Shoulder dystocia

[Mon2468]

Hi all, been having growth scans due to slight polyhydramnios and size of baby, they believe he is larger than average and have offered me an induction at 39 weeks, currently 38+5 to prevent shoulder dystocia which has got me nervous. First baby and was hoping to go naturally which they said they don't have a problem with but said about the risks of nerve damage/brain damage etc if shoulder dystocia did happen so it's made me worry. Just wondering if this happened to anyone and all was ok?

My eldest was born after a significant shoulder dystocia. I had no risk factors except for I was induced which increases the chances.

I won't lie it wasn't an easy birth, and if I had my time again I would absolutely refuse forceps anywhere near me and insist on a CS. We were both injured.

It took 3 attempts at forceps (which failed) to get her out and in the end they had to go in by hand and get her out. Not very nice.

But we are both ok. Alive, no brain damage etc. I have had to have surgery after birth (two years after) to put my bits back together and my child has permanent eye damage from the forceps (which means she will wear glasses always, but nothing worse).

I don't say this to scare you, but there are risks and you should make sure that you educate yourself on these. If you feel that you and baby would be safer, then it is your right to insist on a CS. I wish I'd have done that.

Good luck.

I should say too, I know you were hoping to go natural, but a planned CS is better and easier than a rough 'natural' birth whether you labour naturally or are induced.

I should know, I've had both! So just explore all of your options fully.

I had an emcs with my first and a VBAC for my second so a cs first time does not mean to it can’t try a VBAC next time.
In your position I’d go cs as you will know exactly what you are getting in terms of recovery

My DD had shoulder dystocia (unpredicted, although we knew she would be big) and I too would strongly advise you to consider planned c section. My DD was whisked off to NICU and although she was fine in the end it was a traumatic birth for both of us. She still has a small scar on her forehead from the forceps! I suffered a bad tear and while mostly recovered I still can't run because of the pelvic floor damage. Not a risk I'd want to take in your shoes.

I was told I was at high risk for shoulder dystocia with DS as they thought he was very big based on scans, and the size of my bump. I did loads of reading (healthcare job so very comfortable with the research literature), and concluded firstly that scans are not a great indicator of birthweight, and secondly that dystocia is actually quite hard to predict accurately. But, understandably, midwives and doctors are quite worried about it because it can be very serious.

Ultimately I ended up having an EMCS, but that was to do with his position and labour not progressing, not because of dystocia risk. And he was a completely normal sized baby, not the giant one I'd been expecting. EMCS recovery was fine but a planned CS would definitely be easier.

All of which is to say, it's hard to judge and I understand your worries. Good luck.

I mean this kindly, but if you have been appropriately counselled regarding the risks of shoulder dystocia (since Montgomery we must do the) then what do you hope to gain from this?

Do you want to hear from women who decline IOL & went on to have a shoulder dystocia which resulted in no harm?

Shoulder dystocia is a horrible obstetric emergency. Horrible. Horrible for the woman, her baby & her midwife & obstetric team. There is no such thing as an ‘okay’ one. The absolute best case scenario is a well woman and baby and a traumatised midwife. That’s the best case scenario.

@Mon2468 I had polyhydraminos picked up at 30 weeks. Ds was born at bang on 39 weeks, he weighed 8 and a half pound. They estimated he would of been 9.5/10lb if I’d gone to 42 weeks. I had a sweep at 38+3 and another at 38+6 and he was born the next morning.

He was a difficult birth but not due to his size or polyhydraminos, he was back to back, had failed forceps ventouse and emergency section.

Only you can decide what you should do. But if I were you, take everything they say on board, they are advising you for a reason x

Book a c section

@AgathaMystery I'm just looking for people who have had experience as they are saying the weight of him may not be accurate and could go on to have a normal labour and shoulder dystocia doesn't happen. Just basically if anyone was told same as me and went on to have a straight forward labour. I've not been keen on a section but thinking this may be better off to reduce the chances of any damage to me or my baby. Any positive c section stories?

@Mon2468 I have tokophobia and chose to have planned c-sections with both of my babies and I had excellent experiences both times. Lovely births, calm (I actually chose to have a GA each time but that's quite rare for an ELCS). I made excellent recoveries quickly, both times. Babies were both well and I managed to breastfeed them both for a long time.

If you and your baby are higher risk of shoulder dystocia you are at higher risk of damage to both of you. I would be really worried for my baby and my own body. I don't see how that risk is worth it.

I had shoulder dystocia with my first child. I was induced as my waters broke but I didn't go into labour. I had awful care looking back and was left to make that decision myself. I am very lucky that my child was born undamaged , but I was in so much pain I couldn't sit for three weeks, even on a rubber ring. Failed forceps, failed Ventouse. He was wrenched out by hand in the end.

I have had two subsequent sections as was told in no uncertain terms not to have another 'natural' birth.

If there is any risk , have a section.

I had shoulder dystocia with my DD, following a long induction. She is okay, but the birth was traumatic and I'm now receiving psychological treatment to help with the trauma.

My second was also big and was born by ELCS. It was a dream and recovery was far easier.

