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?

One of mine turned out to have it at the last moment. She was in distress and a scan showed everything was fine to push, apparently. It was a very very difficult event, she had a lump the quarter of the size of her head, we waited three minutes for her to breathe. The staff's huge relief suggested to us that they were not sure how things would go. I would advise anyone at risk to avoid the possibility.

It is a hellishly traumatic and rough experience for the mother. I wouldn't take professional concern lightly.

Shoulder dystocia just means the shoulders get stuck as the baby is coming out. It’s always “at the last moment” and it can’t be diagnosed. Half of all babies with shoulder dystocia are small-average size.

*diagnosed in advance

My DS had shoulder dystocia. It was quite a long birth (gas and air) and I was exhausted by the end. When I eventually pushed the head out the midwives were gathered and the next thing I knew the emergency button had been pressed and a Dr came flying in. Baby was somehow yanked out - he was blue when he came out and whisked away for a few mins. He was 9lb 3oz, which was a shock as husband and I both very average sized. Luckily he was completely fine. I didn't tear too badly, but was very uncomfortable for a few weeks. I hadn't even heard of shoulder dystocia before this. I went on to have DD 2.5 years later as a normal birth.

I was in a similar situation to you OP and opted for an ELCS.

Ultimately shoulder dystocia is hard to predict, but larger baby (esp large head / broad body) is a risk factor. Even if you are higher risk they likelihood is it won’t happen.

Most babies are born following shoulder dystocia are fine - the biggest risk is nerve damage to the arm which usually resolves in days/months but can sometimes be life-long. Occasionally babies suffer oxygen deprivation which can result in brain damage or, very rarely, death.

Because of the risk of oxygen deprivation when it happens it is an emergency and action will be taken to ensure the baby is out as fast possible which can result in a traumatic delivery (physically and mentally).

For me, the decision was that, although the chances will still low, having been warned of the possibility, if the worst had happened I would never have forgiven myself and I was happy to sacrifice the hope of a ‘good’ birth for what felt like the greater certainty of an ELCS.

I’d had a forceps delivery with my first (so history of a less than smooth delivery) and my 2nd was predicted to be 12lb +. In the even he was ‘only’ 10lb 7oz but had the biggest head and widest shoulders you have ever seen on a baby so I feel I made the right choice!

I still feel a little sad about not getting a natural birth but my recovery from the ELCS was good (not going to lie the first two days I was in agony but after that my recovery was better than it was following the forceps delivery), and I can’t even really see my C-section scar now.

If you definitely want to be scared into an ELCS watch the last episode of ‘This Is Going to Hurt’, otherwise don’t even consider watching it until you’ve safely given birth. But there’s a more realistic example of a safe shoulder dystocia deliver on One Born Every Minute, there’s a clip on YouTube if you google it.

*14:44HarrietM87

Shoulder dystocia just means the shoulders get stuck as the baby is coming out. It’s always “at the last moment” and it can’t be diagnosed. Half of all babies with shoulder dystocia are small-average size.*

I am not sure how many families affected would consider shoulder dystocia as you have, it wasn't JUST that my baby got stuck, it wasn't JUST that the clinical team couldn't release him, it wasn't JUST them using force to contort my body into different positions both externally and internally, it wasn't JUST the panic as they clinical team tried their hardest including shouting at me to stop pushing mid contraction, it wasn't JUST that my husband got pushed out the way as they JUST dealt with this medical emergency. Perhaps you had a shoulder dystocia, perhaps not either way please don't minimise shoulder dystocia as just the shoulders getting stuck which is as likely to occur with a small /normal sized baby.

