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Old 11-21-2012, 06:24 PM   #21
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

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Originally Posted by steph410 View Post
what do you mean by red flags?

Do you mind if I ask if your son who was injured, was it your first child? Only asking because I wonder if having had multiple babies vaginally makes a difference to how a doctor would treat me.

I certainly need to discuss with my doctor. I know that BP injuries are quite serious and SD is very dangerous. I want to do the right thing, but if I can avoid SD through labor position or other means I would prefer that.
From the United Brachial Plexus Network (I bolded the ones I had):

Risk Factors for Shoulder Dystocia:

Suspected large baby - over 8 lbs. 14 oz.
Maternal diabetes / gestational diabetes (fetal assymetry)
Maternal obesity
An overdue baby - over 40 weeks
Short maternal stature
Contracted or flat (platypelloid) pelvis
Maternal weight gain -more than 35 lbs.
Protracted first stage of labor 30 hours total
Prolonged second stage of labor 4 hours pushing
-My first son also "turtled" a lot (doctors say another sign of a shoulder dystocia). Meaning he went up and down, up and down, etc in station. Not being able to engage well

Risk Factors for Shoulder Dystocia That May Be Associated with Prior Pregnancies:

A history of shoulder dystocia during a previous delivery
A history of giving birth to large babies
Eight years or more since your last birth

Other Factors That May Be Associated with an Increased Risk for Shoulder Dystocia:

Epidural: Because of loss of sensation from an epidural, the mother may not be able to feel the 'pushing' sensation and the baby might descend in a slightly awkward position.

Tools: The use of tools (for example, forceps or vacuum) to help the baby descend may possibly increase the risk of shoulder dystocia as well.

Labor Induction: There appears to be a possible association between an increased risk for shoulder dystocia and the use of labor-inducing drugs.

-----Yes, my son was my first child. There is a woman who has a blog called "Raising Olives" who had like 7 out of 9 kids be a shoulder dystocia, 6 with broken clavicles and the last s/d one with a brachial plexus injury. She decided to have c-sections after that one (... I must admit, it surprised me she waited to have c/s till then, but I don't know her, wasn't there, etc). Anyway, I thought that was interesting. I talk with a lot of BP mamas and they all range from their s/d baby being their 1 to their 7th. arg.

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Old 11-22-2012, 04:00 AM   #22
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

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If there is a true emergency and your baby is crowning but is stuck in a major room, they can do a c/s at that time. But to plan for one, on the idea that something *could* happen that *MIGHT* not be able to be remedied any other way.... seems a bit unfair IMO.
I think this tends to be the opinion of many, I was told by so many people when I was debating with my third what to do that a broken clavicle wasn't a big deal in a newborn. But they never seemed to acknowledge that there could be much worse outcomes with a dystocia. Green Baby Bottoms

Exactly what GBB said! Shoulder dystocias can have worse outcomes that a broken clavicle and even my son's brachial plexus injury (paralysis of one or both arms) and sensory issues from lack of oxygen. I've talked with many moms who's children were not able to be rescusitated in time to prevent permanent, serious brain damage and cerebral palsy. I've talked to doctors who've had babies die because of s/d as well.
And c-sections don't always prevent injury once the baby has got to the point of crowning and is engaged. I've talked with one family who's infant suffered an OBPI when they realized she was stuck and her heartrate was still there and so they went in for a c-section. Had to push the baby back up through the canal and out the incision and that force was enough for the injury to occur. My old midwife (who was formerly a nurse) has been party to a similiar situation in the OR. Many times though there is simply not enough time to get back to the OR for a c/s because when a baby is stuck, many times their oxygen is totally cut off and by the time the docs/midwives see the situation, they need the baby out "NOW" (thus episiotomies, major tearing, etc to Mama).

