Have been advised by docs to have elective c section cos first baby had slight shoulder dystocia. What to do?

[redbird]

I was hoping to have natural birth 2nd time around but now the mood has changed... doctors seem to be getting anxious and recommending c section. Midwife is not happy bout me having waterbirth in lovely natural birth centre at hospital and there would now be senior people present at the end in case of difficulties. I had a big first baby, 9pounds 4 and was induced and epiduraled and then ventouse.. all pretty horrendous and all took hours and hours. It looks like baby 2 is big too and thats what they are worried about. Has anyone had similar experience? Finding it really hard to make decision.Any advice very welcome.

I am having an ELCS tomorrow because my second baby was shoulder dystocia, and I couldn't be happier about it.

I have spent a week on the antenatal ward (unrelated reasons - unstable lie) and thus have talked to a million and one consultants about it. Apart from one, who said the risk of it happening again was 3-16 per cent but would be nearer 16 with me for various reasons, they all encouraged me to go for the CS.

My son's birth was absolutely terrifying. One of worst moments of my life - certainly the scariest. I was traumatised by it for months afterwards, even though thank God he was ultimately ok.

He was induced at 38 weeks and weighed 8lb 13oz. I am now 39 weeks with my third baby and it is looking set to be bigger than him, and having done loads of research in what can happen with dystocias, I am quite convinced that although I have had two vaginal births and will have two toddlers to look after when I get home with my new baby, I would rather the risks and discomfort to me than risk even the tiniest thing for this baby.

However I admit that the thought of recovery with two children aged 4 and 3 is horrendous!

If you are feeling up for it, why don't you go for a VB? The odds are still in your favour. I am just so traumatised by DS's birth three years on, and I know a little girl with a shoulder injury thanks to dystocia, and I just couldn't face taking the risk.

HTH!

i would think that if you are expecting a big baby, and even if you've been scanned, tehre is still a margin of error.. it is easier to deliver a big baby without an induction and epidural

being confiend to the bed, stops you being mobile and upright which stops the pelvis opening up as much as it can do..

many women do have difficutl first births, which can be to do with too much intervention and too little mobility, and go on to birth their second much better

what is your gut feeling"

you can give labour a go.. you have deliverd vagianlly, albeit with some help, but you have got a big baby through your pelvis

i had a c.section first for failure to progress after induction and epidural, second baby was a VB with no intervention, spontanous delibvery on her due date

speak to the supervisor of midwives if you feel you are being pushed into a course of action you don't want

as far as i am aware.. you either have shoulder dystocia, or not.. i was not aware there are degrees. but am willing to be corrected !!

Good luck tomorrow litdog. Thanks for your advice. Yes I think the thought of anything happening to babe because I made the wrong decision is very hard to take. Doc said to me 20% more likely to have probs. They are scanning me again to see if there is a massive amount of water in there so maybe I will wait til then. Yes am not sure bout degrees of dystocia. They wrote ' slight' on my notes thats all. But midwife did say in extreme cases they have to break the shoulders. I know knowledge is power and all that but really wish I did not know that. Its hard enough but now i just feel mired in fear and I wonder if they are all over reacting a bit.

Re. the "degree" of shoulder dystocia, does it depend on how that given PCT (or hospital, or Dr) defines shoulder dystocia? I'm pretty sure I've seen a range of definitions being discussed from a very stringent one (unless the body is delivered in the contraction immediately after that which delivers the head) through much more pragmatic ones (how much help is required).

Is it shoulder dystocia if the mother delivers the head but the shoulders don't follow until she changes position, at which point the baby slides out easily? By some definitions, yes, by others, no .

Not sure this is helping - other than that I think it might be worth doing a bit more digging into exactly what happened in your 1st birth and trying to find out what exactly triggered that particular annotation.

As to whether or not a CS is a good idea, I think its a very personal decision. DD1 was breech. We did a lot of reading, a lot of talking and a lot of thinking before deciding to go for a home birth with IMs confident and competent in breech birth - we ruled a medicalised vaginal breech delivery in hospital, which left us with a HB or a CS. Both had risks and benefits, and the two sets weren't directly comparable. For us, with the information we could access and the HCPs we had a available, a HB was the right decision - but many others would have chosen differently. Our conclusion was that there was no, single, universal "right" answer - you just have to go what feels most right (or least wrong) at the time.

I have big babies and had shoulder dystocia with my second, who was 11lbs.

Personally I think if you managed to get a 9lbs 4oz baby out with an epidural in place with only a 'slight' shoulder dystocia first time around, you must have a good roomy pelvis!

When I had my third I did everything I could to reduce the risk of S/D happening again, which in my case meant having an active birth, avoiding induction, avoiding supine positions for birth and avoiding an epidural.

Third birth was completely straightforward and baby was 2lbs smaller!

My first baby was emcs due to failure to progress and distressed baby.
Second was VBAC failed ventouse ended up with forceps and shoulder dystocia. He's fine but was a terrifying experience.
I have been under the consultant at the hospital. The first time I saw him he looked through my notes and suggested a elcs.
Since then I have seen two other doctors who work under him and they are not keen. Want me to have growth scans etc and will not make a decision till 36 weeks.
I would prefer to go with a ELCS as the first consultant pointed out everything that could go wrong with shoulder dystocia. I hope he has the final say as the other two seem determind for a natural birth if possible.
Frightened of anything going wrong.

Hi I'm hopeing for a natrual bith 2ed time round to. My first was a forcepts delivery with shoulder dystocia resulting in 3ed degree tear. I haven't seen the consultant yet as am only 18weeks. But am thinking they are going to push for a CS.

It does seem to be one of the things that they get very nervourise about and having done more reading I can understand that is can be a very serious emergancy. But the reucerance in risk seems a little poor on data, giving between 1-16% chance of it happening again. Mortality rate for SD is actualy quit low as most babies are succesvaly delivered with manipluation.

I'm prity convinced that the problems first time round for me was giving birth on my back to a back to back baby with forceps afther having been given a drip to regulat my contractions all of which are risk factors. So I don't see the need to have a sction this time round unless baby is not in a very good possition. DD was big but only 8lb 4oz so not in the size range for a higher risk it also seems that size isn't a big risk factor for SD anyway as apparently 48% of SD happens in babies weighing less then 8lb 8oz and a baby isn't considered medicaly large unless it's over 9lb 9oz. So I'm still not conviced the chance of a seconded SD is worth the risk of a CS you have to remeber also carries a higher mortality rate than a natrual delivery although I haven't been able to gain any reall comparable date yet.

If you'd like to do some more reading then all the Data I had so far came from www.rcog.org.uk/womens-health/clinical-guidance/shoulder-dystocia-green-top-42 which is the Royal College of Obstetricians and Gynaecologists web site.

It is a difficult decision to make, also I was told by a MW that growth scans are not very acurate and are less acurate the bigger the baby not sure how ture that is.

Goodluck