I was in your position with my first. DD was measuring big and they advised me to be induced on my due date due risk of SD. I did ask if a ELCS would be possible and they said oh you should try given that it’s your first birth etc. I had an awful induction at exactly 40 weeks (much of it was alone due to COVID restrictions) and I actually had a hyper reaction to the induction pessary. Had a horrible midwife too who told me I couldn’t deal with pain very well 🙄

Once I was joined by DH things progressed well and I got all the way to 10cms when DDs heart rate wasn’t varying. The decision was made for me to have an EMCS 36 hours after that pessary was inserted. DD was 9lb 2 and absolutely wedged, so much so I could feel and hear the two doctors both trying to yank her out.

Now pregnant with baby no 2, he is measuring bigger than DD was, and I also saw that episode of This is going to hurt which tipped me over to definitely have an ELCS this time over a VBAC.

The trouble is everyone’s stories are only relevant to them but it’s important to know what’s possible.

@Landlubber2019 couldn't agree more

@HarrietM87 I'm not saying they have diagnosed me with it, but there is obviously a risk if the consultant has got involved going by my growth scans. I know growth scans aren't 100% accurate, but going by most of traumatic stories I've read on this thread the past few days has made me realise why put myself and baby at risk if the consultant and midwife are saying there is a risk due to his size.

Thanks all for your honest stories, Had another scan today and measuring above 97th centile. Going to speak with midwife on Monday regarding C-section, I'm glad I wrote this as I would never imagined half the stuff most of you have been through happening to myself and was certain I wouldn't like a C-section but it seems best for myself and baby.

Shoulder dystocia just means the shoulders get stuck as the baby is coming out.

I don't think you have personal experience of this Harriet.

Shoulder dystocia absolutely does not just mean the baby's shoulder just stuck coming out, it means the baby is stuck and is NOT coming out without assistance. Add on the potential brain damage from oxygen starvation to the baby or damage to mother and baby from forceps - I don't think you have any idea about what you are talking about Harriet.

@Mon2468 absolutely fight for a C-section. My DD had shoulder dystocia, she was dead when they pulled her out by hand, luckily the baby crash team revived her but she was taken to NICU, had seizures and was cooled for 72 hours. She was oxygen starved for between 4 and 6 minutes and flat line brain activity the morning after she was born. I couldn't hold her for a week and she was on a ventilator. She has mild brain damage and I had extreme PTSD. Fast forward three years and two years of peadetrician reviews and she is a medical miracle, you would never ever know what happened to her at birth. I however, am still traumatised. I am not trying scare you but the awful truth is the worse can happen, my daughter was lucky and we were lucky that the hospital she was born at had a cooling unit and an incredible NICU team. I am 20 weeks with our second and have been told I will be having a C-section by my consultant but the honest truth is that I am still very frightened about this upcoming birth. I really don't want what happened to us to happen to you, or anyone else for that matter.

Someone on the other side.. my baby was 10.4 and I had a home birth. Both of us ok.
It's so so hard to predict what will happen so go armed with all the information. No one can tell you what to do or what will happen. Good luck with you decision xxx

Good luck with whatever you decide OP - I remember it being a really tough decision for me. I had lots of different and conflicting advice from professionals- i had an old experienced midwife telling me about 13lb babies that just slid out, and a hospital consultant who had vaguely mentioned induction but didn’t seem overly committed to it.

What tipped me to an ELCS was having a growth scan and the sonographer asking what the birth plan was - I said “oh I think it’s just wait and see” and they were appalled that an ELCS hadn’t even been discussed.

There are absolutely no guarantees whatever you choose, it is always a matter of weighing up different risks and unknowns.

An analogy I used at the time: it was like I really wanted to swim in the sea but I’d been told there’s a risk of a shark attack - I would rather stay on the beach, even if I then got hit by a falling coconut, than risk going in the sea and being attacked by the shark I was warned about.

Every time I put an adult-sized hat on his two year old head or struggle to find a t-shirt that will accommodate his broad shoulders I do think “yeah I was probably right to be worried about the shark and not the coconuts”.

