Am I being foolish? Please be honest... - Page 2

[mwherbs]

the studies do not support doing a c-section just in case there is a repeat shoulder dystocia-

[lunita1]

MsBlack, it seems like you're seeing... black and white. A hospital birth doesn't have to mean a birth with an ob who is unexperienced with natural birth. Sure, it often does, but it's not the only option. I think the OP might benefit from a hospital birth in the right setting. I see a hospital-based group of CNM who would be able to help with pushing positions (with the aid of the birthing tub if you desire) and naturally resolving dystocia, but with the option for an emergency c/s in the next room instead of a drive away. The ob they work with also does vaginal breech births (or used to anyway... I saw pictures in my childbirth ed class with my first, but that was almost 11 years ago). In OP's shoes, I'd feel more comfortable with a hospital based practice like this one than at home. I know they're rare, but they're a good option for a slightly more complicated case.

That said, after one vaginal birth, pushing the next out should be easier.

[LiLStar]

Originally Posted by lunita1

I see a hospital-based group of CNM who would be able to help with pushing positions (with the aid of the birthing tub if you desire) and naturally resolving dystocia, but with the option for an emergency c/s in the next room instead of a drive away

an emergency c-section isn't really a practical option for shoulder dystocia. with SD being the only real concern, the decision of where and with whom to birth is one to make with the possibility of a c/s off the table entirely.

[MsBlack]

Lunita--

You are very right in seeing that I don't think too highly of a woman's and her baby's chances, letting most OBs/CNMs hospitals deal with something like SD! However, in my last paragraph I said:

"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."

So I don't see it entirely black and white.

And Lil Star is right--emergency csec is not a viable way to manage serious dystocia.

Zinemama--Sure, in one way it could be said that having had an SD, now the OP is more at risk than some women, and perhaps should consider the hospital for her next birth. However, there is really no way to assess that risk in advance, certainly it is not reasonable to assume that the OP is now high risk. And as you can maybe see, I'm not the only one on this thread to think that her/baby's risk will actually be lower at home due to her mw's skill in dealing with SD. Not to mention now, the mama's reflection on both dietary and positional matters that may help in the future--her understanding of her last birth, and her willingness to work more effectively with what she/baby need next time--this can make all the difference.

There are lots of reasons why going to a hospital actually puts women and babies at higher risk for harm than if they stayed home--and a growing body of research on this topic.

[loveneverfails]

Question: isn't the Brewer Diet to avoid LOW birthweight infants and pre-e, essentially by helping the placenta grow as well as possible, thus giving optimal conditions for fetal growth?

Now, I only have my own history to go off of, but my Brewer Diet babies were pretty much 2-3 lbs heavier than my non Brewer Diet babies with gestational ages not really accounting for the difference in size, same father of baby, etc. And both my Brewer Diet babies had shoulder dystocia. Eating normally, I grew a 7 lb 12 oz and 8 lb 2 ozer. On Brewer Diet, I grew 10 lbs 2 oz and 11 lbs even. And I had no GD with any of those babies. The only difference diet wise was normal eating versus Brewer Diet with the Brewer babies being significantly larger and with very large frame sizes (including 17 1/2 inch shoulder measurements.)

Now, I'm following twin diet guidelines for this current twin pregnancy, but I feel like the Brewer Diet is itself an intervention and that it may not be appropriate for everyone. If you put everyone on a bell curve, you're going to have most people in the middle, and a few outliers on both ends. For the people who would normally have very low birthweight babies, Brewer could make a tremendously positive difference in their outcomes. As it's difficult to predict who is going to normally grow a low birthweight infant, it makes sense to make a general recommendation for Brewer's because most people will not be negatively impacted by a baby who is 1 to 1 1/2 lbs heavier, and the people who would generally grow very small infants will benefit tremendously.

