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?

@AgathaMystery

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.

I didn't find out until after the birth that I had this with DD (3rd baby, 40+5, 8lb15oz) when I was reading my notes and saw McRoberts manouvere and asked what it meant. I had wondered why the room suddenly filled with people and they were shoving my knees up to my ears... Thankfully DD and I were both absolutely fine (I didn't even tear), but that's probably because I'd had 2 other large babies in the previous 4 years and I've got wide hips/pelvis. No one told me what was happening at the time or mentioned it afterwards, it's only since learning more about obstetrics that I realised how lucky we were. Looking back, they really should have been more concerned from the beginning as I had a history of big, overdue babies (8lb1oz at 40+10 and 9lb5oz at 40+7). I wish we'd been induced!

If it's a risk and you can avoid it, OP, I'd go with their advice and the induction option.

Thank you. I've been reading non stop since and think I will possibly go for the C-section, will discuss with my midwife on Monday. Never ever thought I would say that 🙈

10lb baby born on my living room floor. Shoulder dytocia. We were both fine - no damage to baby at all, despite needing a little CPR initially. I had a 'slight graze', no tears. HOWEVER i employed independent midwives, so I had two highly experienced and focused midwives just for me. If I was having an NHS birth I'd probably choose c section.

Baby is now 7, one of the brightest buttons in her class and very physically able. She can't sit still for the life of her, but I don't think that's related

Just to add, this baby was a VBAC, so essentially my first vaginal birth, so it can work, but like I said, elective c section would probably be my choice now. But with vaginally seeding, delayed cord clamping, skin to skin etc

100% ask for a c section. A big baby is one of the biggest risk factors for both instrumental delivery or EMCS and severe tearing. Induction a few days earlier isn't going to make much difference to that. I'd go with the planned caesarean at this point.

Hi OP

Firstly do remember that anecdotes are just that, do your research and consider the actual data from reputable studies.

When I was doing my research I found the RCOG information helpful: www.rcog.org.uk/en/patients/patient-leaflets/shoulder-dystocia/

I also advise you to request a meeting with the consultant midwife to discuss your options, prepare any questions you have before the meeting and see what she says.

This should help you to make an informed decision and feel ok about whatever you decide.

FWIW this is what happened to me (but note what I said that it's just my experience):

DC1 born at 41+4, 9lb4, vaginal delivery with mild shoulder dystocia that was quickly and easily resolved. I went into labour naturally, it was a stressful labour with an unsupportive midwife who insisted I stay on my back on the bed, baby got partially (not completely stuck) so emergency button was pressed, obstetrician did the McRoberts manoeuvre I think it's called? And it worked. So they got baby out without having to use forceps or ventouse. I had already had an episiotomy, if I hadn't I think I probably would've had a tear. I was very sore indeed afterwards, not sure if it was the episiotomy or the shoulder dystocia or both. But baby was completely fine.

I will never know for sure but I am convinced that DC1 only got stuck because I was forced to lie on my back, which was not what I wanted and is not an optimum position for opening the pelvis.

When I was pregnant with DC2 they offered me a scan to estimate her size, she was measuring big which was unsurprising given DC1's birth weight. They were concerned the risk of shoulder dystocia but after discussing it with the consultant obstetrician and consultant midwife, who answered my questions, I decided to aim for another vaginal birth.

DC2 was born at 40+1, weighing 9lb1, vaginal birth with no issues whatsoever. She was actually born at home, it was very fast and the midwife arrived in the nick of time! Recovery was much better, I had a tear but it was much less sore and healed quicker.

Have a watch of the 'This is Going to Hurt' episode with the shoulder dystocia.... and then ask for the c section.

PS Just to be clear, I realise that other women might make different decisions with the same information I had, and that's obviously completely fine - your body, your labour, your choice.

My then baby had shoulder dystocia, not realised until birth. It was a horrific delivery and my daughter has a permanent disability in one arm. Though we were lucky, it could have been a lot worse for us both. If you are at risk of this, I’d suggest doing everything you can to mitigate the risk.

The problem is that shoulder dytocia cannot be diagnosed in advance. There are indicators that point to it being more likely to occur, (like a larger baby) but you'll only know for sure if it happens during birth. It would be so much easier if you could know for sure in advance

I think if you had actually seen a real shoulder dystocia you would opt for a c section. I don't want to tell you which program it was on as you are so close to giving birth I think it would not be a good thing to watch. It can take some time to dislodge the baby.

If you can avoid any chance of that I would. I had an EMCS with my first child (failure to progress and then a baby in distress) then I opted for an ELCS the second time. Very calm, walked to theatre, very lovely experience. Not saying the first one wasn't but I hadn't slept for over 25 hours and I was exhausted with complications. The second one felt so much better as I wasn't in any pain when I went into theatre.

You have the right to ask for an elective section and I would.

My second DC had shoulder dystocia. No risk factors picked up during pregnancy although both babies were large. The first thing I remember was the midwife (on natural birthing unit) asked if anyone had warned me about the baby's size. I didn't realise at the time but I thankfully had one of the units most experienced midwives with me throughout my labour plus a trainee. They barely left the room. As the time came to push I shouted that the baby was stuck. The midwife told me not to worry but soon after noticed the head retracting back in. They called for the crash team with the alarm and the midwife amazingly performed both the mcroberts and the Rubin techniques to turn the baby with her hands. She delivered the baby moments before the room filled with people as the crash team literally crashed through the doors. Neither me or baby had any damage but me and my husband agree that we wouldn't risk another pregnancy. It was an extremely scary experience. I am so grateful for that amazing midwife.

