental deliveries are also a known risk factor.

The very best of luck with whatever you decide to do.

Yes, you give me hope, Hatrick!

I wouldn't be as worried if could have this baby at St George's like the other two though...

Howdie, thanks for the post - am thinking if I do opt for a vaginal birth I would go to the midwife-led NHS birthing unit near us (Crowborough) rather than hospital (East Surrey) - or is that not a good idea in case of emergency?

Previous sd would make most birth centres unwilling to take you (particularly a freestanding one).

But like most things - it might be open to negotiation.

hatrick - but would I get there in time, that's the thing....

Sabire - ah, yes, hadn't thought of that

Hi

Just been reading all these posts and felt the need to register and reply.

I gave birth to my first son in August this year. After a great pregnancy I went two weeks overdue and was booked in to be induced on the monday. On the sunday night my waters broke but still no sign. I was given the gel twice (8 hours apart) and still nothing!!

Later that night I was put on a drip to start the contractions and sure enough they started! Pain was so bad that I opted for an epidural.

The labour lasted 37 hours and after being fully dilated at 27 hours I was left a further 10 hours.

It was obvious to me that there must have been a reason why he wasn't moving down the birth canal but, having never heard of shoulder dystocia and having faith in the medical staff I was not too concerned.

After 27 hours a female consultant came in and said to the midwife to prepare for a c-section as there was no chance he was moving down.

Several hours later a male consultant came in and said he would like to take me down to the operating theatre and attempt the delivery and if he fails we will be in the right place for c-section.

Tired and fed up I agreed and was prepared for theatre. With hindsight I should have just asked for a c-section there and then but doctor knows best!

Once in the operating theatre I started to sense things were not going as planned. My legs were lifted up and pressure was applied to my stomach in what can only be described as a barbaric way - one doctor had her hands on my stomach and her feet off the floor!!! This didn't work and several other maneouvres were carried out including woodscrew.

Finally, my son was born but taken straight to the other side of the room where they had to assist him with his breathing.

I didn't see him until that night, about 8 hours later and was extremely worried as his head had been out for just over 5 mins before they delivered the rest of him.

He ended up in SCBU for 3 days and had slight erbs palsy which is thankfully better now. He still has a small scar and a lump on his eye where he was pulled down the birth canal.

I had a massive heammorage and was very sore down below for quite a while.

The doctor told me what happened about 5 mins after it but I was still in shock and didn't take it in....is this classed as a de-brief?

I am due to go back to work in Jan after only 6 months but I feel like I don't want to leave him so soon and I wonder whether this is because the experience?

Finally, the whole experience has put me off ever having any more children and I wonder if anyone else felt like this but got over it in time?

Hi, I know you posted your question a long time ago but I am now in the same position & having a hard time deciding whether to attempt vaginal delivery again or go for elective c section & would be really interested to hear what you decided to do & how it all went for you?