In your shoes, I would ask to discuss an ELCS

Thanks all for replies. It hasn't really been put to me the way you all have explained it it was kinda like yeah well there's a chance his shoulders will get stuck and he would need assistance to come out 🤷🏻‍♀️ I have another scan tomorrow then midwife on Monday so will explore my options then

@Mon2468 After my first (horrible!) shoulder dystocia birth as I described before, I was told I was not to attempt a natural delivery ever again. Fine by me! Second birth was a planned CS, and it was an absolute breeze in terms of both the actual operation and the recovery.

Yes it was sore for a couple of days afterwards and obviously I needed help looking after my two year old with a newborn and the stitches. But I was up and about and able to manage by myself when DH went back to work ten days later with no issue (just no heavy lifting).

My shoulder dystocia birth took me months to recover. No exaggeration, and then I needed surgery later to fix the mess they'd made of my innards.

Obviously there are risks in a CS. But I would take those over a SD birth any day.

I was told baby will have big head circumference and at risk of shoulder dystocia. I asked how they got baby out if shoulder got stuck. They said sometimes they have to break baby's shoulder bone! This was my first child. I burst into tears at this point and they offered me a planned caesarean which I took. I know sometimes growth scans are wrong but in my case very accurate. DS was a few ozs below 10 lbs and they did the csection at 2 weeks before due date as I was 38 ie considered an older mum. When I saw the size of him I was very glad I had the c section.

DD had shoulder dystocia. She was 8lb14 and her heart rate plummeted after she became stuck. She was extremely distressed, as was I. Emergency forceps got her dragged out but they'd warned they could only make 1 attempt before c-section so I was being prepped for that while they did the forceps. She came out that way and had a very cut face, damage to me was extensive (included damage to back passage).

For my subsequent birth (several years later because the 1st was so bad) I was strongly advised a c sec. it was genuinely brilliant and if you're being told that it might be the best course of action I wouldn't think twice. I had a much better and instant bond with my DS with immediate cuddles instead of him being whipped away to resuscitation and then X-ray the way my DD was.

Have the c sec.

DS had an unexpected shoulder dystocia. I'd been introduced post dates, drip, went on so long I ran out of pain killers. He got stuck, manually pulled out with a fully dislocated shoulder, meconium, big tear for me. Absolutely horrific experience that I try hard not to think about. For DC2 I was induced on dates to decrease the risk.

I'd go for the CS. Yes, it's not the birth you want but my DS has SEN (unknown to what extent linked to SD) and an unstable shoulder that he can (and does) dislocate at will. I wish I'd been told the risks of a big baby and had had a CS.

I was at school with a girl who lived with nerve damage due to this.

Anecdotally I also know more people who have had failed or totally grim inductions than I know people whose inductions went well.

I'd be asking for a planned c-section instead.

As far as I can tell the evidence of issues because of big babies is limited and not great unless you have diabetes - so if it was me in your situation I would probably decline induction and hope for labour to start.
evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

I had shoulder dystocia in my last pregnancy and I wasn't upset or traumatised by it- the midwife sounded the buzzer and extra people came to help and they got the baby out and he was fine. My baby wasn't big either. As when it will happen is unpredictable all birth attendants need to be trained to deal with it.

No experienceof dystocia but DS did get stuck and was violently ventouse/pulled out.

I was scanned in labour and he was estimated as 8lb 8 add he was born less than 24 hours later 7lb 3. And was 4 weeks early.

I know you have other risk factors, and done excellent services above, I'm only pointing out that weight estimates based on scans are not hugely accurate at this stage of pregnancy.

By contrast his brother was 9lb 4 and was born no bother at all. But is and was long and skinny with a much smaller head

Good luck with whatever you decide

And the baby who was stuck was an induction due to waters being gone too long, midwife was determined for me to not have a section and argued with the obstetrician for such over me

Thanks all, sorry to hear most of you had traumatic births. I've only really been offered induction, I wonder if I asked about c section they would ok it?

@Mon2468 they absolutely should offer you a c-section if that is your decision. I think you need to be really clear in your mind though- so you can be firm about wanting it when you discuss with your midwife and with a consultant!

I know it may not have been your first choice but honestly the vast, vast majority of posts about planned C-sections I have read on Mumsnet over the years are overwhelmingly positive. Of course there will be some negative experiences and it's not without risk but the risks are very small and my god I'd rather choose those risks over the risks of shoulder dystocia for both my baby and myself.

I was sore and tired and felt a bit weak for a couple of days after having my c-sections. Soon started to feel well again, was back to being near-normal in 10 days-2 weeks and felt fully recovered in a few months. Felt pretty good a day or two after the ops, just didn't want to be doing too much but with a newborn it's easy to cuddle up on the sofa anyway 😊

I experienced an unplanned shoulder dystocia birth with my son so was never offered a planned section, (I would've probably declined one) was booked for induction at 42wks but went into spontaneous labour at 41+5 after 2sweeps.
At the time there were many professionals in the room to manoeuvre him out and forceps were used but I was very lucky to have sustained no injuries, slight tear that healed very quickly with a few stitches, minimal blood loss, my baby was fine and my overall recovery was good. Just giving my experience as every woman's body is so different and every baby is but it is a medical emergency and you need all info from your professionals who know your medical history to make the right decision for you and your baby. I hope you have a safe delivery Xx

Id be asking for a planned c section. First DD was an emergency section after a long, difficult labour (big baby, back to back etc), and second was elective. Second was fantastic, and even first was better than the hours of trauma I endured beforehand. Both recoveries were surprisingly quick too.