I know someone whose baby was stuck with this and without oxygen for 7 minutes. He survived, but with brain damage. Please, anyone reading this thread for more information, please don't choose the birth you want to have over the health of a baby. The birth is just one day, the health of your baby will keep you worrying a lifetime.

I had an elective cesarian - at 37.5 weeks due to size and another reason, on the scan they said he was around 8.6lbs - he was born weighing 9lbs 11!!
Scans can be wrong either way but if they are worried about shoulder dystocia then you should ask for a Caesarian because it’s dangerous for both of you.

Every time I put an adult-sized hat on his two year old head or struggle to find a t-shirt that will accommodate his broad shoulders I do think “yeah I was probably right to be worried about the shark and not the coconuts”.
I agree. I think exactly the same when buying an adult size cycle helmet for my four year old and have to check things go over her head and shoulders before buying them. Delivery is one day. This is a very precious delivery. Your child can be brain damaged for a life time. Doctors are scared of SD for a reason. Why not go for the safest option available and take advantage of advances in medical science. Many more babies would have died this way in the past and would die without CS options being available.

I forgot to say that we were actually induced over a week early to avoid shoulder dystocia because doctors felt it was a risk. They were right it was a risk. The induction just wasn't early enough and we really did nearly lose her. We watchedb the shoulder dystocia episode of This is Going to Hurt and it was tame compared to the reality, and the baby was fine compared to the reality of how our baby was. It really doesn't matter if you have a c section. What matters is doing all you can to ensure that you and baby can enjoy the life ahead of you together without brain damage, broken collar bones, tears and sheer trauma.

The NHS is not running at safe staffing levels at tha moment either. You would need to be very very sure there was a team of people available at a moment's notice. There were at least eleven people in the room when my daughter was born.

From what I've read there's not much evidence that shoulder dystocia is more likely just because a baby is big in the absence of diabetes.
It's also odd to offer induction to avoid it when induction increases the chances especially if you have a drip.

I had a shoulder dystocia - no risk factors and size of baby average so no one knew it was going to happen- midwife pressed buzzer and team of people dealt with it - they didn't seem panicked but efficient and in control - baby fine and I only had a small tear that healed easily.

I've been reading up on it a lot as thinking about next birth (as is more likely to reoccur if happened before) and being able to be upright and move about reduces the risk so that is my plan a. Although if I am advised an induction which I might be for other reasons and end up needing to get drip I'm considering requesting a C-section instead.

Ultimately it is up to you what you do but do read up on the evidence as it's not straightforward for big babies.

I'm also not going to watch this is going to hurt while pregnant - don't think it will be helpful from what I've read.

BrownOrange
I agree with all that.

After seeing the damage this did to my friend's child I would definitely push for a planned CS.

I mean it’s far from as simple as ‘big babies get stuck’ and even with a large baby the chances of NOT experiencing shoulder dystocia are much higher than the risk of it happening.

For me it was as simple as given the risk had been identified, I didn’t want to risk it as if anything had gone wrong, however unlikely, I would have had live with the consequences of having known I’d decided to expose myself to that risk.

It's also odd to offer induction to avoid it when induction increases the chances especially if you have a drip.

It's not odd. Better chance of a safe birth with a smaller baby. Unless you're a consultant and can explain why they're wrong?

I had a shoulder dystocia

You didn't really. Your description is nothing like a baby who is properly stuck. It would be helpful if more women were aware.

@Choppingonions

It's also odd to offer induction to avoid it when induction increases the chances especially if you have a drip.

It's not odd. Better chance of a safe birth with a smaller baby. Unless you're a consultant and can explain why they're wrong?

Actually inductions do have associated risks, including an increased risk of shoulder dystocia, so I agree that it is a slightly odd recommendation. I think it would be better to recommend ELCS but of course that requires more resources.

The fact is that there's a crisis in maternity services atm and many maternity hospitals just don't have the staff to ensure that women are properly monitored and looked after during inductions.

It is important to research the pros, cons and risks of induction before agreeing to it.