Sorry to go into so much detail, but the comment seemed to not realize the gravity of the situation and the really harsh outcomes that can occur. It's not an easy call on "what to do next time" for many mothers to make. The worry of the next time, the greater risks, and knowing it could always be worse is a hard thing to have in your head, esp. WHILE pregnant again.
If you, OP, are a praying woman, pray for God's guidance; for open doors if you should try again or shut doors if it could harm the baby more; for His peace to wash over you; for sensitivity to His voice to lead you and make the way known to you; and for comfort during this time of decision.
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Old 11-22-2012, 06:32 AM   #23
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

thanks everyone!
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Old 11-25-2012, 09:43 AM   #24
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

I just gotta add my story, if you don't mind. I have had biggish babies for the most part, but #4 was the biggest. 9lbs 15oz. I had not eaten healthy or exercised one bit during the pregnancy. I was miserable and at 37 weeks was begging my OB to induce. She did an U/S and determined that baby was probably about 9 lbs. But she put off induction until I was 39 weeks. I had all the regular interventions, Pitocin, epidural, oxygen, strapped down to the monitors in bed. After piddling around all day with barely any contractions, my nurse accidentally broke my water (I was only dilated to 3 or 4 at the time and he was way way up there, so definitely could have caused a prolapsed cord, praise the Lord it did not). Baby boy decided to come fast and furious then, my OB had just gone home and the MW of the practice came in to deliver baby. His head came out right away but then there was a problem. Everyone kept yelling at me to push as hard as I could (well, having an epidural sure hindered that) and I was just laying flat on my back with no idea what was going on. My husband had a very frightened look on his face and was asking me to push harder. My mom was also in the room and she said that the MW just kind of froze and didn't know what to do. Finally after a couple of minutes a nurse said, "Should I get a doctor?" This random OB in the hall rushes in, cuts me the biggest epidural ever, snaps his little clavicle (thought no one said she did, I now know this is a common last ditch effort by OB's and MW's when a baby is really stuck) and got him out. He had been stuck for 4 minutes and much longer would have had brain damage. A pediatrician that came in after the delivery joked that as long as the two parts of his broken clavicle were in the same room, they would heal back together perfectly. And he was right! It healed within just a few days, we have the x-rays to prove it. Thankfully my son didn't have any long term problems due to his difficult delivery. Both the OB's in the practice along with the MW said, "Next time, you're getting a c-section." At the time, I thought, "Good!" But as time went on and I learned about natural birth from Mama's here at Diaper Swappers, and from good documentaries, etc. I changed to a more natural-leaning Midwife who could actually remember my name and spent an hour listening to me at our first appointment. I became more educated and started to figure some things out.
#1 My big babies were not just the result of genetics, they were a product of a junk-food eating Mama who didn't take care of her body.
#2 Being induced even though my body was not ready, likely caused my hips and pelvis not to be prepared to deliver such a big baby. It also did not give baby a chance to move into the correct position for delivery.
#3 Babies are squishy
#4 God doesn't accidentally put great big babies into places where they weren't meant to be. I know everyone will claim they are the exception, but I truly believe this is a RARE situation and not nearly as common as the medical profession would have us believe.
#5 Having an epidural seriously impeded my ability to feel contraction, bear down and push the way I needed to.
#6 My MW was not trained enough to know that a simple change in position could have solved everything. I remained on my back the entire time.

All of this knowledge was put to the test when I delivered baby #5 three years later. I tried to eat better (sometimes not so successfully and sometimes yes), did pregnancy exercises, and positioning to be better prepared. I read natural birth stories from well-loved midwives and other Mama's. I used Hypnobabies which helped me achieve my first every totally natural birth. Baby Joshua was almost the same size as his big brother, Ben. 9lbs, 12oz and was 5 days overdue. I could absolutely feel my hips opening up and my body changing the day before I went into labor. He was born without any interventions and the birth was amazing. He DID get stuck for a moment while I was pushing on my hands and knees. My wonderful NEW Midwife had me flip over and try a different position. Out he came without any problems whatsoever and I didn't even tear!!!

I am due with #6 in May and looking forward to having my first ever homebirth/waterbirth with a lovely Midwife. Can't wait!!!

