Your experience with shoulder dystocia - Page 2

[MsBlack]

Hmmmm, I can't say for sure, but I think if the doc thinks the baby is 'big', med ppl believe SD is highly likely--and then if baby's head emerges and does not *instantly* rotate/restitute, then SD is assumed. As mwmom3 indicated, it is 'normal' in hospitals to try to 'pre-empt SD' by getting on with force/manuevers *before* SD occurs (well, in their mind, before it occurs, and in my mind, before they even know if it will). As I mentioned before, even some hb mws have this approach of 'pre-emptive moves' if SD is expected from size of baby and relative ease/speed of head delivery.

Thing is, with mom in that position--resting on her sacrum, not allowing fullest mobility/expansion of pelvis--you are much more likely to see slow delivery of head, and slow or absent restitution.

[Charmie981]

The only "sign" I know of that you may have a SD is a long and laborious pushing stage. I've gotten to where I start to wonder if we're looking at SD when the head takes 10 minutes to crown and its been way longer than that since head was visible. And yes, slow crowning and birth of the head is more common in semi-reclined, but so is SD, for the same reason...the sacrum can't move out to accommodate the shoulders. Interestingly one of the best tips I've ever heard for avoiding SD is to not let baby restitute before having mom birth the body (ie, once the head is out, don't wait for the next contraction, but go ahead and use hand maneuvers and have mom continue to push so that head and body are born in one contraction). Restitution brings the shoulders into vertical position within the pelvis, which can then allow the anterior shoulder to get trapped if it isn't already. This contradicts a lot of what you read about SD, where not restituting is listed as a sign of SD. Something else I've learned is that when mom says "I can't" after the head is born, ESPECIALLY in an experienced birther, beware. I had a friend who had a case of very sticky shoulders with her third baby and she told me "I can't." When I said, very encouragingly in my most hands-off midwife voice "Yes you can, reach down and get your baby," she said "NO, I CAN'T! I'm pushing against a brick wall...she's not coming."

I like The Shoulder Dystocia Handbook published by MW Today for good information on when to wonder about SD (I use the word wonder, because anticipate or predict sounds too definite...the most I ever do is wonder to myself "are these shoulders going to make it out okay?") and how to handle it when you find that you've got one on your hands.

[durafemina]

great discussion - just piping in to ask a side question.

I'm a senior midwifery student and have yet to see a true SD, however, I have had several occasions which might be termed 'sticky shoulders'.
In these cases, the head has been born and restitution has occured. Then with the next contraction there appears to be no further progress. Towards the end of that contraction, I've been taught/encouraged to reach in and hook my finger under the anterior shoulder (ie in the armpit) and gently guide the shoulder out. I emphasize that the shoulder is not 'stuck', and I'm not even pulling on it - it's just sitting there and I slip it out. This has always worked - sometimes in addition to gently encouraging the mother to continue her effort (other times not). It seems my preceptors find this preferrable to asking/suggesting the woman change position, especially if she is tired and the second stage has been intense for her (the birthing woman).
What do you think of this practice? invasive? helpful?
I'm sort of ambivalent about it. It does seem to make a difference and to not be extremely invasive. . . but if it's unneccessary in light of a position change, I'd like to know that!

[MsBlack]

From what you describe it sounds unnecessary. For both philosophical and physiology reasons, I much prefer to leave birth between mom and baby if at all possible. Manual 'helping' always carries the risk of backfiring--I believe that this kind of help should be entirely Last Resort. Besides, Birthing women are capable of so much! When we are clear about this, we will never do for a woman what she can do for herself, thus taking something from her unnecessarily.

I have seen apparently fatigued women suddenly find a nice burst of energy when I say (firmly but not frantically) "Mom, you really need to move *now*, baby needs your help getting out". I have seen how this brings moms right out of themselves and back into being a mom--bringing her energy, attention and love to bear in a focussed way on her baby. They suddenly find that they CAN move, they can move very sprightly indeed! The position change helps get the baby out--and the energy burst helps mom give her all to her baby immediately, which can help bring a baby around who may be a little stunned/depressed if birth was a little too sticky/slow for baby's comfort.

When we do rely first on mom's abilities and her love for her baby, we can also know that she is bringing everything she can to the baby. This is good for all babies, but especially so for babies who may be stunned/depressed. Her energy-burst and focussed attention may be all the baby needs by way of 'help'--and far better for baby to get that kind of help, straight from mom, than for us to initiate rescue of any degree if we don't have to. Her love for her baby, her ferocious desire for her baby's health, is not something we can carry in our bags--but I believe it is the most necessary ingredient: not just to help a sticky/scary birth as it well might, but also in starting the mother-baby bond on the best, most focussed and least hindered terms possible...and that goes toward their lifetime together, not just the birth.

[major_mama11]

Originally Posted by Om Girl

Still are there any warning signs of SD in labor?

Disclaimer: not a birth professional; I've only seen about 20 births, so take anything I say with a grain of salt...

In the SD I witnessed, the L&D nurse thought something was wrong before pushing even began, just based on the babe having a large caput forming before the mom had fully dilated. Also, the baby's head delivered soooo slowly and was so molded, that I spent a couple minutes thinking it was very deformed, before realizing that the baby's face was facing right towards me the whole time.

The attending OB ended up breaking the baby's humerus to get him out (HR had dropped to 60s by then), and babe was born with Apgars of 1 (1 min) and 4 (5 min)- intubated in delivery room, several days in nicu. Babe was actually under 8 pounds, but was very oddly proportioned- huge head and shoulders, small lower body. Mom had poorly controlled GD, and the nurse felt that she had an oddly shaped pelvic outlet.

