Am I being foolish? Please be honest...

[shells_n_cheese]

My first child was born via c/s after a FTP/CPD induction (was induced because I was "overdue" by barely a week). My second was born at home almost 7 months ago--but she had shoulder dystocia. Scared the living hell out of me and my husband.

She was stuck for 4 horrifying minutes. We went through a cycle of various positions--like McRoberts and the Gaskin etc. When she was finally out, she needed to be resuscitated, her apgars were 3 and 7. Her right arm was limp for a week or so--but has since healed. She was 8 lb 14 oz. (my c/s baby was 8 lb 7 oz)

DH and I are pretty sure we are having #3 someday. Though we don't even plan on starting to TTC until another year or two--I can't help but be afraid of a repeat.

I am having a hard time talking about this with family or friends, because I either get, "Isn't it a little early to be talking about this?" and/or ,"just schedule a cesarean next time".

Well, it's not too early to me. I can't help but to be preoccupied with it sometimes. It's an important decision to me. I do not want another c/s... yes, to be honest I have thought about it, especially right after the birth, but as times passes I KNOW I would have a very, very hard time signing up for a c/s unless I knew for a fact my baby would be in danger.

In a perfect world, I would go for another vaginal birth at home... but I know this world isn't perfect. What if it happens again?? What if it's worse?? I am worried I would be petrified during the birth--especially when pushing.

I know of someone (not in real life, but through the internet) that lost her first child after also having a shoulder dystocia during their homebirth. Her baby was stuck for just ONE MORE MINUTE than my baby. They live very close to me and used one of the midwives that I almost had attend my birth--so it really hits close to home. I worry... what if we were just lucky last time?? What if it happens again and we also endure this tragedy? Would I forgive myself? This woman is opting for a c/s next time... which makes me feel like I am being reckless by not doing the same. I know her child did not make it--and I am sure that is the reason. If I had lost my daughter, I would probably do the same, but it still makes me feel like the choice to have a VB after the SD is "selfish" or "wrong".

Part of me thinks I may try a hospital birth this time--but who would take on a woman with a prior c/s for FTP/CPD and shoulder dystocia?

My MW believes in me. She already told me she has NO PROBLEM attending another homebirth of mine. She has told me she thinks I need to change my diet though (I am a carb ADDICT) as she feels that may have contributed in some way.

Still, even though I had a c/s for a FTP induction where my son was posterior, I was stuck in bed, not given enough time etc. etc... I can't help but to think my OB was right--I have a small pelvis. I mean, for her to tell me that, and me to say "yeah right", then go on to have a SD, kind of makes me feel... stupid.

It's just one more thing that makes me think I would be doing something reckless and foolish if I went on to have another homebirth.

Please be honest... I know the majority of the women here are more natural birth oriented, as I am too, but still... do you think I am being foolish for having another homebirth after SD?

Sorry so long! If you made it this far, thank you!

[GoBecGo]

I don't think it's foolish. OUt of interest, what position was your LO in? I know several mama's of dystocia babes which weren't huge (and i don't think your babies have been huge) but got stuck and most of them were OP or coming down in some other weird, slightly off position. Dystocia is very often positional, rather than to do with the size of the pelvis/baby.

I also know several women who have had 4 or 5 kids and one or 2 were dystocia babies, but not all of them by any means. You have a sample size of 1. I tore having my (only) baby. It doesn't mean i'll tear next time, it only means i tore last time, kwim?

I think i'd trust your midwife on this. She believes in you. She knows a dystocia baby can die too, and still, she believes in you. Your DD didn't die, choosing a bith you fee isn't right for you won't bring your friend's baby back (i know you know this). SOmetimes the world is really really unfair. I know a woman who, after 2 stillbirths, had a c-section at 35 weeks to avoid it happening again and that baby suffered a rare prematurity related complication and died. Life is bloody cruel sometmes But we cannot always meet that cruelty with fear.

Consider your options carefully, look into your heart. You know which path is best for you, it's ok to find peace with that path.

[shells_n_cheese]

Thank you so much for your reply. It meant a lot.

By looking at my birth video, she was facing my right side when crowning. I think she was anterior the whole time. A posterior or malpositioned baby was one thing I really tried to avoid my whole pregnancy (I was afraid of having another posterior baby!). However, I WAS laying on my left side--but during pushing I was almost flat on my back. I was just too tired to push any other way. I often wonder if this contributed to the SD.

