Shoulder dystocia

[chickpea1982]

Has anyone experienced shoulder dystocia when giving birth? If so, how bad was it?

I am 36 weeks pregnant with my third DC, and recently found out that I have gestational diabetes. The baby has been measuring really big for a while, and so they are concerned about the risk of her shoulders getting stuck during delivery. They want to induce labour between 39-40 weeks - hospital policy is to have the baby delivered by 40 weeks. They've told me that in 90% of cases shoulder dystocia is fine and manageable, but in 10% of cases the shoulders get stuck and it ends up with trauma to mother and baby.

I've got nothing against induction in principle, but having her at 39-40 weeks means she will be the absolute youngest in her year, whereas if I wait just one more day until 40+1 she will be a September baby!

Obviously I want to do what's best for her health, but I also feel like waiting a couple more days won't make any real difference. Or maybe I'm wrong and I should just do what they say, I don't know.

Does anyone have any similar experience to share?

I don't have any experience but I'm FTM with GD and a relatively big baby (vs my own petite size). They want him out at 39w for the same reasons as yours, either by induction or c-section. I'll most likely go with c-section as don't want to risk the baby's head or shoulder getting stuck.

My friends all say that having an Aug baby will save me a year's nursery fees! So I really don't mind that.... If I were you I'd definitely try to get them out earlier (after 39w) rather than waiting and risking shoulder dystocia. From what I read it's rare but very risky to the baby's health.

Good luck!

As gently as possible, if shoulder dystocia is in the mix that should be your number one priority, not what month the baby is born. It’s potentially incredibly serious and I would be looking to get the baby out as early as possible.

The size of the baby doesn’t mean you’ll definitely have shoulder dystocia so I don’t agree with PPs. You may have a big baby but a very straight forward and simple birth.

Honestly I’d also be trying to wait until 1st Sept. I’m a teacher and I really feel August babies have some tough challenges to overcome. I had mine in October and November and intentionally didn’t try to conceive on a month that would result in a summer baby.

Or compromise and wait till 40 + 1 and have a planned c-section to avoid risk of shoulder dystocia but also give them the academic advantage of being Sept born?

Have you had a growth scan (not always accurate)? Also were your other babies big?

2 days isn't going to make a big difference so I'd be inclined to wait too unless obvious other risk factors came up. I'm a midwife too. I assume no problems with previous deliveries?

Look up NICE guidelines on shoulder dystocia.

Have a conversation with your medical team about the risks and benefits of various courses of action.

You could consider various options including c section at 40+1 to avoid august baby and shoulder dystocia.

If baby is born in august you could ask to delay for them to be educated out of cohort (this is increasingly happening and I imagine will be more straightforward in 4 years time).

Overall though - make sure you are well informed about the risks - preventing shoulder dystocia would definitely be my priority over a September birthday - but I'd want to understand more about how much an induction at 39 weeks would reduce that risk.

I had mine induced in August last year as he was measuring big. The scans were bang on and I was glad he'd not got to full term size! We figured the guaranteed saving of a year's nursery would more than pay for any tutoring he may need to catch up later.

I had a late august baby as was induced as measuring big. You can defer kids now much easier if needed, so do what is best for your and baby health. (She is due to start school next month and is sooo ready, I'm glad she was not born a week later!)

There were a lot of people in the delivery room but in the end it was the midwife that delivered the baby and all was well. I felt like drs being aware of the risk and ready for action if needed was pretty much the best position to be in tbh. The hospital did offer me elective c section but I didn't take it and was pleased how it all worked out.

I wouldn't worry about August/Sep baby. I was born end of August and was youngest in my year all the way through primary/secondary and I was never any less off academically and achieved sometimes more in terms of grades then my peers who were almost a year older in the group. Same with my friend who was also an August baby. Never felt left behind in that sense and always managed to keep up, so I would definitely prioritise anything medical over that.

My daughter was 8lb 14 and I had shoulder dystocia when she was born. We didn't know she would be big as my previous 2 were fairly small although not the easiest deliveries ( one forceps and one c section) I optimistically opted for a VBAC which was prob alt a mistake.