*Disclaimer: Yes, I know there are exceptions, and I'm not disregarding those. I know there are babies who must be born via c-section and I'm grateful we have the technology to help those Mama's and babies out. But we are an intervention-minded society and the average OB has been trained as a SURGEON - no question that is what most of them rely on as a good alternative when any type of issues arise.
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Old 11-25-2012, 11:14 AM   #25
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

Lots of opinions!

OP, is your doctor one in a practice of many? I would probably want to meet with at least 2 other doctors to see what their opinions were, and I'd ask for them to recommend me some resources to look at.

I can only hypothesize at this point, as I've never experienced it, but I would think that a TOL with careful monitoring and the agreement that a c-section be performed with red flags is a good compromise. I'd also probably make sure to get U/S measurements in those last weeks. I know they can be off, but often they are dead-on. It could very well turn out that this baby is much smaller, relieving a lot of your stress, you know?
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Old 11-25-2012, 05:26 PM   #26
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

I had a 100% natural, non-medicated birth but my 10lb 7oz baby still had shoulder dystocia.

Just having a drug free birth is not some sort of guarantee that you won't have this issue.
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Old 11-25-2012, 05:37 PM   #27
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My first two were also 10lbs 7oz. They both got stuck, but were maneuvered out (McRoberts maneuver) with no damage. I had an OB who knew how to handle it.

With my third, I was at a new practice with a midwife who was not comfortable with dystocia, and not comfortable maneuvering I guess. So she wanted me to deliver vaginally, but in an OR. But once I finally got my epidural, things moved quickly for me and she let me deliver right there, in 1 push. He was 8lbs 12oz, and had no issues at all. I think if I'd not been so against a CS, they could've talked someone with the same history into an unneeded surgery.
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Old 11-26-2012, 06:34 PM   #28
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

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Originally Posted by steph410 View Post
I had a 100% natural, non-medicated birth but my 10lb 7oz baby still had shoulder dystocia.

Just having a drug free birth is not some sort of guarantee that you won't have this issue.
This was my experience with my first 2. My first two were unmedicated, I moved around and stayed off my back and both had shoulder dystocia. My third I did everything the natural birth community told me not to do and it was my only birth without a dystocia. I know I am very much the exception to those rules but you can't always make the blanket statements that you should avoid an epidural and avoid laying on your back without really understanding the full situation that each individual person was in.
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Old 11-27-2012, 04:56 AM   #29
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Re: Anyone had previous shoulder dystocia & large baby- did you doctor suggest c-sect

Sending a prayer of safety for your homebirth and smaller babies, papoosecaboose! Surprised with your shoulder dystocias, that a midwife would think you are low risk enough to have one. That worries me. Even the doc who was gonna let me try a TOL, said no waterbirth incase we needed to change positions quickly and he needed to be able to get more involved... waterbirths don't lend itself to that as easily. Sometimes a quick change of position does not solve anything (didn't for me before my homebirth midwife reached in and started pulling), sometimes this sinful/imperfect world we live in has consequences and one can not birth a baby even under or over 9lbs without lifelong injuries (even with a natural homebirth), and sometimes eating healthiest produces bigger babies (mine sure did too).
With your previous birth, yes, your risks increased because of outside circumstances (induction, epi, back pushing) and that is awesome you decreased your risks every way you knew how with your last birth. But you stated your natural birth boy got stuck for a short time then as well. Glad your midwife got him out okay and that is was easier for her. Will she monitor the size of your next baby? Typically, the higher the birth weight; the greater the injury (not in all cases, like my son); but that is the statistical norm.
Anyway, I hope your midwife is also trained in other manuevers to help with s/d and also that she has all emergency equipment out and ready "just in case" as you have a higher risk of it happening again. Something to talk about with her as you are attempting a homebirth this time.
I hope you have a wonderful, uneventful labor though, truly. With your history though you should be taking some extra precautions (not as fun, but maybe wise). Good luck!
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