Questions for my consultant?

[jackieg123]

Hi all,

I'm 35 weeks pregnant and due to see my consultant next week to discuss delivery options for my baby. My last baby was 10lb 7 1/2 and was a shoulder dystocia delivery. The growth scan they did was out by 1 1/2lbs.

At my 20 wk appointment in this pregnancy the consultant confirmed that at 36 weeks we'd discuss delivery options if this little one was measuring big (which she is) and feels big on palpation (something the midwives who have seen me thus far have confirmed).

I have quite severe SPD with this pregnancy (am on crutches etc) but have also suffered from a pulmonary embolism in my past (thought to have been fat from one of the long bones which I shattered). The consultant said for the PE they would give me warfarin / fragmin for 6 weeks after delivery if I have a section or prolonged delivery.

At 20 wks the consultant suggested that if the baby was big, it would be likely that induction or a section would be the best delivery options. At that point she was unaware of my SPD.

I'm in the process of preparing a list of questions for the consultant, but also wondered what other mum's experiences were with any or all of the above complications?

Positive experiences would really be appreciated as I'm now getting nervous...

I was induced with SPD, and was on crutches at the time.

I ended up with a ventouse delivery (due to cord being round DD's neck twice), in stirrups, but because they were all so very careful about lifting my legs together and minding my pain-free gap it did no further damage, and I was walking around very happily afterwards. Of course, pushing a big pram around in the ensuing weeks totally ruined that but nothing to do with the delivery.

Hi,

I have had four big babies (smalled 9lb 12oz, biggest 11lb 3oz) and have had horrible SPD with all of them.

What position were you in with your last child? if you were on your back and the birth was medicalised that is probably the biggest contributory factor to the dystocia (and pretty horrible for the SPD too!).

The best birth you can have with a big baby and SPD (and either or!) is a natural, active birth, perhaps in water - this is far more likely to get you into a position that is likely to get your baby out by maximizing your pelvic capacity whilst also minimising any damage to you by being in a bad position for your SPD. The absolute worst position you could be in is lithotomy (stirrups) for both the SPD and big baby. An induction is probably more likely to lead to this and an epidural (which masks pelvic warning pain that you are opening your legs too wide!).

Have a look at my site which explains big babies more:

[www.bigbaby.org.uk]

In terms of what to ask your consultant:

1. Why do you want to induce, when all known evidence and NICE guidelines point to the fact that induction for a macrosomic infant is NOT ADVISABLE???????

2. How will inducing early help?

3. What do you think caused my shoulder dystocia last time (not just the big baby!)?

4. What is the best way I can avoid a supine (laying) position and epidural with this birth?

5. Do you have a fear about big babies?

6. Why are you recommending a C-Section when evidence shows this is not advised for a large baby alone.

7. Is it true that SPD actually gives me more pelvic capacity? (the answer is yes!)

8. Can you recommend anything to help with the SPD? (the answer is probably a girdle of physio - when actually the best thing they could recommend is a chiropractor!).

Re. the last point, chiropractors work MAGIC on SPD..........don't suffer needlessly!

Good luck!

Thanks for your replies. With my daughter I went into labour myself. There was meconium in her waters and she was monitored using a head clip as she was showing signs of distress. I ended up giving birth to her after the mcphillips etc interventions and she was ok. We didn't have ventouse or forceps because she was firmly wedged with her shoulders. I was on my side for the last two hours but ended up delivering her on my back.

At 20 weeks my consultant said about induction / section to avoid another dystocia.

Insofar as SPD is concerned, I currently have two sessions of physio and accupuncture a week. I'm also on crutches and have paracetamol 4 times a day. I will ask my consultant the questions you've mentioned, as I really don't fancy a section or the fragmin etc afterwards. Can you recommend a position that doesn't involve kneeling, as since I broke my leg I can't kneel on my left leg?

Thanks..

Well if you can birth a large baby on the bed (thus reducing your pelvic capacity by 30%) - with all the accompanying adrenaline of meconium worries and scalp clips causing your uterus to produce far less effective contractions than your body is capable of. I'm sure you can easily birth a baby in a more birth friendly position and environment!

Squatting is the ultimate birthing position and aided by water would be perfect for you, ditto all fours in water (am sure your left leg will be fine with the warmth and bouyancy and support of the water). And all fours (aka Gaskin position) is effective at getting out over 90% of sticky shouldered babies. Waterbirth really is the way to go for SPD though.

Re. physio it simply isn't effective with SPD and whilst acupuncture is great at many things, I really really don't think it is with SPD (and I'm an alternative therapist myself!). You need to address the root cause, bones and ligaments and you need to get them back into the proper position with some stability. Physio and acupuncture will NOT do this - ever. They are like covering a wound with a sticky plaster, the wound is still there, it's not healing, just masked. PLEASE PLEASE PLEASE PLEASE book an appointment with a chiropractor specialising in the care of pregnant women, you will never look back, give it 3 appointments and you'll be off your crutches. I suffered for 2 pregnancies with physio, belts etc...and truly thought I had to put up with it. You don't, there IS a way! (and no I'm not a chiropractor, I just feel passionately about it after my own experiences and seeing several 10s of clients transformed by treatment!).

p.s: your consultant is WRONG!!!

please read the research page on my website, I might go so far as printing out the abstracts of the trials and the NICE guidelines stating induction is not advised for macrosomia and ask the consultant what evidence they are basing their suggestion on!!