You are right--life is really cruel sometimes, but I can't always live in fear... so true.

OMG... how awful for your friend. My heart goes out to her. I cannot even imagine...

[MsBlack]

If your baby was 'facing your right' as she was crowning, then she wasn't anterior. An anterior baby faces your back as the head is born, then rotates to face your side--either between head birth and next contrax, or as the shoulders are being born (it's kinda fun to see a baby 'corkscrewing out' that way).

I would also be likely to help you again, as your midwife is. But given your last birth, I would definitely not be comfortable with you on your back, or sitting, or any position that puts any pressure at all on your sacrum and tailbone. This limits the ability of the pelvis to move and open to a maximum degree. Hands and knees, squatting, standing, even sidelying--just not sitting or semi sit, nor on your back. You want those joints on either side of your sacrum to be able to shift, open, make as much room as possible for baby.

Just so you know, while it is true that a baby can die in a severe SD, it is also true that babies have come through just fine with far longer stuck times than you or your friend. Obviously, not something anyone wants to test! Still--just so you know. And I know it was horrifying...but 4min is not too long. It is after 4min that it is time to be concerned about baby's wellbeing.

And it would probably be a good idea for you to read up on SD, find out all you can about preventing it, and dealing with it should it again occur. The more active and mobile you can be during birth (not just during labor, which is also a good idea, but during the birth itself), the better. Sure, consider ways to grow a smaller but still healthy baby...but IMO, more important to be ready for birth itself, and for you, probably a more upright birthing position (to hazard a guess).

[shells_n_cheese]

Originally Posted by MsBlack

If your baby was 'facing your right' as she was crowning, then she wasn't anterior.

I hadn't watched the birth video in a while (hard for me to watch), but I just went back to double check her crowning, and she was facing my back when she crowned, not my side. It wasn't until after the next contraction that it looks as if my MW was helping her rotate to the right. Can't tell for sure though. So I guess she was anterior. I think at that point my MW suspected SD.

I am hoping it WAS my position when pushing. I remember a little voice telling me I wasn't 100% comfortable in that position (as in it didn't feel "right") but was too tired and in too much pain to even care at that point.

I also remember while in labor, all I wanted was to hang from something, but grew very frustrated because there was nothing to hang from. I think that's the position my body instinctively wanted to push in.

If I do indeed go for another homebirth next time--I told my MY I want a birth tub for pain relief and a squatting bar!

Thank you so much for your response!

[kltroy]

Shoulder dystocia is really scary and I'm glad your little one didn't suffer any permanent damage. I think the key question you need to answer is how likely it is that you will have another dystocia. And then I'd want to know how this would be treated differently or more quickly at home versus in the hospital. If I were you, I'd try and dig up some statistics on how likely someone is to have a second dystocia and would speak to a hospital CNM or OB/GYN about how dystocia is treated in that setting, since this will help you make your decision. There *are* hospitals that will support you, especially since you've had a successful VBAC. It sounds to me like you just don't have enough data to make an informed decision at this point. I had a really fabulous intervention-free hospital VBAC, so I know it can be done. Good luck.

[LiLStar]

sounds like you have a good midwife who believes in your ability to birth! my experience was similar. 4 min SD. I pretty much figure that hospital birth isn't even an option for me anymore. Who wants to attend the birth of the mom with a prior c/s followed by a 10lb SD? I feel safer at home anyway. I figure in a hospital, the only thing they can do for SD that can't be done at home is zavanelli *shiver* NO THANKS! and in the hospital most the experience is with epidurals. Which means less chance for experience in changing positions to help with SD. We tried mcroberts first, and my MW couldn't even reach his shoulders in that position. What if I had had an epidural and couldn't get on hands and knees easily? I'm sure he would have been stuck a lot longer. I'm definitely having another home birth. But i'll be watching the sugar and trying to make a smaller baby. I'm a really bad sugar addict. My MW attended a birth once with a SD stuck for 12 minutes! Oh another thing, they suspect ds might have been just a teeeny bit asynclitic, just enough to cause problems. My doula heard them whispering about that long before the SD occured, and they mentioned it later as a possible cause for the SD. And for both of us, it was our first vag births so maybe next time will be easier simply because its no longer an uncharted path!