If your previous deliveries were uncomplicated I'd probably go for it on the date recommended by the doctors.

If they were in any way complex, I'd ask for a c section. If I had my time again that's what I'd do. My daughter wasn't particularly injured in the process of getting her out, some babies get broken bones in the process, but it was a medical emergency and very surreal with doctors and nurses running into the room. I had a haemorrhage and tore pretty badly.

Hope all goes smoothly for you.

My first was over due and I refused induction. Went I to labour at 40+8. I had a shoulder dystocia at the birth and it was bad. Full on emergency, button pushed, loads of people rushing in. It took them 8 minutes to get him out and he was born with an apgar score of 1 and had to be resuciated. He was dark blue. Honestly we were very lucky he survived and no long term effects after a few days in SC.

That said, my third, who I went into labour with on due date, also developed SD at birth, but it was a lot less dramatic as we were prepared and the midwife was more on it so didn't develop into a full blown emergency, they managed to get him out more quickly and there was just some meconium.

I am quite short and they both had big heads! Dc2 is a different shape and shot out like a rocket. It's luck of the draw in some respects but you really, really don't want to experience a full on emergency SD. If I had my time again I'd prob still go to plus 8 but I'd insist on more positioning check during the birth and more checks generally. The midwife was useless and just left me to it right up to the point when she realised he was stuck and hit the emergency button.

How were your previous deliveries/baby weights?

I had similar ish experience - diagnosed with “borderline” GD at 36 weeks, had no risk factors so hadn’t been tested previously, but baby was measuring big. They then pushed me to have an induction before 40 weeks. I wasn’t convinced re the GD and my DC1 had been big (8lb 12 though at 42 weeks) so I knew I could give birth to a big baby.

I did lots of reading around it and from what I can recall as many small babies get shoulder dystocia as big ones, as it’s mainly about positioning. Check evidence-based births.

In the end I agreed to induction on due date. Baby was as big as predicted (9lb 1 so not a giant) and the birth was smooth and fast (1 hour start to finish).

I would absolutely try to avoid a late august baby if I were you - a day or 2 is not going to materially impact anything and if you/drs think it will then go for a c section in September.

No August/September issues but my third was a big baby, (4.25kg), badly positioned possibly due to needing to be turned from breech, and a home birth. Also a shoulder dystocia birth. I suspect the midwife had nightmares for a while, but it was resolved by a change of position. And a lot of subsequent stitching. DD was and is absolutely fine. I had to climb out of a birth pool with her head out but not her shoulders! Strange times.

I was induced with my first at 42 weeks - he’d been flagged as large although no one did anything about it. He turned out to be 10lbs 6 oz and got stuck. In the end they got him out with forceps and we were both ok but sitting down was pretty painful for a while.

She almost died. I ended up with a 3rd degree tear because they had to get her out.

You can defer her school place.

I'd go for early induction or insist on c section.

This

I wouldn't worry too much about the August birthday. I have one that is a September birthday and one that is an August birthday, so both ends of the spectrum! Yes they may struggle a little at the beginning (my daughter did) but then they settle in after the first year. My youngest is the August birthday and has just graduated on a first hons degree so no problem academically due to her birthday. Hope it all goes well for you.

@grangegrove My August daughter actually academically did better than my September daughter. I didn't plan for birth in any given month based on their schooling. I think it is a bit unfair to generalize that all August birthdays face 'tough challenges'. I am not a teacher but as a parent I saw no evidence of this amongst her peers at the school my daughter attended. My daughter has dyspraxia which she would have had whenever she was born. The only disadvantage I found that she was still struggling (at just turned 4) with the toileting side of things and getting changed after PE. Lots of collecting her with her jumper on back to front! Academically, not so much a massive difference from my September born daughter.