I agree that there is a different "feel" to SD vs sticky shoulders- based on my limited experience. The SD babe's head came out millimeter by millimeter, it seemed...

I left the above birth thinking that I wanted an elective c/s for any more babies I had- it was that terrifying (although the terror must have faded, since I ended up having a waterbirth with my next).

[minelli]

I personally experienced what was described as severe shoulder dystocia. people usually don't get it. they say, "oh yeah, my baby got stuck at the shoulders too". funnily enough my doctor would come and see me everyday in hospital and tell me that people would say this and i was not to believe them. she also came in daily and said i must have a cesarean next time.

The labour was 'textbook' apparently. Just going so smoothly but i have to say it was very very hard. I'm beginning to think it was particularly harder than most labours after hearing other people's experiences. I was considerably fit and told by doctors that i have a high pain threshold.

The labour was what i considered to be about 6 hours long, 5 hours of hard work.

The details are foggy because i was so exhausted and i just felt like i wanted to give up. Only the thought of my baby's life kept me going. Doctors have told me how it went.

Baby's head came out but the shoulders didn't seem to be following, i knew something was wrong. An emergency call was made around the hospital and people flooded the room, it went from about 4 people in the room to what seemed like 15 ( i don't know how many). The delivering doctor attempted EVERY move, mcroberts, corkscrew, trying to break collar bone (sorry, i don't know the technicalities) but i was told everything was attempted. i had 2 midwives push my thighs back to my shoulders with so much force. My baby was so tightly stuck the doctor couldn't even move him enough to break his collar bone. i could see panic on the doctors face and everyone in the room. i just shut my eyes and kept saying 'please Lord let my baby be ok' (or maybe i was saying this after bubs came out but wasn't crying and swept over to emergency table???)

My baby's head was stuck for 5 minutes. Eventually the doctor was able to reef him out by one arm (i had an episiotomy at some stage). I believe it was a miracle that my baby came out alive. Doctors came to my room afterwards and told me my baby didn't have brain damage (i didn't know to expect it!?)

My baby was resuscitated. that sweet sweet cry was the best sound i have ever heard in my life. my husband was in the delivery suite toilet crying and praying during the delivery. He said all he could see was a blue baby and when they took the baby over to be revived it just looked like a limp blue baby...this was the most horrific experience for us.

All the doctors who have read my notes have asked me how my delivering doctor was after the experience and how many years did it shave off her life? my mum saw a midwife come out of the delivery suite wiping her brow exclaiming "oh that was the worse thing i've ever seen". I'm so thankful to that doctor and at our 6 week check up she was so thrilled to see the happy healthy baby she ran to get one of the other doctors to come and see him :)

My baby boy is perfectly healthy and is 3.5 yrs old now. He had erbs palsy...that is, his arm was limp from shoulder down from nerve damage upon being yanked out of me. Thankfully he could raise his lower arm (bend at elbow on his own) by day 5 and by week 6 he could lift his entire arm. we had to do exercises for his arm several times a day. He stayed in intensive care for 24 hours in a humidy crib. he was my first baby, 9lbs 12 oz and there was no gestational diabetes. I didn't see him till a couple of hours after birth apart from a glance as they took him away. i got first contact with him 7 hours after birth.

I'd really like to hear other people's experiences...

[greenhands]

Originally Posted by Charmie981 

The only "sign" I know of that you may have a SD is a long and laborious pushing stage. I've gotten to where I start to wonder if we're looking at SD when the head takes 10 minutes to crown and its been way longer than that since head was visible. And yes, slow crowning and birth of the head is more common in semi-reclined, but so is SD, for the same reason...the sacrum can't move out to accommodate the shoulders. Interestingly one of the best tips I've ever heard for avoiding SD is to not let baby restitute before having mom birth the body (ie, once the head is out, don't wait for the next contraction, but go ahead and use hand maneuvers and have mom continue to push so that head and body are born in one contraction). Restitution brings the shoulders into vertical position within the pelvis, which can then allow the anterior shoulder to get trapped if it isn't already. This contradicts a lot of what you read about SD, where not restituting is listed as a sign of SD. Something else I've learned is that when mom says "I can't" after the head is born, ESPECIALLY in an experienced birther, beware. I had a friend who had a case of very sticky shoulders with her third baby and she told me "I can't." When I said, very encouragingly in my most hands-off midwife voice "Yes you can, reach down and get your baby," she said "NO, I CAN'T! I'm pushing against a brick wall...she's not coming."

I like The Shoulder Dystocia Handbook published by MW Today for good information on when to wonder about SD (I use the word wonder, because anticipate or predict sounds too definite...the most I ever do is wonder to myself "are these shoulders going to make it out okay?") and how to handle it when you find that you've got one on your hands.

It seems to me that trying to force a baby out before restitution is given a chance to occur is just asking for a brachial plexus injury.  We have wisdom but we also must work with the wisdom and unique timing of the motherbaby dyad.  I have "managed" a severe SD so I do know what I'm talking about...I'm not just spouting trust birth rainbows and fairy dust.

Restitution is not an alignment of the shoulders at all.  Restitution is when the head, after being born, turns to its natural position again:  central relative to each of its shoulders.  Then the next step is internal rotation of the baby's body.  That's when the shoulders can get stuck at the pelvic inlet or outlet.  Gail Tully of Spinning Babies teaches an excellent webinar about SD.  I'd highly encourage all birth attendants to check it out!