[mntnmom]

Personally, I think your fear is a bigger issue than the SD. Do your research. Give yourself time to heal. And when it's time for #3, be honest with yourself. I don't think opting for another homebirth in your situation would be foolish, but if 3(?) years from now, you still have your doubts, look for the most natural birth friendly OB you can find. A lot can happen between now and then!

[Harmony08]

OP, I think that you said it yourself when you said you just aren't sure you would be able to relax and push and everything if you birth at home next time. Maybe you would feel more comfortable birthing at the hospital. You could still try for a natural and intervention free birth but you wil be right there if anything were to happen. Don't write off the hospital because you think no one will take you. Look into it. Can you have a midwife attend your hospital birth? Trust yourself.

[Harmony08]

question....how do carbs impact shoulder dystocia?

[Carolyn R]

If I may add my two cents, there probably isn't a "right" answer to this question...each person you talk to is going to have a different statistic/horror story/advice.

That being said, I also had a hard time deciding where to give birth (after we lost our daughter during our homebirth.) (FWIW, we have gone on to have a beautiful homebirth). After seeing several specialists, talking exhaustively with my midwife, and doing tons of my own research it finally boiled down to this:

The best place to give birth is where YOU feel comfortable.

Give yourself time. You might not decide until you are in labor where you want to be, and that's okay. Give yourself permission to not decide right away. It sounds like your midwife would be okay with that.

And for growing a healthy baby that is not too large, check out the Brewer Diet, developed bya physician specifically for pregnant women. It is taught by the Bradley Method of childbirth, and there's lots of info online. It emphasizes lots of protein and fresh foods, and is very nutritionally dense so you don't feel hungry at all.

Best of luck, and good for you for being proactive.

[shells_n_cheese]

Originally Posted by Harmony08

question....how do carbs impact shoulder dystocia?

I was always told too much can contribute to bigger babies.

[Peony]

I understand about needing to wrap everything up in your mind now.

While DS (my 3rd baby) wasn't a true SD, he had very "sticky" shoulders, he was also a UC, and 8lbs 12ozs. I always eat a lot a carbs to begin with, to make matters worse, I traveled during most of his pg. My diet was horrid, I know that. He was the only child that I've ever had a problem with during pushing, I knew something was wrong from the second I started, I flipped to hands and knees because I felt a sense of urgency, that I had to get this child out now. He was also posterior which does make a difference like others said.



I can't say that I still won't UC next time, or maybe I'll have a MW friend of mine come for sure (we had a loose arrangement with DS's birth). What I do know is that my diet needs to be better, if I don't do Brewer then I still need to do something more low-carb. I did have to come to terms with his birth, it was so different and so much harder then the others. Frankly, I never care to repeat that experience again! I also never bothered to figure out what position baby was in, another mistake I won't repeat. What I do know is that I need to take better care of myself and make sure to listen to that little voice in my head.

[zinemama]

I'm sorry, but I vote reckless and foolish.

After an experience like that, one minute from a dead baby, I would not be comfortable with another home birth.

In your shoes I wouldn't be so quick to rule out the possibility of a hospital VBAC. I'd at least do some serious research about it before concluding that a c-section or homebirth are the only options.

I don't agree that the most important consideration is where you feel comfortable. The most important consideration is where the best outcome is likely to be. For the vast majority of women, that's at home. But it doesn't strike me that you're one of them.

Best of luck.

[MsBlack]

The thing that you seem to overlook, zinemama, is that where a mama feels most comfortable is where she is most likely to be safest--because a relaxed woman is functioning, physically and mentally, far more efficiently than one who is under stress, anxious, afraid. The effects of stress--and of relaxation--are very much physiological. Do the research, this is well established over decades of study.

And shells....the only way I'd give birth in a hospital in your shoes, is if I decided to have a cesarian. Reason being that OBs just do not have the skill that a good mw does in helping to resolve an SD. You are unlikely to find an OB, for instance, who will truly be comfortable helping you give birth in any position besides lying flat or semi sit. That is what they are used to--and I believe that those positions (as I described earlier) are what you want to most avoid. I also think those positions contribute to SD in a lot of cases in the hospital. Not to mention the intense fear and hurry that tends to generate in hospital birth rooms when anything is not 'just perfect' (in their minds)--that adrenaline and attempt to control does not have benefits.

I have seen some 'SDs" handled in the hospital and it makes me shudder. I've heard plenty of hospital SDs described--and they make me shudder. I saw a video at a birth conference of a near-disastrous SD (baby lived, had permanent arm damage) handled by docs. It was just awful.