But for people at the other extreme of the bell curve, the ones who will grow 8-9-10 lbers without diet modification, I think it could make a difference in a negative way. I sort of wonder if when you've got maybe a very hospitable endometrium, your body naturally grows placentas the same way the Brewer Diet is supposed to. Is there too much of a good thing, though? I don't know, but I am inclined to think so and will not be doing the Brewer diet again. That said, I will also be carefully watching and avoiding any bad carbs that could make for sugar babies.

And to the OP, I do not think you are being foolish. I remember your story, and I've had two dystocias myself in the 2 1/2 to 3 minute range including an Apgar of 0 due to my daughter turtling on her nuchal cord x2. I stay home because I don't want oxygen compromise going into a possible dystocia, and a pit induction DOES threaten oxygen compromise. I stay home because when nurses and doctors are used to c-sectioning for a too big 8 1/2 to 9 lber, I do not trust that they will necessarily know what to do when an 11 lber is stuck. And if you get to pushing with your doctor out of the hospital, you will have whoever is available on the floor. Panic is dangerous with dystocias, and a nervous caregiver CAN do damage. Outside of a c-section, there is nothing better that the hospital can offer you, and many typical hospital protocols will make resolving a dystocia successfully more difficult.

I strongly encourage you to do the research yourself, because knowing what you're looking at can give you a sense of peace. I've spent a lot of time thinking, praying, and reading to reach the positions that I feel comfortable with. I think I'm just going to have higher risk deliveries, period, and that not every higher risk scenario does better in a hospital set up. For my particular complications, the outcomes can be worse in a hospital. So, I will avoid a hospital unless there is a particular indication that makes me think the complication I'm facing is best handled in a medical/surgical setting.

[lunita1]

So, assuming somehow that both places provided the OP with knowledgeable caregivers who can help position her in a way to best get baby out even in the case of repeat SD, what happens after birth with a baby who was moderately stuck and has an apgar of, say, 3? Is that something that can always or usually be taken care of so successfully bedside or at home, or is it something that a NICU might handle more successfully?

After looking up what a zavanelli actually entails and its risks I totally understand how the availability of an emergency C/S isn't a good thing. I'm learning.

[loveneverfails]

Lunita1, there are going to be variable factors in there, although immediate cord clamping is standard in hospitals if there is something going wrong and that could be detrimental.

My baby was stuck, came out Apgaring 0 at 1 minute and was at 8 at 5 minutes with oxygen, stimulation, suctioning, etc. In the hospital, she would have had immediate cord clamping (BAD IDEA ON AN OXYGEN COMPROMISED INFANT TO REMOVE A LIFE SUPPORT SYSTEM) and would have been observed in NICU for an indeterminate amount of time. She could have been separated from us and in the NICU for 12 hours or more when she was at an 8 and vigorously crying at 5 minutes old.

At home, if you have that baby coming around quickly, you keep that baby with you and go back to things as planed. But if you truly do wind up needing more advanced care, your at home team can stabilize for transport but may not be able to adequately treat what is going on and there will be a delay in getting to that more advanced care. To me, that would make a difference in how far I would feel comfortable giving birth from a hospital distance wise, but it wouldn't mean an automatic hospital birth.

There is so much balancing risks with this complication set in particular, especially since the odds favor that the next birth is a completely normal, spontaneous delivery that you could even do unassisted and be fine. UC is outside my comfort level with my history of dystocia, but the odds do say that the most likely outcome would be spontaneous vaginal delivery. Add in a skilled midwife with training and equipment to handle the complications that come with dystocia, and my comfort level is such that I would rather run the small risk that my baby's condition would be better on NICU admission if I had been in the hospital than have the near certainty that a dystocia baby with apgars that low initially will spend her first hours in the NICU even if she is completely fine at that point.

