Midwife pushing induction & shoulder dystocia

[Faithy72]

A little history...try to keep it fairly short.

Ok, so here I am at the end of pregnancy #4...my due date originally was 12/2 and after the sono was bumped to 11/14. This is completely typical for ALL my births...always bumped that far, always deliver close to original due date.

Baby #1, dd, 9lbs10oz.
Baby #2, dd, 9lbs10oz.

Both delivered w/o pain meds or intervention by supportive female OB in birth care center w/o complications.

Baby #3, ds, 10lbs 9oz.

Delivered at birth care center by midwife w/attending male OB who is VERY natural birth oriented (he is awesome). No complications although I did have a small amount of pitocin to get my contractions steady. I resisted until I was 42 + weeks and found that my ambiotic fluid was really low and both midwife & ob that I trust (recommended by all the BRadley instructors in town) agreed I needed to have baby. I had tried everything from acupuncture, castor oil, sex, walking etc. AND they did just as they said...very, very low dose and it came right off after contractions were steady and I birthed w/o help after that.

No idea why #3 didn't go on it's own....any ideas?

OK, so here we are w/#4...feeling good but showing no signs of labor. Gained 48 lbs (typical for me) and measuring 42 weeks (again typical)

BUT the last week at the appt w/midwife she has suggested induction. I was shocked. My dh told me to relax and keep in mind I have big babies and am 38 and she's probably being cautious.

Ok, so yesterday, went in for the weekly appt w/an open mind and she wanted to know if we wanted to schedule for next Tue!! I was offended! I haven't been checked at all and told her I didn't need to be yesterday either. She sounded offended and when I asked her why she was suggesting this she mentioned that "you weren't able to go on your own last time" and "you have big babies and the last one was close to shoulder dystocia" WHAT? No one ever mentioned that when I birthed him. "You had to push a long time" Well, yes, my babies have never just fallen out unfortunately...they've all required an hour or more of pushing. She said "it was close and we almost didn't get his shoulders out and this one could be getting bigger and your pelvis will only stretch so far".

So, we left on a sour note...didn't want to argue in front of the children as they pay close attention to this appts and I didn't want to cause alarm.

I did call her when I got home though and asked her if she felt comfortable attending this birth. She said yes but wanted me to have all my options given me so if there are complications (implying there will be) I won't say she didn't give them to me. And again she warned about shoulder dystocia (not sure if I'm spelling that right) and how if it's bigger than last one is a big possibility etc.

So, here I sit ready to go into labor w/in the next couple of weeks and feeling completely deflated. We were so excited to have the same team attend our birth and now I'm 2nd guessing everything. I can NOT go into delivery scared or nervous...I know that.

Soooooooooooooo, I need feedback about shoulder dystocia, suggestions for getting body primed (I've read eating pineapple, licorice etc) and if any of you have had trouble getting going w/one and then the next one kicked in ok...worried my uterus has gotten lazy and won't kick in again like it did on 1 & 2. What would you do if you were concerned over big baby & shoulder dystocia? My sil had a 10lb 14 oz and did have that problem although was lucky and healed fast and didn't have any lasting problems. And she is built a lot bigger than I am (I'm 5'8" and was 125 before preggo...I'm a thin build).

This is long I know but there's a lot wrapped up in it!

Thanks in advance for any feedback! I'm grasping for straws now...my dh is worried and I need some advice from women who know...

Faith

[lunita1]

When was your first ultrasound? (an early one in the first trimester is much more reliable for dating than a later one) What position did you push in last time? Did they get you to move around to help him fit out? If they didn't and he still fit out fine, I'd assume there was still some wiggle room/space, right? Also, (gosh I have a lot of questions!) how is your blood sugar? Do you think that any of your tendency to grow big babies is due to gestational diabetes (diagnosed or otherwise?)

I hate that your midwife has got you scared, but on the other hand it sounds like SHE is scared and at least she was up front about her concerns, right? How would you feel about scheduling a NST/ultrasound for around 41 weeks (that would put you past 38 weeks according to your original dates, right?), and then deciding whether to schedule an induction at that point? It sounds like the way they induced last time was pretty gentle, and I think the risks of inducing a fourth baby are fairly minimal (compared to a first baby).

[Faithy72]

My first ultrasound was around 23 weeks. I actually delivered baby in a semi squatting/hands & knees position so that was good. Definately was never on my back w/this last one at all. My blood sugar has always been ok w/all of them...I've done the glucose test w/all of them. I think the big babies are a lucky inheritance from dh's side...lol. We did 3 biophysical ultrasounds w/#3 after I was 40 weeks...1st 2 looked good and then the last one is the one they determined the fluids were really low.

Thank you for your response! Any is encouraging. I hate the idea of inducing and just do not know WHY my body would kick in w/2 and then NOT kick in w/2!

Faithy

[lunita1]

I found this study http://www.ncbi.nlm.nih.gov/pubmed/8459954

[moonglowmama]

1. A 23 week ultrasound is only good for getting a date within 1-2 weeks, either way.

2. Don't do licorice or pineapple. I've never heard of that, but I would suspect any benefit would be minimized by the fact that they are both very high in sugar, which at this point in your pregnancy will make for a larger baby. I have a friend who overdid the sugar a lot in one of her pregnancies, and did end up with a scary dystocia, but that was ultimately resolved by the good care of her midwife. She really watches it now. Stick to a diet with lots of veggies and protein.

3. Your body didn't forget how to birth. You will do just fine. Believe in your body's ability to birth the baby it has been growing! I imagine with your last you were having prodromal labor for some reason. The pitocin kicked it into gear, but that doesn't mean it wouldn't have kicked into gear on its own.

4. I think your mw is "remembering" the "dystocia" now because she is fearful, for whatever reason. (maybe she has had one since you- they are scary for everyone involved when true.)

I would recommend another conversation to say, look I don't want to have a baby get truly stuck any more than you do, but I do trust my body, I do trust my dates, as my history has born out, and I'd like to talk about other ways to approach these last weeks of my pregnancy, as I don't think an induction is good practice in my situation.

eta: low fluid levels is often a mistaken diagnosis, and can be affected by how much water you are drinking. Be sure to stay well hydrated.
Good luck mama!