How does inducing (forced incredibly painful contractions) help if they think shoulder dystocia is an issue? You'll be in a hospital for delivery either way, baby will be in far more distress if induced. I was put on a drip against my will during labour (less than 6 hours after natural labour started), baby went into distress and the only way they could find her heartbeat was putting a clip on her head while she was still inside me. I didn't give consent for that either, but both things they just went on and did.
I’m sorry to point out but if baby does go into distress and then gets stuck shoulder wise, you'll be rushed into theatre for emergency c section and have a whole hand shoved up the other end to push baby back up to come out that way instead. Wouldn’t they rather see the birth play out naturally without added drip and go from there?!
Measurements are very rarely accurate. They might estimate big but your baby could just as easily (very common) be much smaller.
If they are so concerned then they should be recommending a c section.
I don’t understand why the majority of obstetric health care is so completely backwards, always as if they're basing their advice on previous women in entirely different circumstances. It just doesn't work like that. Please demand an explanation from a consultant before you let whoever's available have at it and be responsible for how it plays out.
Wishing you the best of luck OP, please make sure you're fully informed and have a plan in place that echos reality, no unnecessary risks should be taken here.

In this scenario, I really wouldn't be worried about school. Worry about you and your baby. Once she's out safe (one way or another) and you've both recovered, then give that a second thought.

I once saw an episode of One Born Every Minute where the baby has shoulder dystocia and it was frightening to watch. I can't imagine how it must be if it's your body, your baby, your partner. Not sure if this is the one I watched but series 3 Episode 6 has a birth where baby is stuck.

www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiiwYXZ2cGAAxWeTEEAHYRIA70QFnoECBEQAQ&url=https%3A%2F%2Fwww.channel4.com%2Fprogrammes%2Fone-born-every-minute%2Fon-demand%2F52556-006&usg=AOvVaw3skNJnnKKwUwxzJ-PjHxfB&opi=89978449

I had shoulder dystocia with my daughter. I hadn't had any kind of warning about it so to be honest I didn't really know what had happened until it was explained to me after the birth. She weighed 9lbs 1 when born and I had been induced at 39 weeks due to reduced movements.
It took 4 minutes from her head coming out until getting her out. It was very very painful, I was pushing and pushing until I couldn't anymore and vomiting everywhere and all over myself, a button got pushed and loads of people were in the room immediately and they managed to get her out. She was purple and not crying at first, they took her away immediately, I was on morphine and could t understand why because I didn't really realise what had happened. They had taken her to give her oxygen but then didn't actually need to and brought her back.

She's 6 weeks now and seems to be doing fine but it wasn't a nice experience.

As anaesthetist who worked in maternity for many years I would not take any risks with shoulder dystocia. Take the section and it can nice and calm and planned and yes maybe august but you can defer a school place.

You don't want to experience shoulder dystocia if at all possible

My second child had some kind of shoulder dystopia. From what I remember (in between them pushing a oxygen mask over my face amd shouting at me to push) was that there were people about to come into the delivery room as he suddenly came out. They did had done something along the lines of forcefully pushing mynlegs/knees up around my shoulders but as I said, itbis all quite hazy amd vague.
And I had a fairly nasty tear and in my later pregnancies I had significant pelvIc arthopathy (the kind that does not disappear after birth) and is still niggling on at times many years later.
So it was quite traumatic, even in a best type scenario like mine where the baby is okay amd no forceps etc needed it can lead to longterm injury for the mother (he is in his mid twenties now).
So in that scenario go with the advice but also ask for scans in the fetal assessment unit to determine if it is just a chunky baby or one with broad shoulders.
Most of my babies were between nine and 10 pound but only one had that kind of broad shoulders.

There’s a lot of very muddled thinking on this thread.

If you are going for a section then book that in for 1 September. There’s no reason to book it earlier than that. You can agree with the hospital that if you go into labour before your planned section date then you’ll go in as soon as labour starts and they give you a c/s then. That’s the normal arrangement with most planned c sections.

Yes you will get people saying their August baby was fine but if you look at the actual data it would be better to avoid it and I can’t see any reason why you wouldn’t if you had the choice (obvs if you go inti labour naturally before then it’s not within your control).

Shoulder dystocia is no joke but it is rare. Half of all babies with shoulder dystocia are small. The risk can be higher with GD because weight can be distributed different in GD babies. It’s most risky where the head is smaller compared to the shoulders - how big is your baby’s head measuring?

This article sets out all of the scientific research and medical facts that you need to make an informed decision:
https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/