[GoBecGo]

Brewers diet is for prevening PE (pre eclampsia) by ensuring the maternal body is well-nourished and the blood volume and chemistry is good. It does tend also to grow bigger babies, but often those who "follow" it are really eating a lot of extra protein and not following the rest of the diet properly (NOT saying that's what happened to you loveneverfails!), it's a very pure diet when followed properly but it does require vigilance (it's recommended that if you're going to do it you print the lists and put them on your fridge and tick off as you go and put NOTHING not on the page in your body), it's hard but worth it to avoid PE if you have a history.

Lunita dystocia babies sometimes need resussitation measures at home. That can be anything from suctioning the airways and vigourously rubbing to bagging or intubation and heart massage. Without seeing the specific apgar sheet it's hard to know what the 3 meant, but i would assume it mean baby had a heartbeat and some small breathing efforts but was blue and had no tone. In a hospital a baby like that would be stablised in the birthing room, before they decided if NICU was needed (though in many hospitals low apgars mean an automatic NICU stay which is a shame since being on mum's chest stabilises breathing and heart rates in newborns very effectively and without the multiple blood tests for blood sugar levels and so on babies go through in NICU). They only take them to NICU like that if nothing is working. My NHS midwives at DD's birth carried an infant bag to bag if necessary, plus adrenalin and oxygen, and were fully trained in infant resuss so they could have done quite a lot if need be, certainly what the paed at the hospital would have done in the first 10mins anyway. Beyond those 10mins we'd have needed help, but i was only 5mins from the hospital and i'm sure they'd have had XP call an ambulance as soon as they realised it was a dystocia.

As an aside i once asked an Ob about zavanelli and he said he'd never done one and never seen one and never met anyone who'd done one in the last 20 years (UK 2005 i met him) so i don't know how commonly this is actually done anyway nowadays. The hospital dystocia women i know got massive episiotomies (well into the glute in one case) and the babies are often injured (broken collar bones/arms/damaged nerves). Sometimes that's all necessary to save babe's life, but equally options on un-sticking the baby are VERY limited in the woman who is numbed up, on her back, and unable to move.

[shells_n_cheese]

Loveneverfails--I am not sure about the Brewer Diet causing big babies for women who have average to bigger than average babies--I don't read up on it and don't plan to follow it.

I simply plan to eat healthier overall. Starting even before we conceive. I plan to eat less sugar/carbs and more fresh fruits and veggies, lean protein etc. I don't plan to follow any strict guidelines.

[shells_n_cheese]

Zinemama--thank you for your honesty. I appreciate it.

I am still weighing the options of hospital birth vs. homebirth if there ever is a #3.

[LiLStar]

Originally Posted by lunita1

what happens after birth with a baby who was moderately stuck and has an apgar of, say, 3? Is that something that can always or usually be taken care of so successfully bedside or at home, or is it something that a NICU might handle more successfully?

officially, my ds's apgar's were 8 and 10. my concept of time wasn't very good but I think it was a minute or so before he started "coming around" and that my mw simply didn't bother to do an apgar until then simply because she was more focused on getting him to breathe! here's how he looked right after he was born (warning, might be triggering, he doesn't look good) http://s970.photobucket.com/albums/a...secondsold.jpg completely unresponsive, limp, bad color, just a heartbeat. and after some oxygen and suctioning, here he is after his first meal! maybe 20 min later? not sure http://s970.photobucket.com/albums/a...t=DSC02310.jpg pink, bright eyed, alert and perfect!

Shortly after that I went upstairs to bed with my perfect sweet newborn, reflecting on the birth, and *thanking my lucky stars* I was at home with that midwife who knew what she was doing, and not in a hospital where I might have had an unnecessary episiotomy (I had no tearing with my 10lb baby! yay!) immediate cord clamping, a baby resuscitated across the room, possibly taken to the nicu for "observation". All I could think was, "this could have been BAD in a hospital!"

[shells_n_cheese]

Originally Posted by lunita1

what happens after birth with a baby who was moderately stuck and has an apgar of, say, 3? Is that something that can always or usually be taken care of so successfully bedside or at home, or is it something that a NICU might handle more successfully?