I've got my growth scan tomorrow the midwife of Monday to discuss, tbh at my consultant appointment on Tuesday she wasn't exactly adamant that this would happen, just offered me IOL at 39 weeks which I asked if I had to she said no I could wait until natural labour started but then reading all these stories scares me in case the shoulder dystocia does happen. I'll see what they say tomorrow at scan and take it from there.
@NameChange30 thanks for the link

Good luck with whatever you decide OP.

I planned a section for the birth of my DC. i did end up with a GA but it was okay. I would not change it.

Second baby, growth scan had suggested normal birth weight expected. Spontaneous labour at 37 wks and ds arrived at 10lbs following shoulder dystocia. I won't go into the details, but I have long term damage. DS recovered from erbs palsy at around 6 months.

I would urge you to have an elective c section, I would never in a million years want to experience it ever again and not only was I traumatized but my DH too!

I should add I lost an enormous amount of blood and am very lucky my baby survived. Another one urging you to have a section. I recovered so much more quickly the second time and bonded much better with my baby.

I was offered induction at 38 weeks or csection at full term due to large baby and risk of shoulder dystocia. Chose csection without hesitation and baby was born 8 weeks ago at 9lb 9 exactly as estimated on the growth scan. Can't say how a natural labour might have gone but I chose not to risk it. ELCS was a wonderful process and my recovery was easy.
Have to weigh it up for you personally but I thought the csection risks seemed more favourable than possible risk of natural labour!
Good luck with your decision, it's not an easy one but just do what feels right for you!

My first baby was born at 40+4 weighing 8lb 14oz, so big but not huge. He had SD and even though it was resolved relatively quickly with McRoberts manoeuvre, I tore badly, it was really traumatic and I had a PPH afterwards. My mum and DH were both at the birth and could hardly speak about it for literally years afterwards. My mum has since told me that when she was looking at his (blue) face and they couldn’t get him out she thought he was already dead. I was left with really painful scar tissue and when he was 8 months old I had to go back and have my tear reopened and repaired under general anaesthetic. Recovery from that was really painful. My overall memory of that birth is a blur (thanks, pethidine) but occasionally I get horrible flashbacks. I’ve got to stress that the midwives were brilliant and none of what happened was their fault. It was just one of those things.

When I got pregnant again, I opted for ELCS. I can’t tell you how much calmer and nicer it was (and I’m very pro-natural birth). I only have lovely memories of breastfeeding DD in recovery, rather than lying in a pool of blood on the floor after collapsing which is a recurrent memory I get from DS’ birth.

I’m not trying to scare you. But if they are concerned about SD, I would take that seriously. I wouldn’t risk it at all.

DS1 was undiagnosed shoulder dystocia. It was absolutely terrifying. Eventually the consultant managed to get him out with ventouse. I had a third degree tear which took months to heal. With DS2 I had an elcs which was a hugely positive experience.

If they started mentioning shoulder dystocia and early induction then you are quite right to ask for a c section. However, you might need to be pretty adamant you want it as they will see any wavering that they can get away without doing it. They mentioned it as a possibility not you so you can use that in your arguments. Good luck.

My first birth was ventouse with a 3rd degree tear. 2nd the consultant recommended planned section due to concerns about SD and permanent incontinence so I went with a section

Why have several people referred to undiagnosed shoulder dystocia? It only happens during labour so it can't be diagnosed in advance. Do you mean that the midwives didn't realise it was shoulder dystocia when it happened? They are all trained to recognise and deal with it so I would have thought that would be unusual?

There is a lot of misinformation on this thread OP. I suggest you read evidence based birth (another poster has linked and see also: evidencebasedbirth.com/wp-content/uploads/2018/01/Big-Babies-Handout.pdf)

First, similar numbers of small babies have shoulder dystocia as big babies - it’s about positioning not necessarily size. And things like GD increase the risk.
Second, scans are very inaccurate, so your baby may not be the size they think.
Third, c sections are not risk free and there are benefits to mother and baby of vaginal birth.

Fwiw I had two big babies - 8lb 12 (scans thought he would be 7lbs!) And 9lbs. With my second child I also had mild polydramnios and was tested for GD. They were pushing for early induction due to size/shoulder dystocia risk but I refused and in the end I gave birth day before my due date.

Both my labours were lovely, calm, fast waterbirths (no dystocia). With my second I had confidence because I’d already had a straightforward labour with a big first baby, so I appreciate it’s different for you.

It’s possible to have a plan that involves different options - eg you could wait until 40 weeks in case you go into labour naturally, and then plan a CS soon after due date?

I have no experience with shoulder dystocia (my son was a tiny little squirt), but I had an unplanned C-section after a failed induction.

I was exhausted and disappointed after spending a day in labour and making hardly any progress at all, but the C-section itself went very well and I recovered quickly.

I'm now planning my next pregnancy and if there's even the slightest indication that I won't have a straightforward vaginal delivery I will want to go straight for another C-section.

In your situation I would seriously consider an ELCS.

@nameChange30 I used that term because I had been given no indication there was any possibility of either having a large baby or that there was any risk at all of shoulder dystocia, despite being well post-dates and borderline for GD. I specifically mentioned it because the OP has been warned of this. "Undiagnosed" seemed a faster way to put it than the entire paragraph above.