Now you could find an OB with experience and comfort in dealing with various birthing positions, and a hospital that is going to support your birth wishes. If so--then great, if you do feel that home is not going to be safe enough for you next time. Just please, do not assume that having an OB, and being in a hospital, is necessarily safer for you and baby with an SD--it just ain't true most of the time.

[zinemama]

Originally Posted by MsBlack

The thing that you seem to overlook, zinemama, is that where a mama feels most comfortable is where she is most likely to be safest--because a relaxed woman is functioning, physically and mentally, far more efficiently than one who is under stress, anxious, afraid.

I agree that this is true in cases of normal (i.e low risk) birth. That is not what the OP is dealing with. She has a history. In her shoes I would not disregard it.

[katelove]

Originally Posted by zinemama

I'm sorry, but I vote reckless and foolish.

After an experience like that, one minute from a dead baby, I would not be comfortable with another home birth.

It wasn't necessarily "one minute from a dead baby" though. There is no precise number of minutes after which a baby will die. The OPs friend had a terrible experience but there have been plenty of babies stuck for longer than 5 mins who have survived. And the OPs baby had a 1 min Apgar of 3 not 0 which suggests to me that they still had some time (although obviously I can't test that theory).

OP, I don't think it is unreasonable to consider another homebirth *if* you decide you are comfortable with that option. I also don't think size is everything when it comes to SD. I have dealt with a few and none of them have been huge babies. I would be inclined to think that it is more positional and it seems like your body was telling you that too.

I would think that looking at ways to minimise your exhaustion - eating/drinking/resting in the early part of labour/ not pushing until the urge is overwhelmming etc and maintaining an upright position with no sacral pressure during second stage *could* go a long way towards preventing SD for your next baby.

However, as others have said, if, on reflection, it is not something you feel comfortable with then it is probably a good idea to look at other options.

All the best and I'm so glad your LO has recovered.

[LiLStar]

Originally Posted by zinemama

I agree that this is true in cases of normal (i.e low risk) birth. That is not what the OP is dealing with. She has a history. In her shoes I would not disregard it.

speaking from having a very nearly identical history, I have to disagree. I absolutely do not feel that the hospital would be safe for me. Hospitals deal with medicated women on their back 90+% of the time. If I had a repeat SD, I do not trust that it would be handled appropriately in the hospital. I do trust my midwife. And the point is, there is nothing that can be done for SD in a hospital that cannot be done at home. Except shoving the baby's head back in and doing a c-section, which is extremely dangerous.

[moonglowmama]

Originally Posted by shells_n_cheese

I was always told too much can contribute to bigger babies.

Yes, this was my first thought when I read your story. Sugar and carbs make a bigger, fatter baby that is not healthier. Craving carbs is the same as craving sugars. Especially in the last half of pregnancy I'd ask my mw to really help me with my diet, in finding alternative ways of eating that will make a healthier baby who is also easier to push out.

And I agree with the pushing positions. You sound like you are pretty in tune to what your body needed with your last labor, and I'm sure that will be even more true next time around. Be sure to keep hydrated and fueled as you labor so you can make it till the end with energy to stand, squat or whatever you need.

I really think you would be fine with another homebirth, and you still have a long time to figure out how you might like things to be when you get there.

I have a dear friend whose baby had shoulder dystocia at a home birth, and it was very scary, even with a very qualified midwife. She attributed it to eating too much sugar in her pregnancy, and the next time ate much better, and had no problems at all pushing out her baby, who, by the way was 8 pounds instead of the 10.8 pounds that her sd baby was. Just to encourage you!

[wbg]

I have no experience with SD, but I was told that when you crave sugar, your body might be asking for protein. With my last bub, I was really wanting to only eat sugar, and not the good for you kind! Turns out I was highly anemic(which was another story), but I did start to increase my protein and decrease my processed sugar. Wow, what a difference healthwise. My DH and I still find that now, when we are run down and craving chocolate, that we make ourselves a steak and spinach dinner instead and the cravings go away! We look at our diet and immediately notice that we have been slack with the protein and veggies. I was also amazed to find processed sugar in all sorts of weird places like in my wheat bread etc? So I started to buy organic sugar free breads etc. Sorry, hope I am not off topic. Just thought it might help with regards to growing a less large but still healthy baby.