Right - talk to me about preventing, minimising shoulder dystocia

[Habbibu]

Due in about 4 1/2 weeks, and saw consultant today. Good news is that baby is now head down (phew). Likely to be big, though - dd was 10lb 11oz, and this one is measuring 2cm ahead in fundal height.

Cons would rather I was in labour suite than MW unit, just in case of SD - I'm fine about this, as I had a good experience last time. I said I wanted to labour in water, and he rang to check that can be done in LS, so that's all ok.

Last time I was on all fours, and then lay down for a rest, and just could not get up again. They used McRoberts manouevre, and dd came out reasonably easily; small repair (4 stitches) required, and good recovery. DD had brief and mild erbs palsy, which resolved in a few days.

I think I could do a "better job" this time, knowing how things went with dd - I feel confident in delivering a large baby, and have said to hosp that I want to remain more active and upright - I know that there are gym balls, mats etc in the labour rooms, and that I should have access to a pool - so what do people recommend I do? I'm thinking labour in water, but I'm not that keen on the idea of delivering in water, so out and maybe all fours leaning on gym ball or something? Have told dh not to let me lie down - poor soul!

Sounds like you have it sussed to me!

Well, in theory! I'm not as fit as I was with dd (swam and walked a lot when pregnant with her), but am just knackered this time, and worried about collapsing in a heap again.

This is a topic very close to my heart as DD suffered a shoulder dystocia and had erbs for a few months, which has luckily subsided with physio (she is now 2yrs 5 months).

Last Friday I was induced at 38+1 as they decided that instead of a c-section which was the original plan of action (and one I wasn't that keen on!) they would induce early to keep the baby smaller than DD (who was only 8lbs) as I'd had an awful time delivering DD, ventouse after 2 hours of pushing and lots of repair etc.

I just wanted to let you know that deliveries after a shoulder dystocia can go really well. I was induced at 11.30am, labour came on very quickly and I delivered my 6lbs 10oz DS at 5.36pm the same day, with no complications and I was on my back as by the time I'd been transfered to the delivery suite he was almost out!! He came out in 3 pushes and no sign of any shoulder dystocia!!

Hopefully you will have a great birth this time around! Have they considered inducing a bit early to keep the baby's weight down?

Remaining upright and mobile was the advice we were given at ante natal classes. Avoiding an epidural also minimises the risk of it. Sounds like you've already been given this advice - good luck

ds1 has Erbs. he's needed 2 operations at Stanmore and goes to Bolsover Street for his reviews (did you ever see Mr Birch? - bloody fantastic man! Retired now, I'm told.)

they've said there's no point doing any more ops because he's recovered all function he's ever going to have, so we just work on maximising the function he does have.

Obv the hospital was very concerned to make sure that the birth of ds2 went well. I think the most important thing is that they are all prepared. With ds1, it came as a shock to them! The doctor panicked and PULLED HIS HEAD!!!!

With ds2 they knew, they planned, they prepared. The consultant stayed for the delivery (at just before midnight!!!) and they kept a theatre on standby, for the first sign of trouble! and they made me have an epidural, in case I needed a cs. (I didn't!) because I'd had ds1 with gas & air and 1 shot of pethadine.

ds2 was born with no problems. Even though he was, like ds1, induced, which I have been told can increase the risk.

btw - ds1 was 10lb 4oz and ds2 was 10lb 5oz!! so he was the bigger of the 2 by a whisker. I can only say again that awareness and planning are key.

Something REALLY important is to make sure the midwives with you are not scared of the fact you are having a big baby. This is MUCH more likely if you are on an MLBU (even better to be at home! - I've had two 11lb+ babies at home for this very reason) than an delivery suite - where they are far more likely to be more medicalised and controlling of your labour and inadvertently at far more likelihood of a self fulfilling prophecy and causing problems.

Research suggests that the birth of a "big baby" is far more likely to be successful/easy if the caregivers (and mother to a degree) aren't suspecting a big baby - for the very reasons above!

There is nothing they cannot do in an birthing unit re. shoulder dystocia that they would do in a DU (consultants know this but for some unknown reason are still more happy to have you "under their watchful eye", step 1: is gaskin maneouvre, step 2: is McRoberts and step 3 is Zavenelli which is VERY VERY rare and irrelevant where you are!

Birth in water is great, birth on all fours is great but far more importantly is birth in a position you are instinctively comfortable in - that position (not one that you think you should be in or one that you have been put in) is far more likely to result in a good outcome.

