Shoulder Dystocia Consultant appointment?

[MichelleOR84]

I have this appointment tomorrow and have been feeling anxious over it . I wasn’t anxious in the slightest until yesterday at my 28 week appointment and my midwife realised I hadn’t been booked in for a Shoulder Dystocia consultant appointment ( my first baby got stuck coming out after a long labour with forceps) . I didn’t even know I would have this appointment but it makes sense and I’m glad my hospital takes extra precautions.

What gets discussed? I’ve been told we’ll come up with a plan . What sort of plan ? I was under the impression I would likely deliver fine this time around so I’m feeling really down about it . Baby is measuring big as well which they are worried about .

I have this coming up too after DS1 getting stuck! As far as I’m aware the appointment means I will then be consultant led and have an elective c-section. I got told this almost as soon as I have birth last time so have been prepping for this plan throughout my pregnancy. I did also end up with a 3rd degree tear though, so this may have an additional impact on the decision making.

It might be worth doing a bit of research into the reoccurrence of shoulder dystocia. Not to scare you, but it’s helped me come to terms with a different birth plan second time around. Good luck!

@Annalou30

Oh no ! I hope a C-section isn’t recommended for me . I can’t see why it would . Shoulder Dystocia is unpredictable so there is no true medical reason to offer a C-section. I know inductions , epidurals , forceps, big babies all play a role though but who knows what my next labour will be like .

Absolutely, but you were asking what might be discussed and this is what has been planned with me, albeit with a few additional factors you may not have. Ultimately it’s your birth plan, your choice, they will just make you aware of info such as this:

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf

I had this with baby number 3 and ended up with a c section. The other option was induction at 37.5 weeks. Obviously they can’t make you do this, but when I read about the risk to the baby I was more than happy.

I had shoulder dystocia with my second, my consultant appointment with my third was a simple case of him saying I would need a cs, I was happy with that, I'm sure you can discuss your feelings and options if that's something you want to avoid, they won't force you against your wishes, they might recommend having growth scans and arranging an induction before your due date if baby is looking big.

Reoccurrence of shoulder dystocia is around 25%. The consultant will go through your notes from last time and look at the cons tribute for factors and try to individualise that risk. If they are concerned that this baby is measuring large, they will likely recommend growth scans and monitoring carefully for gestational diabetes. They may recommend that cesarean is safer than induction and/or augmentation if this becomes necessary. You don’t have to agree to anything, but it’s worth discussing what, if any, their concerns are, and what the relative risks and benefits are.

*contributing - stupid fat thumbs!

I would hate to go against medical advice and then for something to go horrible wrong 😔. I’ll see what they suggest .

OP don’t be nervous about the appointment - it’s just a discussion so you can plan what you feel most comfortable with. It doesn’t mean they’ll say you have to have a CS - some shoulder dystocias are more severe than others, and more or less likely to happen again - so your story won’t be the same as for everyone else. They’ll likely just review what happened last time and see what your feelings are, and then talk through pros and cons. They might discuss things like avoiding forceps this time, lower threshold for CS if slow progress, or perhaps an induction a little before your due date, all to reduce possible risk; as well as elective CS. You should hopefully just feel like you have lots of extra information and reassurance whatever you decide.

@TenThousandSpoons0 thank you 😊! That is reassuring!

I had my appointment yesterday and I’m so relieved 😅. The consultant asked me how I felt about my labour and I get the impression they would have 100% supported me if I wanted a csection this time around . However my birth experience , although complicated and ended in an emergency , was a positive one for me . I asked if it would be risky if I tried for a 100% natural birth this time and she was happy for me to try that 🙌

She advised a few things like giving birth at my hospital vs my birthing centre, a senior midwife present for the birth in addition to a regular midwife and extra growth scans. If baby is measuring big we will discuss inductions although she knows I want to avoid that if possible. She also warned me that if the baby is measuring big then it’s likely that during labour if I can’t push the baby out they will skip forceps all together and go straight to a csection. I felt that was all reasonable.

Fingers crossed now that everything goes
to plan 🤞

P.s She told me my risk of shoulder dystocia happening again is (between) 1-16% so my risk is still very low .

I thought I would update everyone as I appreciate it when I see others update !

My baby boy arrived 3 days ago ! It was the perfect vaginal delivery with no shoulder dystocia. I was even labouring on my back half the labour and baby was on the big side .

I wasn’t able to deliver the placenta though and lost a lot of blood and had to go the theatre for a manual remover but the most important thing is baby was okay and I’m recovering well !

Congrats! Must feel so amazing - despite the placenta not behaving :)