My daughter had a 1 min. apgar of 3 (after the SD). And then 7 after 5 min. We were at home. The MW's handled it beautifully.

Though we did end up going to the hospital just to be sure she was okay (totally my choice), it turned out we could have just stayed home (looking back--I WISH WE DID!). When we were at the hospital, she was totally fine--it ended up causing more trouble--I was barely able to hold my daughter and was not able to breastfeed her at all until 2 hours after her birth! She was being assessed and given test after test. ARGH!

We would have definitely would have been better off staying at the the whole time.

[prancie]

If I were anticipating a possible difficult birth because of the baby's position and wanted a professional there I would go with a very experienced midwife. I don't think doctors these days get a lot of experience with odd presentations or SD. They are much more likely to have coerced a woman into a c-section. I would be hesitant to go to a hospital unless i was doing a rcs.

My gut tells me that you were not in a good position during the birth (at first). There may have been other factors that contributed to your exhaustion as well that could be remedied for next time. I would not rule out another home birth at all. Life is a gamble every day, we just don't agonize over the risks of driving across town as much as where we give birth. It's cultural. Do what your gut says is right.

[Adasmommy]

My dd had shoulder dystocia during her homebirth, and I was very pleased with how my midwife handled it--dd was perfectly fine. My second birth was a cesarean and our baby died (not due to the birth).

So I struggled with this question too. I found that when I came to terms with what had happened, I was no longer scared and I have no fears of my homebirth next month.

I talked about my experience a lot, I researched a lot, I read over the operative report, and I generally made peace.

I think if you are scared, a bad outcome (and difficult labor) is much more likely, wherever you are. I think either a hospital or homebirth can be safe and perfect for you, once you are emotionally and spiritually ready to birth again. At that time, you should go with whatever feels right to you.

For me, it is DEFINITELY a homebirth. My chances of birthing vaginally are slim in a hospital, and as others have said, I feel that my midwife is much better qualified to handle any difficulties than a hospital would be, short of surgery.

I was also on my back when the shoulder dystocia occurred. I am also planning a water birth this time. It sounds perfect for you for solving the problems of too tired to be in any other position, and wanting to hang onto something!

[Belle]

[seashells]

If I feared SD, for the safety of my baby I would choose a very experienced home birth midwife to attend.

Few OBs know how to deal with SD at all other than brute force (yank and pull and/or break clavicle), which is far from the ideal first choice procedure. As PPs have mentioned, c-section is not a viable solution for SD. If I had reason to believe I would need a c-section, then an OB would be a natural choice, but SD is basically the worst fear of OBs because they have no solution to it. Well, to be fair, SD is probably the worst fear of midwives too, but a really good midwife has possible solutions.

Unfortunately this choice is compounded by social pressure. If a fairy or something came to me and told me I would have SD (but would not tell me the outcome or give me advice or whatever), then a midwife with excellent SD experience would, to me, be the obvious choice. But if it doesn't go well, the fallout from that could be disasterous in a way that wouldn't happen if I were under the care of an OB. If the baby died under the care of an OB, my family and friends would mourn with me and support me and there would never be any question that I killed my baby. Under a midwife, I would wear a scarlet letter of sorts for life. Even if there was zero logic to it - people don't understand birth and they always assume an OB could have done better, even if an OB honestly would have likely done worse. Most people assume a c-section can solve anything, and don't realize that it can't solve SD.

We should be able to make the safest choices for ourselves without considering whether we would be outcast for it, but unfortunately that's part of the choice.

I had a homebirth with my one and only, and so I didn't have a history of SD to consider (and it didn't happen) but I did have to consider the "fallout" question before making my choice. I did not feel safe in a hospital, and felt safer with a midwife. It says something that a mother would almost always pick the safest choice to her mind, even with those kinds of pressures.