Have a read of some of the research and stories on here:

www.bigbaby.org.uk

Good luck!

childrenchildren - that's really interesting.

I have long suspected that consultants are far too ready to insist that only a full blown hospital can deal with some situations which can just as effectively be dealt with in a MLU.

Obviously not all situations - there's a place for consultants, operating theatres etc but there is an awful lot that a skilled midwife can do.

When I booked into a MLU for my first baby (which I knew from scans was big) one of my pg friends warned me about shoulder dystocia - 'Wouldn't you be safer in hospital' etc. Thankfully my midwife was confident and reassuring and told me that an active birth, as natural as possible, in the MLU was every bit as safe as the hospital!!

Really, CCE? that's the total opposite to what I have always been told and what the consultant told me when I was expecting ds2. I have always been led to believe that them being prepared was better because they have it all in mind.

It was the total shock of the situation that led the doctor to panic, start screaming "I need help, help me, I need help" and pull ds1's head so hard she caused permanent nerve damage and left him with a partially paralysed arm.

In fact, we are suing. Fingers crossed that will FINALLY go to court this year!

IME midwives panic less than doctors.

An experienced midwife will have delivered far more babies than your average SHO who happens to be on duty in a larger hospital.

As I said, one of my main reasons for booking into a midwife unit rather than a hospital for my first baby.

Your experience sounds shocking Hecates.

Oh it was! Not going to go into it of course, not on H's 4.5 weeks to go thread!!

I agree your experience sounds shocking, I'm sorry you had such a hard time.

I agree completely there is a place for consultants/hospitals/medical intervention - for roughly 5% of births, women and babies have been saved thanks to modern medicine and for some it is very appropriate - however for many it also causes problems . This is particularly true for "macrosomic" babies. Research repeatedly shows that suspected big babies should NOT be induced early, should NOT be delivered by C-Section and ideally as few as possible should be aware of the predicted size (and incidentally maternal instinct is time and again proven to be the most effective/accurate way of predicting baby birth weight!!!). Reoccurance of shoulder dystocia is estimated to be around 10% - sadly no studies have ever been done where the caregivers weren't aware of the previous dystocia - i bet it would be a LOT lower if they weren't aware!!!!!

Early induction/monitoring/C-Section for suspected big babies does NOT improve foetal or maternal outcome and does NOT reduce shoulder dystocia risks (incidentally shoulder dystocia is just as common in small babies! the prob with "big babies" is they get lumped in with babies from uncontrolled diabetics who are big and tend to have hefty shoulders and abdomens out of proportion, a "normal" big baby does not have these dimensions - if we had stats for non-diabetic big babies it would be a diff story!!).

Anyway, I digress, SHOs/registrars/consultants are generally terrified of big babies because they are experienced in ABNORMAL birth, when it goes wrong, they simply do not know how to attend (as oppossed to control) a normal physiological birth where the woman's oxytocin is uninhibited, she is active and free to mobilise and can generally birth a decent sized baby.

I've summed up all this research on my website www.bigbaby.org.uk the article by Gloria lemay and the VBAC youtube links are particularly inspiring and enlightening - suffice to say that unless there was a medical need for me to be in hospital (i.e: I was induced with pre-eclampsia with one of my children) there is no way I would set foot in a DU with a "suspected large baby" (who may well turn out to be a 7lber anyway ).

Well, in fairness to my consultant, he was the one who ensured that I didn't have forceps with dd, and delivered her himself - it was a great birth in the end, and down to him being confident enough to NOT overmedicalise, iyswim. But this is typical of him - he's no fan of inducing early, or even of sweeps - reckons babies come in their own time as a rule. he also doesn't believe in trying to predict size - just reckons that as dd was big, this one is likely to be as well.

I think if I didn't know (and love!) this hospital so much I'd be more apprehensive - as it is, our treatment through various complications has been extraordinary, and I feel very comfortable and confident with them, which helps. I've had no concerns expressed from hosp, tbh - community mw was a different story - I just think the cons likes to be handy for "his" people - he's kept track of all our ups and downs over the years, and I really do like and trust him, which for me is really important.

So - upright; all fours, something like that? What do you do to support your legs if they start to turn to jelly?

The other thing is that we have a family history of big babies - it honestly never occurred to me I'd have a baby under 10lb! No diabetes, and I have good peasant hips, so I do feel confident - just want to really try to be a bit more active in the process this time.